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1. Are we asking the right questions to people with Achilles tendinopathy? The best questions to distinguish mild versus severe disability to improve your clinical management

Author

Murphy, Myles C., Green, Brady, Amundarain, Igor S., de Vos, Robert J., Rio, Ebonie K., Murphy, Myles C., Green, Brady, Amundarain, Igor S., de Vos, Robert J., and Rio, Ebonie K.

Abstract

Objective: Determine the capacity of individual items on the Tendinopathy Severity Assessment – Achilles (TENDINS-A), Foot and Ankle Outcome Score (FAOS), and Victorian Institute of Sports Assessment – Achilles (VISA-A) to differentiate patients with mild and severe tendon-related disability in order to provide clinicians the best questions when they are consulting patients with Achilles tendinopathy. Design: Cross-sectional. Participants: Seventy participants with Achilles tendinopathy (61.4% mid-portion only, 31.4% insertional only, 7.2% both). Outcome measures: The discrimination index was determined for each TENDINS-A, FAOS, and VISA-A item to determine if items could discriminate between mild and severe disability. A Guttman analysis for polytomous items was conducted. Results: All 62 tems from the TENDINS-A, FAOS, and VISA-A were ranked with the best items relating to pain with physical tendon loading, time for pain to settle following aggravating activities and time for the tendon to ‘warm-up’ following inactivity. Conclusions: Pain with loading the Achilles tendon, time for pain to settle following aggravating activity, as well as time taken for the tendon symptoms to subside after prolonged sitting or sleeping are the best questions indicative of the severity of disability in patients with Achilles tendinopathy. These questions can assist clinicians with assessing baseline severity and monitoring treatment response.

Published
2024

2. TENDINopathy severity assessment–achilles (TENDINS-A): Evaluation of reliability and validity in accordance with COSMIN recommendations

Author

Murphy, Myles C., McCleary, Fergus, Hince, Dana, Chimenti, Ruth, Chivers, Paola, Vosseller, J. Turner, Nimphius, Sophia, Mkumbuzi, Nonhlanhla S., Malliaras, Peter, Maffulli, Nicola, de Vos, Robert J., Rio, Ebonie K., Murphy, Myles C., McCleary, Fergus, Hince, Dana, Chimenti, Ruth, Chivers, Paola, Vosseller, J. Turner, Nimphius, Sophia, Mkumbuzi, Nonhlanhla S., Malliaras, Peter, Maffulli, Nicola, de Vos, Robert J., and Rio, Ebonie K.

Abstract

Objective To evaluate the construct validity (structural validity and hypothesis testing), reliability (test–retest reliability, measurement error and internal consistency) and minimal important change (MIC) of the 13-item TENDINopathy Severity assessment–Achilles (TENDINS-A). Methods Participants with Achilles pain completed an online survey including: demographics, TENDINS-A, Foot and Ankle Outcome Score (FAOS) and Victorian Institute of Sport Assessment–Achilles (VISA-A). Exploratory factor analysis (EFA) assessed dimensionality. Confirmatory factor analysis (CFA) assessed structural validity (root mean square error of approximation (RMSEA); Comparative Fit Index (CFI); Tucker-Lewis Index (TLI); standardised root measure square (SRMS)). Correlations between TENDINS-A and the FAOS or VISA-A assessed hypothesis testing. Intraclass correlation (ICC) assessed test–retest reliability. Cronbach’s alpha assessed internal consistency. SE of the measurement (SEM) assessed measurement error. A distribution-based approach assessed MIC. Results 79 participants (51% female) with a mean (SD) age=42.6 (13.0) years, height=175.0 (11.7) cm and body mass=82.0 (19.1) kg were included. EFA identified three meaningful factors, proposed as pain, symptoms and function. The best model identified using CFA for TENDINS-A had structural validity (RMSEA=0.101, CFI=0.959, TLI=0.947, SRMS=0.068), which included three factors (pain, symptoms and function), but excluded three items from the original TENDINS-A. TENDINS-A exhibited moderate positive correlation with FAOS (r=0.598, p < 0.001) and a moderate negative correlation with VISA-A (r=−0.639, p < 0.001). Reliability of the TENDINS-A was excellent (ICC=0.930; Cronbach’s =0.808; SEM=6.54 units), with an MIC of 12 units. Conclusions Our evaluation of the revised 10-item TENDINS-A determined it has construct validity and excellent reliability, compared with the VISA-A and FAOS which lack content and construct validity. The TENDINS-A is recomme

Published
2024

3. Platelet-rich plasma injection for chronic Achilles tendinopathy

Author

de Vos, Robert J., Weir, Adam, van Schie, Hans T.M., Bierma-Zeinstra, Sita M.A., Verhaar, Jan A.N., Weinans, Harrie, and Tol, Johannes L.

Subjects
Achilles tendon -- Care and treatment, Achilles tendon -- Patient outcomes, Blood platelets -- Usage, Blood platelets -- Health aspects, Exercise -- Health aspects, Plasma devices -- Comparative analysis, Plasma devices -- Usage, Injections, Saline -- Comparative analysis, Injections, Saline -- Usage
Abstract

The study aims to evaluate the efficacy of platelet-rich plasma (PRP) injection for improving the outcome for chronic Achilles tendinopathy. The results indicate that a PRP injection was not effective in reducing pain and improving activity.

Published
2010

5. Tendon Structure's Lack of Relation to Clinical Outcome After Eccentric Exercises in Chronic Midportion Achilles Tendinopathy.

Author

de Vos, Robert J., Heijboer, Marinus P., Weinans, Harrie, Verhaar, Jan A. N., and van Schie, Hans T. M.

Subjects
*EXERCISE therapy, *ACADEMIC medical centers, *ACHILLES tendon, *CONFIDENCE intervals, *STATISTICAL correlation, *EXERCISE physiology, *LONGITUDINAL method, *MUSCLE contraction, *SCIENTIFIC observation, *HEALTH outcome assessment, *QUESTIONNAIRES, *STATISTICAL hypothesis testing, *STATISTICAL power analysis, *PAIN measurement, *BODY mass index, *TREATMENT effectiveness, *PRE-tests & post-tests, *ACHILLES tendinitis, *BLIND experiment, *DATA analysis software, *DESCRIPTIVE statistics, *EVALUATION
Abstract

Context: Chronic midportion Achilles tendinopathy is a common and hard-to-treat disorder characterized by degenerative changes of the tendon matrix. Ultrasonographic tissue characterization (UTC) was successfully used to quantify structural human Achilles tendon changes. This novel and reliable technique could be used in follow-up studies to relate tendon structure to symptoms. Objective: To quantify structural tendon changes and assess clinical change in patients with tendinopathy. Design: Prospective observational study. Setting: Orthopedic department in a university medical center. Patients: 23 patients with chronic midportion Achilles tendinopathy. Intervention: The patients performed a 16-wk home-based eccentric exercise program. An experienced researcher performed the ultrasonographic data collection with the UTC procedure. These data were assessed by a blinded observer. The severity of symptoms was established with the validated Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire. Main Outcome Measures: UTC was performed to quantify tendon structure through measuring the proportion of 4 echo types. Echo types I and II represent more or less organized tendon bundles, and echo types III and IV represent disintegrated tendon structure. On the VISA-A, the total possible score is divided by 100 for a percentage score, with a perfect score of 100. Follow-up was at 2, 8, 16, and 24 wk. Results: The mean percentage of echo types I and II changed by 0.3% after 24 wk (P = .92, 95% CI -5.8 to 5.3). The mean VISA-A score increased slightly but significantly by 11.3 points after 24 wk (P = .01, 95% CI 2.6-20.0). An increased VISA-A score was not correlated with an increased percentage of echo types I and II (P = .94, r = -.02), and the baseline percentage of echo types I and II did not correlate with an increased VISA-A score (P = .74, r = .07). Conclusions: There is no short-term increase in organized tendon structure after eccentric exercises. Tendon structure is not related to symptom severity and cannot be used as a predictor of clinical outcome. [ABSTRACT FROM AUTHOR]

Published
2012
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6. A straightforward implantation method of radioactive sources by means of the Leksell frame

Author

Koken, Phil W., De Vos, Robert J., and Radiation Oncology

Abstract

Stereotactic brachytherapy of cerebral gliomas often involves insertion of catheters through the tumor bed. We adopted the hexagonal tube configuration around a central tube. Such a configuration is applicable to most commonly occurring brain tumors. In order to perform a low-cost, accurate and straightforward implantation, a robust mathematical derivation of all relevant formulas is used to transform CT coordinates to Leksell frame coordinates, including derivations for the two stereotactic angles. The coordinates of the seven tubes (which are essential if no template is available) and the length of the radioactive source are also derived, and an example is presented. The calculations have been implemented on a personal computer (Intel processor 386 or higher). Additional options, such as choosing other stereotactic angles than the calculated ones and rotating the tube configuration around the central tube, are integrated into the program.

Published
1996

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