JMIR Publications

ABSTRACT

Background:

Achilles tendinopathy (AT) rehabilitation traditionally includes progressive tendon loading exercises. Recent evidence suggests a biopsychosocial approach incorporating patient education on psychosocial factors and mechanisms of pain can reduce pain and disability in individuals with chronic pain. This has yet to be examined in the AT population.

Objective:

To compare the effects on movement-evoked pain and self-reported function of pain education as part of a biopsychosocial approach versus pathoanatomical education for people with AT, when combined with a progressive tendon loading exercise program.

Methods:

A single-site, randomized, double blinded, placebo-controlled clinical trial will be conducted in a university-based hospital in a laboratory setting and/or by telehealth. 66 participants with chronic (>3 months) midportion or insertional AT will be randomized for the TEAch study. All participants will complete progressive Achilles tendon loading exercises in 4-phases throughout the 12-weeks and encouraged to continue with personal exercise as tolerated. Participants will be randomized to one of two types of education, in addition to exercise. One will involve pain education focused on biological and psychological mechanism of pain within a biopsychosocial framing of the problem of AT. The other will involve education focused on pathoanatomical processes within a more traditional biomedical framework of the problem of AT. All participants will complete 6-7 treatment sessions over 8 weeks with a physical therapist. Evaluation sessions will be completed at baseline and 8-week follow-up, and self-reported outcome measures will be completed at 12-week follow-up. Both groups will complete progressive Achilles loading exercises in 4-phases throughout the 12 weeks and be encouraged to continue with personal exercise as tolerated. Primary outcomes are movement-evoked pain during heel-raises and self-reported function (PROMIS – Physical Function) Secondary outcomes assess CNS nociceptive processing, psychological factors, motor function, and feasibility.

Results:

Study collection procedures, educational materials, and recruitment and retention strategies have been established. As of March 2020, we have screened 177 people, consented 39 and randomized 24 participants.

Conclusions:

The TEAch study will evaluate the utility of pain education for those with AT and the effects of improved patient knowledge on pain, physical function, and clinical outcomes. Clinical Trial: This trial is registered at ClinicalTrials.gov (trial number: NCT04059146) and Open Science Framework (Osf.io)