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Effect of Bracing and Strengthening Exercises on Posterior Tibial Tendon Dysfunct

支撑和强化练习对胫骨后肌腱功能障碍的影响

基本信息

批准号：
7304897
负责人：
JEFF R HOUCK
金额：
$ 20.81万
依托单位：
ITHACA COLLEGE
依托单位国家：
美国
项目类别：
财政年份：
2007
资助国家：
美国
起止时间：
2007-09-01 至 2010-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7304897
关键词：
Adverse event Ankle Anterior Braces-Orthopedic appliances Clinical Clinical Trials Control Groups Data Diagnosis Effectiveness Effectiveness of Interventions Exercise Experimental Designs Failure In Vitro Individual Infection Intervention Isometric Exercise Laboratories Lead Length Lower Extremity Masks Measurement Measures Metatarsal bone structure Modeling Motion Movement Muscle Muscle function Orthopedic Surgery procedures Orthopedics Outcome Paper Patient Self-Report Posterior Tibial Tendon Dysfunction Protocols documentation Randomized Controlled Trials Sarcomeres Self Assessment Site Societies Staging Stretching Surgeon Tendinopathy Tendon structure Testing Walking Week Weight Work base blind bone cost design dosage follow-up foot functional status improved improved functioning kinematics muscle strength posterior restoration prospective tibialis anterior muscle

项目摘要

DESCRIPTION (provided by applicant): This project will compare the effects of bracing and strengthening exercises, a combination of passive and active treatments, to bracing and stretching exercises, passive treatments, for subjects with stage II posterior tibial tendon dysfunction (PTTD). Current clinical evidence suggests active treatments, not passive, lead to improved clinical results in subjects with other lower limb tendinopathies (e.g. Achilles tendinopathy). Our hypothesis is that active treatment (bracing and strengthening exercises) will lead to improved foot kinematics, posterior tibial muscle length, isometric strength and functional status as compared to subjects receiving passive treatment (bracing and stretching exercises) for stage II PTTD. All subjects included in the study will have stage II PTTD, diagnosed by an orthopedic surgeon. The study is designed to be a prospective, single blind, controlled trial. The intervention is bracing and strengthening exercises. The control treatment is bracing and stretching exercises. The primary outcome variables include foot kinematics, posterior tibial muscle length, isometric strength and validated self assessment scales. The key outcome variables determined from motion analysis will include abnormal foot kinematics and posterior tibial muscle length. Abnormal foot kinematics is a key indicator of PTTD progression which strengthening exercises are expected to improve (Specific Aim #1a). A validated model based on foot kinematics will be used to determine if improvements in foot kinematics are suggestive of shorter muscle length (Specific Aim #1b). Isometric strength tests are expected to document the effectiveness of the strengthening exercise (intervention) over passive treatments (control) (Specific Aim #2), suggesting restoration of posterior tibial muscle function. The extent to which the self assessment scales provide a means to judge the overall effect of the intervention and control treatments on function (Specific Aim #3), strengthening exercises (an active treatment) are expected to show greater increases in function compared to bracing and stretching alone (passive treatments). At the conclusion of this clinical trial we will determine if there is a benefit of augmenting bracing and stretching with strengthening exercises for treatment of stage II PTTD. This proposal will evaluate the effect of a less restrictive brace augmented by strengthening exercises, using a randomized controlled trial experimental design. If successful bracing augmented with strengthening exercises could be an alternative to orthopedic surgery. Because this conservative management approach (bracing augmented by strengthening) does not usually interfere with work, costs less than orthopedic surgery and is associated with fewer adverse events (e.g. infection) there is a clear benefit to the individual and society.

描述（由申请人提供）：该项目将比较支具和强化练习（被动和主动结合治疗）与支具和拉伸练习（被动治疗）对II期胫骨后肌腱功能障碍（PTTD）患者的效果。目前的临床证据表明，对于患有其他下肢肌腱病变（如跟腱病变）的患者，主动治疗而非被动治疗可改善临床结果。我们的假设是，与接受被动治疗（支具和伸展运动）的II期PTTD患者相比，主动治疗（支具和加强锻炼）将改善足部运动学、胫骨后肌长度、等长强度和功能状态。所有纳入研究的受试者均为II期PTTD，由骨科医生诊断。该研究是一项前瞻性、单盲、对照试验。干预措施是支撑和加强锻炼。对照治疗是支撑和伸展运动。主要结果变量包括足部运动学、胫骨后肌长度、等长强度和有效的自我评估量表。从运动分析中确定的关键结果变量将包括异常的足部运动学和胫骨后肌长度。异常的足部运动是PTTD进展的关键指标，加强训练有望改善（具体目标#1a）。基于足部运动学的验证模型将用于确定足部运动学的改善是否表明肌肉长度缩短（具体目标#1b）。等长强度测试有望证明强化锻炼（干预）比被动治疗（对照）的有效性（具体目标#2），提示胫骨后肌功能的恢复。自我评估量表提供了一种判断干预和控制治疗对功能的总体影响的手段（具体目标#3），与单独支撑和拉伸（被动治疗）相比，强化锻炼（主动治疗）有望显示出更大的功能增加。在这个临床试验的结论，我们将确定是否有增加支撑和拉伸与强化运动治疗II期PTTD的好处。本建议将采用随机对照试验设计，评估通过加强锻炼增强限制性较少的支具的效果。如果成功的支具加上强化训练可以替代骨科手术。由于这种保守的管理方法（通过加强支撑增强）通常不会干扰工作，成本低于骨科手术，并且与较少的不良事件（例如感染）相关，因此对个人和社会都有明显的益处。