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Consensus statement
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
  1. Robert-Jan de Vos1,
  2. Karin Gravare Silbernagel2,
  3. Peter Malliaras3,
  4. Tjerk Sleeswijk Visser1,4,
  5. Hakan Alfredson5,
  6. Inge van den Akker-Scheek6,
  7. Mathijs van Ark7,
  8. Annelie Brorsson8,
  9. Ruth Chimenti9,
  10. Sean Docking10,
  11. Pernilla Eliasson8,
  12. Kenneth Farnqvist11,
  13. Zubair Haleem12,13,
  14. Shawn L Hanlon14,
  15. Jean-Francois Kaux15,16,
  16. Rebecca Samantha Kearney17,
  17. Paul D Kirwan18,19,
  18. Kornelia Kulig20,
  19. Bhavesh Kumar21,
  20. Trevor Lewis22,
  21. Umile Giuseppe Longo23,
  22. Tun Hing Lui24,
  23. Nicola Maffulli25,
  24. Adrian James Mallows26,
  25. Lorenzo Masci27,
  26. Dennis McGonagle28,29,
  27. Dylan Morrissey30,31,
  28. Myles Calder Murphy32,33,
  29. Richard Newsham-West34,
  30. Katarina Maria Nilsson-Helander35,
  31. Richard Norris36,37,
  32. Francesco Oliva38,
  33. Seth O’Neill39,
  34. Koen Peers40,
  35. Ebonie Kendra Rio41,
  36. Igor Sancho42,
  37. Alex Scott43,
  38. Kayla D Seymore2,
  39. Sze-Ee Soh44,
  40. Patrick Vallance45,
  41. Jan A N Verhaar1,
  42. Arco C van der Vlist1,
  43. Adam Weir46,47,
  44. Jennifer Ann Zellers48,
  45. Bill Vicenzino49
  1. 1Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
  2. 2Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
  3. 3Physiotherapy Department, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
  4. 4Department of Sports Medicine, HMC Antoniushove Stichting Haaglanden Medisch Centrum, Leidschendam, The Netherlands
  5. 5Department of Community Medicine and Rehabilitation, Sports Medicine, Umea University Faculty of Medicine, Umea, Sweden
  6. 6Department of Orthopedics, University Medical Centre, Groningen, The Netherlands
  7. 7Physiotherapy Department, School of Health Care Studies, Hanze University of Applied Sciences, Groningen, The Netherlands
  8. 8Department of Orthopedics, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
  9. 9Department of Physical Therapy and Rehabilitation Sciences, The University of Iowa, Iowa City, Iowa, USA
  10. 10Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
  11. 11Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
  12. 12Sports and Exercise Medicine, Queen Mary University, London, UK
  13. 13Arsenal Football Club, London, UK
  14. 14Department of Kinesiology, California State University Fullerton, Fullerton, California, USA
  15. 15Physical Medicine and Sport Traumatology Department, University of Liege, Liege, Belgium
  16. 16FIMS Collaborative Centre of Sports Medicine, FIFA Medical Centre of Excellence, Dubai, UAE
  17. 17Bristol Trials Centre, University of Bristol, Bristol, UK
  18. 18Discipline of Physiotherapy, School Of Medicine, Trinity College Dublin, Dublin, Ireland
  19. 19Physiotherapy Dept, Connolly Hospital Blanchardstown, Blanchardstown, Ireland
  20. 20Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
  21. 21Fortius Clinic, London, UK
  22. 22Liverpool Foundation Trust, Aintree University Hospital, Liverpool, UK
  23. 23Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
  24. 24Department of Orthopaedic and Traumatology, North District Hospital, Hong Kong, Hong Kong
  25. 25Department of Trauma and Orthopaedics, School of Medicine and Psychology, University of Rome La Sapienza, Rome, Italy
  26. 26School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
  27. 27Institute of Sport Exercise and Health (ISEH), University College London, London, UK
  28. 28Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds Leeds, Leeds, UK
  29. 29Leeds Biomedical Research Centre, Leeds, UK
  30. 30Sport and Exercise Medicine, Queen Mary University, London, UK
  31. 31Physiotherapy Department, Barts Health NHS Trust, London, UK
  32. 32Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
  33. 33School of Health Sciences, The University of Notre Dame, Fremantle, Western Australia, Australia
  34. 34Australian Physiotherapy Association, Hawthorn, Victoria, Australia
  35. 35Department of Orthopaedics, Sahlgrenska University Hospital, Goteborg, Sweden
  36. 36Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
  37. 37The Physiotherapy Centre, Liverpool, UK
  38. 38Department of Human Sciences and Promotion of the Quality of Life, University of Rome La Sapienza, Rome, Italy
  39. 39School of Healthcare, College of Life Sciences, University of Leicester, Leicester, UK
  40. 40Department of Development and Regeneration, KU Leuven - University, Leuven, Belgium
  41. 41La Trobe Sport and Exercise Medicine Research Centre, The Australian Ballet, The Victorian Institute of Sport, La Trobe University, Bundoora, Victoria, Australia
  42. 42Deusto Physical TherapIker, Physiotherapy Department, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
  43. 43Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
  44. 44Department of Physiotherapy and Rehabilitation, Monash University Rehabilitation Ageing and Independent Living Research Centre, Frankston, Victoria, Australia
  45. 45Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Clayton, Victoria, Australia
  46. 46Aspetar Sports Groin Pain Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
  47. 47Sport Medicine and Exercise Clinic (SBK), Haarlem, The Netherlands
  48. 48Program in Physical Therapy & Department of Orthopaedic Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
  49. 49Physiotherapy, The University of Queensland School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia
  1. Correspondence to Dr Tjerk Sleeswijk Visser; t.sleeswijkvisser{at}erasmusmc.nl

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.

  • Consensus
  • Achilles Tendon
  • Tendinopathy
  • Review

https://doi.org/10.1136/bjsports-2024-108263

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    Footnotes

    • X @rj_devos, @DrPeteMalliaras, @SIDocking, @shawnhanlonATC, @pdkirwan, @ajmallows1, @DrDylanM, @myles_physio, @tendonpain, @sancho_igor, @Pat_Vallance, @ArcoVlist, @Bill_Vicenzino

    • R-JdV, KGS, PM and TSV contributed equally.

    • Contributors R-JdV: guarantor R-JdV, KGS, PM and TSV: concept, project lead, methods, data collection and analysis, writing. BV: project oversight, methods, writing. Achilles working group and expert panel of professional participants: design, Delphi process, patient inclusion, writing.

    • Funding The authors from the steering group (R-JdV, KGS, PM and BV) have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Within this 5-year project, multiple authors have been supported by specific research fellowships and/or grants that were not directly related to the COS-AT development. One author (DM) mentioned indirect support by the National Institute for Health Research Barts Biomedical Research Centre (NIHR203330).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.