The influence of dosing on effect size of exercise therapy for musculoskeletal foot and ankle disorders: a systematic review.
Jodi L Young, Daniel I Rhon, Rutger M J de Zoete and 2 others
PMID 29157736WHAT IT FOUND
Exercise therapy produced large improvements in pain and function for Achilles tendinopathy, ankle sprains and plantar heel pain regardless of dose.
Session length, frequency and total number of visits did not consistently predict better outcomes. Prescribe exercise that patients can perform and adhere to.
Key findings
01Most included studies reported large improvements in pain and function for all three conditions, irrespective of the specific exercise dose prescribed.
02Dosing variables such as session duration, frequency and total number of sessions were not consistently associated with larger treatment effects.
03For Achilles tendinopathy, performing eccentric exercises as tolerated resulted in large improvements, while a fixed prescription of three sets of fifteen repetitions resulted in only medium improvements.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The review included only 14 studies, with just two trials for plantar heel pain, making conclusions about dose-response for that condition tentative. Outcome measures varied widely across studies, so a large improvement on one scale may not equal a large improvement on another. Eleven studies used home exercise programs, but only four monitored patient adherence, so it is unclear if reported effects reflect the prescribed dose or actual performance. No study blinded participants or therapists, which is common in exercise trials but may influence reported pain and function outcomes. The methodological quality of plantar heel pain studies was rated as fair or poor.
Declared interests
The authors declare no conflicts of interest. The research did not receive specific funding from public, commercial or not-for-profit agencies.
The easy way to misread this
Do not conclude that exercise dose is irrelevant to all patients. The review found large effects across varied doses, but it did not compare high-dose against low-dose protocols directly, and adherence was poorly monitored in home exercise programs. The finding that as-tolerated repetitions outperformed fixed repetitions applies only to the single Achilles tendinopathy study that reported this comparison.