What is, actually, clinically relevant improvement for patients who’ve been treated with either exercise, injections or both for achilles tendinopathy? And for what time frame—6 weeks, 12 weeks?
What’s Clinically Relevant Improvement for Achilles Tendinopathy?
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Researchers from the Netherlands tackled that question and collected Victorian Institute of Sport Assessment-Achilles score data from 61 patients in order to quantify what whould be considered ‘clinically relevant improvment’ in patients with midportion Achilles tendinopathy.
Their work appears in a new paper, “Victorian Institute of Sport Assessment-Achilles (VISA-A) Questionnaire-Minimal Clinically Important Difference for Active People With Midportion Achilles Tendinopathy: A Prospective Cohort Study” which was in the October 2021 issue of the Journal of Orthopaedic & Sports Physical Therapy.
The team collected data from 61 patients with midportion Achiless tendinopathy who received exercises and an injection and used the Victorian Instiute of Sport Assessment-Achilles (VISAA) score at baseline and at 12 weeks and 24 weeks after treatment. The VISSA score ranges between 0 and 100 points, with 100 points indicating a healthy tendon.
The 7-point Global Assessment Scale which ranges from “worse than ever” to “completely recovered” was administered at 12 weeks and 24 weeks after treatment.
The area under the curve and Youden’s index value closest to 1 were determined for both MICDS (12 and 24 weeks) with corresponding sensitivity and specificity.
Overall, the Minimal Clinically Important Difference (MCID) was 14 points (95% confidence interval [CI]: 3, 19) over a 12-week period, corresponding to 57% sensitivity and 88% specificity. The MCID was 7 points (95% CI: –10, 28)) over a 24-week period, with 85% sensitivity and 62% specificity.
“A change in Victorian Institute of Sport-Assessment-Achilles score of at least 14 points after 12 weeks or at least 7 points after 24 weeks of exercise therapy and an injection reflects a meaningful change for physically active patients with midportion Achilles tendinopathy, the researchers wrote.
The study authors included: Iris F. Lagos, M.D.; Max Reijman, Ph.D.; Jan A.N. Verhaar, M.D., Ph.D.; Robert-Jan de Vos, M.D., Ph.D. of Erasmus University Medical Center in Rotterdam, the Netherlands; and Peter L.J. van Veldhoven, M.D., of the Haaglanden Medical Center, The Hague, the Nethlerands.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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