PTOTCohortThe Journal of orthopaedic and sports physical therapy2023

Differences in Recovery of Tendon Health Explained by Midportion Achilles Tendinopathy Subgroups: A 6-Month Follow-up.

Shawn L Hanlon, Ryan T Pohlig, Karin Grävare Silbernagel

PMID 36688719

WHAT IT FOUND

Four distinct patient profiles emerged in Achilles tendinopathy.

Activity- and Function-Dominant groups recovered fastest, while Structure-Dominant patients showed delayed structural healing. Psychosocial-Dominant patients retained functional deficits. Recovery timelines vary by subgroup, suggesting tailored monitoring is needed.

Key findings

01Mixture modeling identified four subgroups: Activity-Dominant (n=34), Function-Dominant (n=38), Psychosocial-Dominant (n=27), and Structure-Dominant (n=15).

02All subgroups except Structure-Dominant met minimal clinically important difference for symptoms by 8 weeks; Structure-Dominant took 16 weeks.

03Tendon thickening decreased significantly in Structure-Dominant patients but increased in Psychosocial-Dominant patients over 24 weeks.

STILL TO COME

How it was doneWhat they foundWhat it means for PTsWhat it means for OTs

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What it does not show

The study included only participants aged 18-65, excluding adolescents and elite athletes. Subgroups were defined by preselected variables; different variables might yield different groups. 61 participants were shared with a previous study, limiting independent validation. Clinical measures were missed for some participants during the COVID-19 pandemic. Recovery definitions were uniform across subgroups, which may not reflect patient perspectives or ceiling effects in active patients.

Declared interests

There are no conflicts of interest to disclose.

The easy way to misread this

Do not assume all patients with Achilles tendinopathy recover at the same rate. Structure-Dominant patients showed delayed symptom improvement and persistent deficits, while Psychosocial-Dominant patients had worsening tendon thickening despite exercise. Uniform treatment protocols may need adjustment based on these profiles.

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