A Pilot Study on Exercise After Achilles Tendon Rupture

Study Overview
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Brief Summary
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The purpose is to study the effect of early NEuroMuscular EXercise (NEMEX) versus conventional treatment (late exercise) in patients with acute non-operative achilles tendon rupture (ATR).

Detailed Description
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There is currently no consensus on treatment for achilles tendon rupture with regard to surgical or non-surgical treatment. In addition, the optimal time to start exercise treatment after the injury, with or without surgery, is not well understood. Animal studies show positive effects of early mobilization in tendon healing. Neuromuscular exercise has shown better effects than strength exercise in people with knee injury or knee disease. There are few studies in humans focusing on exercise as treatment, without surgical intervention, after ATR.

Official Title
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NEMEX-ATR: A Randomized Pilot Study on Early Neuromuscular Exercise in Non-surgically Treated Achilles Tendon Rupture

Conditions
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Achilles Tendon Rupture

Intervention / Treatment
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* Other: Early Neuromuscular Exercise


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Men and women 18 - 60 years. The patient should before the achilles tendon rupture have been able to walk independently without aid, walk without limping, run/jog and be able to jump on one leg The patient shall be able to read, understand and to assimilate the written information about the study. Exclusion Criteria: Previous achilles tendon rupture Acute achilles tendon rupture, more than 5 days. Medical restrictions regarding physical exercise, not related to the achilles tendon rupture

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Early neuromusclar exercise<br> | Other: Early Neuromuscular Exercise<br>* 30 patients are randomized to early neuromuscular exercise (n=15) or treatment as usual, i.e., late exercise (n=15). Both groups are given an orthosis and are instructed to wear this for eight weeks. The experimental group starts with a structured exercise program one week after the diagnosis. The patients attend one training session/week during eight weeks, guided by a physical therapist. The level of training is progressed during this time. The patients in the control group (treatment as usual) are given exercise instructions and information at one occasion; 2 weeks after diagnosis. Both groups are followed up, by a blinded assessor, with valid and reliable self-reported and physical function outcomes at 1, 4, 8 and 16 weeks after injury.<br>* Other names: Treatment as usual (late exercise);|
| Active Comparator: Treatment as usual (late training)<br> | Other: Early Neuromuscular Exercise<br>* 30 patients are randomized to early neuromuscular exercise (n=15) or treatment as usual, i.e., late exercise (n=15). Both groups are given an orthosis and are instructed to wear this for eight weeks. The experimental group starts with a structured exercise program one week after the diagnosis. The patients attend one training session/week during eight weeks, guided by a physical therapist. The level of training is progressed during this time. The patients in the control group (treatment as usual) are given exercise instructions and information at one occasion; 2 weeks after diagnosis. Both groups are followed up, by a blinded assessor, with valid and reliable self-reported and physical function outcomes at 1, 4, 8 and 16 weeks after injury.<br>* Other names: Treatment as usual (late exercise);|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Heel-raise | Functional performance of calf muscles. The ability to perform a plantar flexion is assessed in a prone position at 1 and 4 weeks after the injury. At 8 and 16 weeks after the injury, the ability to perform a heel-raise standing on one leg is assessed. | Week 16 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Single limb standing balance | The patients stands on one leg with eyes open as long as possible, maximum time 60 seconds. Both legs are tested. | At weeks 4, 8 and 16 | 
| 30-meters walk test | The patients walks a distance of 30 m at self-selected speed. Time and any limbing is recorded. | At weeks 8 and 16 | 
| Single-limb mini squat | The patients performs single-limb mini squats. The position of the knee in relation to the foot is assessed. The test is performed on both legs. | At week 16 | 
| VAS Pain | The patients reports pain on a 0-10 visual analog scale. | At weeks 1, 4, 8 and 16 | 
| Range of Motion | The range of plantar and dorsal flexion motions in the talocrural joint are measured with a handheld goniometer. | At weeks 1, 4, 8 and 16 | 
| The calf muscle circumference | Calf muscle circumference is recording using a measuring-tape. | At weeks 1, 4, 8 and 16 | 
| Foot and Ankle Outcome Score (FAOS) | A disease specific questionnaire for patients with foot and ankle injury. | At weeks 1, 4, 8 and 16 | 
| Short-Form 36 (SF-36) | A generic measure of health status. | At weeks 1, 4, 8 and 16 | 
| Physical Activity Level Scale | A scale that measures the patient's level of daily physical activity. | At weeks 1, 4, 8 and 16 | 
| Re-rupture | Joint specific adverse event; recorded by any patient seeking medical care related to the achilles tendon rupture during the study period. | Weeks 1-16 | 
| Deep Venous thromboembolism | Joint specific adverse event; recorded by any patient seeking medical care related to the achilles tendon rupture during the study period. | Weeks 1-16 | 
| Sick leave | The number of weeks the patient are not at work caused of the achilles tendon rupture is registered. | Measured regularly from baseline until week 16 | 
| Modified Forward lunge from stairs | The patient stands on the first step of a staircase and is encouraged to take step down with one leg, the other leg kept on the step. The examiner stands in front of the patient and observes position of joints in relation to each other. | week 16 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Achilles tendon rupture, Non-surgical treatment, Exercise, Neuromuscular training