Empirically derived guidelines for interpreting the effectiveness of exercise therapy for tendinopathies: A meta-analysis
DOI:
https://doi.org/10.51224/SRXIV.111Keywords:
Tendiopathy, Exercise therapy, Achilles, Patellar, Rotator Cuff, Elbow, Effect sizeAbstract
Objective To quantify and describe effect size distributions from exercise therapies across a range of tendinopathies and outcome domains to inform future research and clinical practice.
Design An extensive search of the literature with meta-analysis exploring moderating effects and context specific small, medium, and large thresholds.
Eligibility criteria Randomised and quasi-randomised controlled trials involving any persons with a diagnosis of rotator cuff, lateral elbow, patellar, Achilles or gluteal tendinopathy of any severity or duration.
Methods Standardised mean difference (SMDpre) effect sizes were used with Bayesian hierarchical meta-analysis and meta-regression models to calculate the 0.25- (small), 0.5- (medium), and 0.75-quantiles (large) and compare pooled means across potential moderators.
Results Data were analysed from 114 studies (171 treatment arms 4104 participants). SMDpre effect sizes and credible intervals (CrI) across all tendinopathies and outcome domains demonstrated sizeable values for small (0.34 [95%CrI:0.31-0.37]), medium (0.73 [95%CrI:0.70-0.77]), and large (1.21 [95%CrI:1.17-1.27]) thresholds. Values were similar across tendinopathies but varied substantially across outcome domains with greater threshold values obtained for self-reported measures of pain, disability and function (small~0.6, medium~1.0, large~1.6), and the lowest values obtained for quality of life and objective measures of physical function (small~0.15, medium~0.4, large~0.70). Potential moderating effects of assessment duration, exercise supervision and symptom duration were also identified, with greater pooled mean effect sizes estimated for longer assessment durations, supervised therapies, and studies comprising patients with shorter symptom durations.
Conclusion
Effect sizes vary for different outcomes but are similar across tendinopathies, with research and clinical outcomes needing to be judged accordingly. Mean treatment effects are expected to be influenced by a range of factors with the most consistent evidence obtained for assessment duration and exercise supervision. The outcomes of new interventions should be assessed against domain- and time-specific effect sizes to be correctly interpreted. Threshold values presented here should be used to guide interpretation.
Metrics
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