168 Chapter 9 CLINICAL IMPLICATIONS OF THIS THESIS Impact • Future clinical trials should use the established core outcome set (COS-AT). This is a minimal reporting requirement and consists of the VISA-A questionnaire, the singleleg heel rise test, evaluation of pain after activity using a VAS (0-10) and evaluation of pain on activity/loading using a using a VAS (0-10). • The single-leg heel rise is influenced by patient characteristics and health care providers may use the adjusted normative values to personalize and optimize rehabilitation programs. • The impact of Achilles tendinopathy on quality of life is severe, especially in the domains mobility, pain/discomfort and usual activities. Estimated annual costs as a result of Achilles tendinopathy are €840 per AT patient. This socio-economic impact of AT stresses the need for optimized treatment and improved preventive measures. Diagnostic imaging • UTC can be reliably used to assess Achilles tendon thickness. • Tendon thickness measurements of the Achilles tendon insertion are less reliable compared to the midportion. • Achilles tendon thickness depends on personal characteristics with older age and higher height being associated with increased values for Achilles tendon thickness. The established normative ultrasonographic values for tendon thickness may help clinicians to differentiate between morphological changes and ultrasonographic features of Achilles tendinopathy. • Not all patients with clinical symptoms of Achilles tendinopathy exhibit increased tendon thickening. Prognostic factors • Clinicians should consider the socioeconomic status of Achilles tendinopathy patients as this may play a role in the response to treatment.
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