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An investigation into accelerated rehabilitation strategies following an achilles tendon rupture
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Kearney, Rebecca S. (2012) An investigation into accelerated rehabilitation strategies following an achilles tendon rupture. PhD thesis, University of Warwick.
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Official URL: http://webcat.warwick.ac.uk/record=b2568663~S1
Abstract
Background
Rupture of the Achilles tendon occurs in over 11,000 people annually in the UK.
Traditional management using cast immobilisation is being slowly replaced by
immediate weight bearing rehabilitation, but currently there is no consensus
regarding the exact protocol to be used.
The aim of this thesis was to develop an immediate weight bearing rehabilitation
protocol for patients who have sustained an acute rupture of their Achilles tendon to
inform a definitive evaluation of its effectiveness. To achieve this aim a framework
(by the Medical Research Council) for defining and developing interventions with
several components was used to underpin the structure of this thesis.
Pre-Clinical Development
The first two objectives of this thesis were focussed on the ‘pre-clinical’
development phase. Firstly, a systematic review of the evidence base identified the
components that define immediate weight bearing rehabilitation. Two of these were
evaluated in controlled gait analysis studies to inform and develop a rationale for the
intervention to establish what changes are expected and why. The key findings
showed that rigid orthoses designs with a large degree of plantarflexion, increased
heel pressures, reduced forefoot pressures and decreased the amount of time spent
in the terminal stance and pre-swing phase of the gait cycle.
Feasibility and Piloting
The first clinical phases (feasibility/piloting) followed, which included testing
procedures, establishing likely recruitment and follow up. Alongside this, a further
systematic review was undertaken to identify what outcome measures are used in
research for this injury to determine effectiveness. The Achilles tendon Total
Rupture score was the only disease specific patient reported measure identified with
supporting validation research. Further evaluation of its measurement properties
found the score to be internally consistent, responsive and with good construct
validity.
Conclusions
This thesis defines the rehabilitation components, proposes a theoretical framework
and tests this in practice. The results will ensure that rehabilitation after an acute
Achilles tendon rupture is based on a systematically developed protocol rather than
ad hoc practice. This will now be used to inform future definitive research in this
area.
Item Type: | Thesis (PhD) | ||||
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Subjects: | R Medicine > RM Therapeutics. Pharmacology | ||||
Library of Congress Subject Headings (LCSH): | Achilles tendon -- Wounds and injuries -- Treatment, Medical rehabilitation | ||||
Official Date: | February 2012 | ||||
Dates: |
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Institution: | University of Warwick | ||||
Theses Department: | Warwick Medical School | ||||
Thesis Type: | PhD | ||||
Publication Status: | Unpublished | ||||
Supervisor(s)/Advisor: | Costa, Matthew L. ; Lamb, S. E. (Sallie E.) ; Achten, Juul | ||||
Sponsors: | Arthritis Research UK | ||||
Extent: | 2 v. (389 leaves) | ||||
Language: | eng |
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