Journal article
The effects of pain science education plus exercise on pain and function in chronic Achilles tendinopathy: A blinded, placebo-controlled, explanatory randomized trial
Pain, Vol.164(1), pp.e47-e65
01/2023
DOI: 10.1097/j.pain.0000000000002720
PMCID: PMC10016230
PMID: 36095045
Abstract
Exercise is the standard of care for Achilles tendinopathy (AT), but 20% to 50% of patients continue to have pain following rehabilitation. The addition of pain science education (PSE) to an exercise program may enhance clinical outcomes, yet this has not been examined in patients with AT. Further, little is known about how rehabilitation for AT alters fear of movement and central nervous system (CNS) nociceptive processing. Participants with chronic AT (N=66) were randomized to receive education about AT either from a biopsychosocial (PSE) or biomedical (pathoanatomic education [PAE]) perspective. Simultaneously, all participants completed an exercise program over 8-weeks. Linear mixed models indicated that there were no differences between groups in: 1) movement-evoked pain with both groups achieving a clinically meaningful reduction (mean change(95% CI), PSE: -3.0(-3.8 to -2.2), PAE= -3.6(-4.4 to -2.8)), and 2) self-reported function, with neither group achieving a clinically meaningful improvement (PROMIS Physical Function- PSE: 1.8(0.3 to 3.4), PAE: 2.5(0.8 to 4.2)). After rehabilitation, performance-based function improved (number of heel raises: 5.2(1.6 to 8.8)), CNS nociceptive processing remained the same (conditioned pain modulation: -11.4%(0.2 to -17.3), and fear of movement decreased (Tampa Scale of Kinesiophobia,TSK-17: -6.5(-4.4 to -8.6)). Linear regression models indicated that baseline levels of pain and function along with improvements in self-efficacy and knowledge gain were associated with a greater improvement in pain and function, respectively. Thus, acquiring skills for symptom self-management and the process of learning may be more important than the specific educational approach for short-term clinical outcomes in patients with AT.
Details
- Title: Subtitle
- The effects of pain science education plus exercise on pain and function in chronic Achilles tendinopathy: A blinded, placebo-controlled, explanatory randomized trial
- Creators
- Ruth L P Chimenti - University of Iowa, Physical Therapy and Rehabilitation ScienceAndrew A Post - University of IowaEbonie K Rio - La Trobe UniversityG. Lorimer Moseley - University of South AustraliaMegan Dao - University of IowaHadley Mosby - University of IowaMederic M Hall - University of Iowa, Orthopedics and RehabilitationCesar De Cesar Netto - University of Iowa, Orthopedics and RehabilitationJason M Wilken - University of Iowa, Physical Therapy and Rehabilitation ScienceJessica Danielson - University of IowaEmine O Bayman - University of Iowa, BiostatisticsKathleen A Sluka - University of Iowa, Physical Therapy and Rehabilitation Science
- Resource Type
- Journal article
- Publication Details
- Pain, Vol.164(1), pp.e47-e65
- DOI
- 10.1097/j.pain.0000000000002720
- PMID
- 36095045
- PMCID
- PMC10016230
- NLM abbreviation
- Pain
- ISSN
- 0304-3959
- eISSN
- 1872-6623
- Language
- English
- Electronic publication date
- 06/17/2022
- Date published
- 01/2023
- Academic Unit
- Radiology; Iowa Neuroscience Institute; Biostatistics; Orthopedics and Rehabilitation; Family and Community Medicine; Nursing; Anesthesia; Physical Therapy and Rehabilitation Science; Neuroscience and Pharmacology
- Record Identifier
- 9984266048402771
Metrics
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