Tendon loading profiles that promote healing in Achilles tendinopathy

促进跟腱病愈合的肌腱负荷曲线

• 批准号: 10182169
• 负责人: Josh Baxter
• 金额: $ 52.16万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10182169
• 关键词: Acute; Affect; Age; Algorithms; Biomechanics; Biometry; Chronic; Clinic; Clinical; Clinical Research; Data; Diagnosis; Diagnostic; Estradiol; Estrogens; Exercise; Fatigue; Female; Flexor; Goals; Gonadal Steroid Hormones; Guidelines; Health; Heel; Heterogeneity; Image; Measurement; Measures; Mechanics; Modeling; Monitor; Muscle; Outcome; Outcome Measure; Pain; Pathologic; Pathology; Patient-Focused Outcomes; Patients; Pattern; Physical therapy; Preparation; Progesterone; Property; Prospective cohort study; Protocols documentation; Recovery; Rehabilitation therapy; Reporting; Research Design; Sampling; Serum; Shoes; Stimulus; Stress; Structure; Subgroup; Symptoms; System; Techniques; Telemedicine; Tendinopathy; Tendon Injuries; Tendon structure; Testing; Time; Tissues; Ultrasonography; Variant; Visit; Woman; Work; achilles tendon; base; clinical care; clinical practice; exercise rehabilitation; experience; female sex hormone; functional outcomes; healing; hormonal contraception; imaging biomarker; improved; innovation; instrument; mechanical load; mechanical properties; pain outcome; pain symptom; patient population; patient subsets; pill; primary outcome; reduce symptoms; remote monitoring; sex; tool; wearable sensor technology

PROJECT SUMMARY Mid-substance Achilles tendinopathy is a painful, debilitating, and chronic tendon pathology. Rehabilitation exercises are the first treatment option for patients, but clinical studies have reported 20-60% of patients continue to experience pain and symptoms 5-years later. Even when patients experience symptom relief, only one-quarter of these patients fully recover muscle-tendon function. Current clinical guidelines recommend patients perform heel-rise exercises to eccentrically load the pathologic tendon and promote healing. However, Achilles tendon loading during daily-living often exceeds these structured rehabilitation loads, and the biomechanical properties of pathologic tendon varies amongst patients. Identifying patient subgroups based on similarities in tendon loading and biomechanics is a critical next step towards improving patient outcomes and tendon healing. Our long-term goal is to develop personalized rehabilitation protocols that maximize tendon recovery following acute and chronic Achilles tendon injuries. The overall objective of this study is to determine similarities in tendon loading and biomechanics in patients with mid-substance Achilles tendinopathy and how these similarities affect tendon healing, pain, and functional outcomes. This study leverages innovative techniques to 1) continuously monitor Achilles tendon loading during rehabilitation and daily-living and 2) quantify tendon status using ultrasound stress-imaging. Aim 1 will identify groups of patients with Achilles tendinopathy based on loading patterns and stress-imaging profiles. Aim 2 will determine if tendon healing and outcomes change over time. Aim 3 will explore the impact of sex on tendon healing and outcomes. This study will be the first to identify Achilles tendon loading profiles that are associated with tendon healing and outcomes based on patient-specific factors including tendon biomechanical properties and sex. By measuring circulating levels of sex hormones, this study will determine if specific levels of estrogen and progesterone – which can be modified using hormonal contraceptive pills – impact tendon health. Finally, with the recent shift towards telemedicine, this study will remotely monitor Achilles tendon loading, which has the potential to expand clinical care beyond patient visits to the clinic.

项目摘要 肌腱病中后期肌腱病是一种痛苦，令人衰弱和慢性肌腱病理学。康复 运动是患者的第一个治疗选择，但临床研究报告了20-60％ 5年后，继续经历疼痛和症状。即使患者缓解症状，也只有 这些患者中有四分之一完全恢复肌肉弯曲功能。当前的临床准则建议 患者进行脚跟锻炼，以偏心加载病理肌腱并促进愈合。然而， 日常生活期间的跟腱负载通常超过这些结构化的康复负荷，并且 患者中病理肌腱多样性的生物力学特性。根据 肌腱载荷和生物力学的相似性是改善患者预后和 肌腱愈合。我们的长期目标是制定最大化肌腱的个性化康复协议 急性和慢性跟腱损伤后的恢复。这项研究的总体目的是确定 肌腱负荷和生物力学的相似性肌腱病患者以及如何 这些相似性会影响肌腱愈合，疼痛和功能结果。这项研究利用创新的 1）在康复期间和日常生活期间连续监测跟腱负荷以及2） 使用超声胁迫成像来量化肌腱状态。 AIM 1将识别针对跟腱的患者组 基于载荷模式和应力成像轮廓的肌腱病。 AIM 2将确定肌腱愈合和 结果会随着时间而变化。 AIM 3将探索性别对肌腱愈合和结果的影响。这项研究 将是第一个识别与肌腱愈合和 基于患者特异性因素的结果，包括肌腱生物力学特性和性别。通过测量 循环水平的性激素，这项研究将确定特定水平的雌激素和孕激素水平是否存在 - 可以使用荷尔蒙避孕药进行修饰 - 撞击肌腱健康。最后，随着最近的转变 对于远程医疗，这项研究将远程监测跟腱负荷，这有可能 将临床护理扩展到诊所的患者就诊之外。