PHYSICAL THERAPY & REHAB
The Influence of Early Weight-Bearing Compared with Non-Weight-Bearing After Surgical Repair of the Achilles Tendon
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by one or more authors of the
original publication.
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(3):51 J Bone Joint Surg Am. 2008 Sep;90(9):1876-83Exclusive Author Interview
Dr. Beaupre on Early Weight-Bearing after Surgical Repair of the Achilles Tendon.
110 patients (ages of 17-70 years) after undergoing a surgical repair for Achilles tendon rupture were kept non-weight-bearing for the first two weeks after surgery. Subsequently, they were randomized to be kept either weight-bearing or non-weight-bearing for an additional four weeks. Early weight-bearing at 2 weeks following surgical repair of an acute Achilles tendon rupture improved the health-related quality of life in the early postoperative period with no consequential detrimental effect on the overall recovery process.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sí = 1
Incierto = 0,5
No relevante = 0
No = 0
La evaluación de los criterios de información evalúa la transparencia con la que los autores informan de las características metodológicas y del ensayo dentro de la publicación. La evaluación se divide en cinco categorías que se presentan a continuación.
3/4
Randomization
3/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
Achilles tendon rupture is a common condition, often managed with open surgical repair. The importance of post-operative rehabilitation can't be over emphasized. The study was conducted, as the the optimal rehabilitation protocol post surgical repair of an Achilles tendon rupture was not well outlined.
¿Cuál era la pregunta principal de la investigación?
Does the early weight-bearing translates into quicker postoperative recovery following repair of an acutely ruptured Achilles tendon in comparison to non-weight bearing?
¿Cuáles fueron los hallazgos importantes?
- At 6 weeks, the weight-bearing group had significantly better scores in RAND-36 domains of physical functioning, social functioning, role-emotional and vitality scores, than the non-weight-bearing group (p<0.05). Also, the weight-bearing group reported fewer limitations of daily activities (p < 0.001).
- 89% (98/109) patients completed the 6-month follow-up
- At 6 months, no significant differences between the groups were seen in any of the outcome measures, although both groups had poor endurance of the calf musculature.
- No re-rupture reportedly occurred in either group at 6 month follow up.
¿Qué es lo que más debo recordar?
Early weight-bearing at 2 weeks following surgical repair of an acute Achilles tendon rupture improved the health-related quality of life in the early postoperative period with no consequential detrimental effect on the overall recovery process.
¿Cómo afectará esto al cuidado de mis pacientes?
In the light of this study's findings, this protocol of early weight bearing should be recommended for adoption, as the new standard of care for carefully selected group of patients. Further research with larger sample sizes is needed.
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