176 Appendices SUMMARY The general aims of this thesis were to evaluate the impact of Achilles tendinopathy, to assess the role of ultrasonographic imaging and to assess socio-economic status as prognostic factor in Achilles tendinopathy patients. Chapter 1 presents an overview of the available literature on Achilles tendinopathy with a focus on the impact, diagnostic imaging and prognostic factors. IMPACT There has been considerable variation in the outcome measures used for AT, which can have implications for patient care, as healthcare professionals and researchers are unable to adequately interpret, compare, and synthesize study results. In Chapter 2 we performed an international Delphi survey and consensus meeting to agree to a set of core outcome measures for clinical trials on Achilles tendinopathy. The following outcome measures were selected as part of the core outcome set: 1) the Victorian Institute of Sports AssessmentAchilles (VISA-A) questionnaire, 2) the single-leg heel rise test, 3) evaluating pain after activity using a Visual Analogue Scale (VAS, 0-10) and 4) evaluating pain on activity/loading using a VAS (0-10). It is strongly recommended that future clinical trials should include the agreed core outcome set for Achilles tendinopathy (COS-AT) as a minimum. Conservative treatment of Achilles tendinopathy partly consists of exercise therapy of the calf muscles, with the single leg heel-rise test (HRET) being frequently used to assess the strength endurance of the plantar flexors. A problem in the assessment of calf muscle strength and endurance is that the non-symptomatic limb cannot generally be used as reference and normative values for the HRET are currently lacking. In Chapter 3 we performed a large international cross-sectional study and presented normative values for calf muscle strength, adjusted for personal characteristics. We found that the median number of repetitions were 24 for the left leg and 25 for the right leg and median peak height was 9.3-9.7cm. There was no significant correlation between leg dominance and any of the HRET metrics. Lower physical activity levels, female sex and higher BMI negatively influenced HRET performance. Except for peak power, we found no correlation between age and HRET performance. We have developed an openly accessible calculator for estimating normative HRET metrics (www.achillestendontool.com/HRET). This can be a valuable tool for healthcare providers to monitor personalized trajectories of recovery and provide well-informed rehabilitation guidance. In Chapter 4 we conducted a cross-sectional study, comprising 80 Achilles tendinopathy patients, to evaluate the impact of Achilles tendinopathy on quality of life, work performance, healthcare utilisation and costs in adults with conservatively treated
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