Table1_Effects of exercise treatment on functional outcome parameters in mid-portion achilles tendinopathy: a systematic review.docx

Exercise interventions are evident in the treatment of mid-portion Achilles tendinopathy (AT). However, there is still a lack of knowledge concerning the effect of different exercise treatments on improving a specific function (e.g., strength) in this population. Thus, this study aimed to systematically review the effect of exercise treatments on different functional outcomes in mid-portion AT. An electronic database of Pubmed, Web of Science, and Cochrane Central Register of Controlled Trials were searched from inception to 21 February 2023. Studies that investigated changes in plantar flexor function with exercise treatments were considered in mid-portion AT. Only randomized controlled trials (RCTs) and clinical controlled trials (CCTs) were included. Functional outcomes were classified by kinetic (e.g., strength), kinematic [e.g., ankle range of motion (ROM)], and sensorimotor (e.g., balance index) parameters. The types of exercise treatments were classified into eccentric, concentric, and combined (eccentric plus concentric) training modes. Quality assessment was appraised using the Physiotherapy Evidence Database scale for RCTs, and the Joanna Briggs Institute scale for CCTs. The search yielded 2,260 records, and a total of ten studies were included. Due to the heterogeneity of the included studies, a qualitative synthesis was performed. Eccentric training led to improvements in power outcomes (e.g., height of countermovement jump), and in strength outcomes (e.g., peak torque). Concentric training regimens showed moderate enhanced power outcomes. Moreover, one high-quality study showed an improvement in the balance index by eccentric training, whereas the application of concentric training did not. Combined training modalities did not lead to improvements in strength and power outcomes. Plantarflexion and dorsiflexion ROM measures did not show relevant changes by the exercise treatments. In conclusion, eccentric training is evident in improving strength outcomes in AT patients. Moreover, it shows moderate evidence improvements in power and the sensorimotor parameter “balance index”. Concentric training presents moderate evidence in the power outcomes and can therefore be considered as an alternative to improve this function. Kinematic analysis of plantarflexion and dorsiflexion ROM might not be useful in AT people. This study expands the knowledge what types of exercise regimes should be considered to improve the functional outcomes in AT.

运动干预在中段跟腱病（mid-portion Achilles tendinopathy, AT）的临床治疗中已得到广泛应用。然而，目前针对不同运动疗法对该人群特定功能（如肌力）的改善效果，仍缺乏充分的认知。因此，本研究旨在系统评价运动疗法对中段跟腱病患者不同功能结局的影响。本研究检索了PubMed、Web of Science及考克兰对照试验中心注册库（Cochrane Central Register of Controlled Trials）数据库，检索时限为建库至2023年2月21日。纳入标准为针对中段跟腱病患者采用运动疗法后跖屈肌功能变化的研究，且仅纳入随机对照试验（randomized controlled trials, RCTs）与临床对照试验（clinical controlled trials, CCTs）。功能结局按动力学（如肌力）、运动学[如踝关节活动度（ankle range of motion, ROM）]及感觉运动（如平衡指数）参数进行分类。运动疗法类型分为离心训练、向心训练及联合训练（离心+向心）模式。质量评价环节，随机对照试验采用物理治疗证据数据库量表进行评估，临床对照试验则采用乔安娜·布里格斯研究所量表。本次检索共获取2260条记录，最终纳入10项研究。鉴于纳入研究存在异质性，本研究采用定性合成法进行分析。结果显示，离心训练可改善爆发力结局（如反向跳高度）及肌力结局（如峰力矩）；向心训练方案可适度提升爆发力结局。此外，一项高质量研究表明，离心训练可改善平衡指数，而向心训练则无此效果。联合训练模式未对肌力及爆发力结局产生显著改善。跖屈与背屈活动度的测量结果显示，运动疗法未带来具有临床意义的变化。综上，离心训练可显著改善跟腱病患者的肌力结局，且有中等强度证据支持其可提升爆发力及感觉运动参数"平衡指数"。向心训练在提升爆发力结局方面有中等强度证据支持，可作为改善该功能的替代方案。跖屈与背屈活动度的运动学分析或对跟腱病患者的功能评估价值有限。本研究拓展了关于应选择何种运动方案以改善跟腱病患者功能结局的认知。