An investigation into accelerated rehabilitation strategies following an achilles tendon rupture

摘要

Background Rupture of the Achilles tendon occurs in over 11,000 people annually in the UK. Traditional management using cast immobilisation is being slowly replaced by immediate weight bearing rehabilitation, but currently there is no consensus regarding the exact protocol to be used. The aim of this thesis was to develop an immediate weight bearing rehabilitation protocol for patients who have sustained an acute rupture of their Achilles tendon to inform a definitive evaluation of its effectiveness. To achieve this aim a framework (by the Medical Research Council) for defining and developing interventions with several components was used to underpin the structure of this thesis. Pre-Clinical Development The first two objectives of this thesis were focussed on the ‘pre-clinical’ development phase. Firstly, a systematic review of the evidence base identified the components that define immediate weight bearing rehabilitation. Two of these were evaluated in controlled gait analysis studies to inform and develop a rationale for the intervention to establish what changes are expected and why. The key findings showed that rigid orthoses designs with a large degree of plantarflexion, increased heel pressures, reduced forefoot pressures and decreased the amount of time spent in the terminal stance and pre-swing phase of the gait cycle. Feasibility and Piloting The first clinical phases (feasibility/piloting) followed, which included testing procedures, establishing likely recruitment and follow up. Alongside this, a further systematic review was undertaken to identify what outcome measures are used in research for this injury to determine effectiveness. The Achilles tendon Total Rupture score was the only disease specific patient reported measure identified with supporting validation research. Further evaluation of its measurement properties found the score to be internally consistent, responsive and with good construct validity. Conclusions This thesis defines the rehabilitation components, proposes a theoretical framework and tests this in practice. The results will ensure that rehabilitation after an acute Achilles tendon rupture is based on a systematically developed protocol rather than ad hoc practice. This will now be used to inform future definitive research in this area.