Tjerk Sleeswijk Visser

124 Chapter 7 Reporting of Observational Studies in Epidemiology (STROBE) guidelines for the reporting of observational studies.17 Participants and procedures Asymptomatic population A study announcement was made through informing potential participants via social media platforms (Twitter, Facebook, LinkedIn and internal websites). If participants expressed interest to participate and passed an online screening, an appointment with a researcher was planned to further assess eligibility and perform measurements in case of inclusion. The inclusion criteria were: (1) Age ≥18 years, (2) no current Achilles tendon pain or stiffness, (3) no localized fusiform thickening of the Achilles tendon on palpation, (4) no history of pain or stiffness in the Achilles tendon region and (5) full score on the adapted Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire (question 1 – question 5).18,19 The exclusion criteria were: (1) Achilles tendon or ankle surgery in the past, (2) known systemic inflammatory disorders or internal diseases that can cause Achilles tendon abnormalities (e.g. Spondylarthropathy, Psoriatic Arthritis or Familial Hypercholesterolaemia) and (3) recent (past 12 months) lower-limb injury requiring immobilisation. Additionally, participants who experienced technical malfunctions with the UTC, such as an empty battery or software errors during scanning, were asked to schedule a new appointment. If rescheduling was not feasible for the participant, they were excluded to ensure the reliability of our data collection. If the inclusion criteria were met, participants were asked to sign the written informed consent form. Subsequently, participants completed a more extensive questionnaire with collection of demographic data (age, sex, height, weight and Body Mass Index (BMI)), past medical history (presence of comorbidities), medication use (including past or current use of fluoroquinolones and statins), smoking and current and past physical activities. A 6-point Likert scale20 and the Sports Activity Rating Scale21 were used to rate physical activity. Thereafter a short physical examination was performed, assessing the amount of localised pain on Achilles tendon palpation (using a 0-10 Visual Analogue Scale; VAS) and localized fusiform tendon thickening using the Arc sign (positive when the area of swelling identified with palpation moves with ankle range of motion).22 Subsequently, the UTC procedure was carried out on both Achilles tendons when the participant was eligible. Achilles tendinopathy patients All adult patients who visited the outpatient Department of Orthopedics and Sports Medicine of the Erasmus MC University Medical Centre with a clinical diagnosis of AT were eligible to participate. Patients were included if: 1) the clinical diagnosis of AT was established by the clinician, 2) informed consent was provided, 3) the baseline

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