ICON 2023: International Scientific Tendinopathy Symposium Consensus - the core outcome set for Achilles tendinopathy (COS-AT) using a systematic review and a Delphi study of professional participants and patients

Robert-Jan de Vos; Karin Gravare Silbernagel; Peter Malliaras; Tjerk Sleeswijk Visser; Hakan Alfredson; Inge van den Akker-Scheek; Mathijs van Ark; Annelie Brorsson; Ruth Chimenti; Sean Docking; Pernilla Eliasson; Kenneth Farnqvist; Zubair Haleem; Shawn L Hanlon; Jean-Francois Kaux; Rebecca Samantha Kearney; Paul D Kirwan; Kornelia Kulig; Bhavesh Kumar; Trevor Lewis; Umile Giuseppe Longo; Tun Hing Lui; Nicola Maffulli; Adrian James Mallows; Lorenzo Masci; Dennis McGonagle; Dylan Morrissey; Myles Calder Murphy; Richard Newsham-West; Katarina Maria Nilsson-Helander; Richard Norris; Francesco Oliva; Seth O'Neill; Koen Peers; Ebonie Kendra Rio; Igor Sancho; Alex Scott; Kayla D Seymore; Sze-Ee Soh; Patrick Vallance; Jan A N Verhaar; Arco C van der Vlist; Adam Weir; Jennifer Ann Zellers; Bill Vicenzino

doi:10.1136/bjsports-2024-108263

ICON 2023: International Scientific Tendinopathy Symposium Consensus - the core outcome set for Achilles tendinopathy (COS-AT) using a systematic review and a Delphi study of professional participants and patients

Br J Sports Med. 2024 Oct 22;58(20):1175-1186. doi: 10.1136/bjsports-2024-108263.

Authors

Robert-Jan de Vos^#¹, Karin Gravare Silbernagel^#², Peter Malliaras^#³, Tjerk Sleeswijk Visser^#^{4

5}, Hakan Alfredson⁶, Inge van den Akker-Scheek⁷, Mathijs van Ark⁸, Annelie Brorsson⁹, Ruth Chimenti¹⁰, Sean Docking¹¹, Pernilla Eliasson⁹, Kenneth Farnqvist¹², Zubair Haleem^{13

14}, Shawn L Hanlon¹⁵, Jean-Francois Kaux^{16

17}, Rebecca Samantha Kearney¹⁸, Paul D Kirwan^{19

20}, Kornelia Kulig²¹, Bhavesh Kumar²², Trevor Lewis²³, Umile Giuseppe Longo²⁴, Tun Hing Lui²⁵, Nicola Maffulli²⁶, Adrian James Mallows²⁷, Lorenzo Masci²⁸, Dennis McGonagle^{29

30}, Dylan Morrissey^{31

32}, Myles Calder Murphy^{33

34}, Richard Newsham-West³⁵, Katarina Maria Nilsson-Helander³⁶, Richard Norris^{37

38}, Francesco Oliva³⁹, Seth O'Neill⁴⁰, Koen Peers⁴¹, Ebonie Kendra Rio⁴², Igor Sancho⁴³, Alex Scott⁴⁴, Kayla D Seymore², Sze-Ee Soh⁴⁵, Patrick Vallance⁴⁶, Jan A N Verhaar¹, Arco C van der Vlist¹, Adam Weir^{47

48}, Jennifer Ann Zellers⁴⁹, Bill Vicenzino⁵⁰

Affiliations

¹ Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
² Department of Physical Therapy, University of Delaware, Newark, Delaware, USA.
³ Physiotherapy Department, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia.
⁴ Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, The Netherlands t.sleeswijkvisser@erasmusmc.nl.
⁵ Department of Sports Medicine, HMC Antoniushove Stichting Haaglanden Medisch Centrum, Leidschendam, The Netherlands.
⁶ Department of Community Medicine and Rehabilitation, Sports Medicine, Umea University Faculty of Medicine, Umea, Sweden.
⁷ Department of Orthopedics, University Medical Centre, Groningen, The Netherlands.
⁸ Physiotherapy Department, School of Health Care Studies, Hanze University of Applied Sciences, Groningen, The Netherlands.
⁹ Department of Orthopedics, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden.
¹⁰ Department of Physical Therapy and Rehabilitation Sciences, The University of Iowa, Iowa City, Iowa, USA.
¹¹ Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia.
¹² Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
¹³ Sports and Exercise Medicine, Queen Mary University, London, UK.
¹⁴ Arsenal Football Club, London, UK.
¹⁵ Department of Kinesiology, California State University Fullerton, Fullerton, California, USA.
¹⁶ Physical Medicine and Sport Traumatology Department, University of Liege, Liege, Belgium.
¹⁷ FIMS Collaborative Centre of Sports Medicine, FIFA Medical Centre of Excellence, Dubai, UAE.
¹⁸ Bristol Trials Centre, University of Bristol, Bristol, UK.
¹⁹ Discipline of Physiotherapy, School Of Medicine, Trinity College Dublin, Dublin, Ireland.
²⁰ Physiotherapy Dept, Connolly Hospital Blanchardstown, Blanchardstown, Ireland.
²¹ Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA.
²² Fortius Clinic, London, UK.
²³ Liverpool Foundation Trust, Aintree University Hospital, Liverpool, UK.
²⁴ Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy.
²⁵ Department of Orthopaedic and Traumatology, North District Hospital, Hong Kong, Hong Kong.
²⁶ Department of Trauma and Orthopaedics, School of Medicine and Psychology, University of Rome La Sapienza, Rome, Italy.
²⁷ School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK.
²⁸ Institute of Sport Exercise and Health (ISEH), University College London, London, UK.
²⁹ Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds Leeds, Leeds, UK.
³⁰ Leeds Biomedical Research Centre, Leeds, UK.
³¹ Sport and Exercise Medicine, Queen Mary University, London, UK.
³² Physiotherapy Department, Barts Health NHS Trust, London, UK.
³³ Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.
³⁴ School of Health Sciences, The University of Notre Dame, Fremantle, Western Australia, Australia.
³⁵ Australian Physiotherapy Association, Hawthorn, Victoria, Australia.
³⁶ Department of Orthopaedics, Sahlgrenska University Hospital, Goteborg, Sweden.
³⁷ Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
³⁸ The Physiotherapy Centre, Liverpool, UK.
³⁹ Department of Human Sciences and Promotion of the Quality of Life, University of Rome La Sapienza, Rome, Italy.
⁴⁰ School of Healthcare, College of Life Sciences, University of Leicester, Leicester, UK.
⁴¹ Department of Development and Regeneration, KU Leuven - University, Leuven, Belgium.
⁴² La Trobe Sport and Exercise Medicine Research Centre, The Australian Ballet, The Victorian Institute of Sport, La Trobe University, Bundoora, Victoria, Australia.
⁴³ Deusto Physical TherapIker, Physiotherapy Department, Faculty of Health Sciences, University of Deusto, Bilbao, Spain.
⁴⁴ Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada.
⁴⁵ Department of Physiotherapy and Rehabilitation, Monash University Rehabilitation Ageing and Independent Living Research Centre, Frankston, Victoria, Australia.
⁴⁶ Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Clayton, Victoria, Australia.
⁴⁷ Aspetar Sports Groin Pain Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar.
⁴⁸ Sport Medicine and Exercise Clinic (SBK), Haarlem, The Netherlands.
⁴⁹ Program in Physical Therapy & Department of Orthopaedic Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri, USA.
⁵⁰ Physiotherapy, The University of Queensland School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia.

^# Contributed equally.

PMID: 39271248
DOI: 10.1136/bjsports-2024-108263

Abstract

To develop a core outcome set for Achilles tendinopathy (COS-AT) for use in clinical trials we performed a five-step process including (1) a systematic review of available outcome measurement instruments, (2) an online survey on truth and feasibility of the available measurement instruments, (3) an assessment of the methodological quality of the selected outcome measurement instruments, (4) an online survey on the outcome measurement instruments as COS and (5) a consensus in-person meeting. Both surveys were completed by healthcare professionals and patients. The Outcome Measures in Rheumatology guidelines with a 70% threshold for consensus were followed. We identified 233 different outcome measurement instruments from 307 included studies; 177 were mapped within the International Scientific Tendinopathy Symposium Consensus core domains. 31 participants (12 patients) completed the first online survey (response rate 94%). 22/177 (12%) outcome measurement instruments were deemed truthful and feasible and their measurement properties were evaluated. 29 participants (12 patients) completed the second online survey (response rate 88%) and three outcome measurement instruments were endorsed: the Victorian Institute of Sports Assessment-Achilles questionnaire, the single-leg heel rise test and evaluating pain after activity using a Visual Analogue Scale (VAS, 0-10). 12 participants (1 patient) attended the final consensus meeting, and 1 additional outcome measurement instrument was endorsed: evaluating pain during activity/loading using a VAS (0-10). It is recommended that the identified COS-AT will be used in future clinical trials evaluating the effectiveness of an intervention. This will facilitate comparing outcomes of intervention strategies, data pooling and further progression of knowledge about AT. As COS-AT is implemented, further evidence on measurement properties of included measures and new outcome measurement instruments should lead to its review and refinement.

Keywords: Achilles Tendon; Consensus; Review; Tendinopathy.

Publication types

Systematic Review

MeSH terms

Achilles Tendon*
Consensus*
Delphi Technique*
Humans
Outcome Assessment, Health Care
Surveys and Questionnaires
Tendinopathy* / therapy