Effect of Additional Treatment With NMES After Achilles Tendon Rupture
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ClinicalTrials.gov Identifier: NCT06009978 |
Recruitment Status :
Recruiting
First Posted : August 24, 2023
Last Update Posted : April 24, 2024
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Increased knowledge is needed about new methods how to treat patients with Achilles tendon ruptures (ATR). A goal is to be able to individualize as well as improve treatment beyond the question about if surgery should be used or not.
An overall aim of the project is to, in a randomized controlled trial (RCT), explore what impact a new treatment method with Neuromuscular Electrical Stimulation (NMES) - attached on the patients ́ calf muscles on the injured leg - in the early stages after an ATR, may have on tendon length, functional performance, biomechanical variables and patient reported outcome, both in the short and long term after the injury. 70 patients are planned to be included in this RCT and will be evaluated 3,6 and 12 months after their injury. Primary outcome will be heel-rise height. Secondary outcome will be tendon length, jumping ability, patient- reported outcome and biomechanical loading pattern.
There is also a need to explore if the patients ́ loading patterns improve after treatment with NMES. Therefore, biomechanical variables in lower leg during walking and jumping will also be evaluated one year after their injury.
The planned studies include completely new ways of exploring how to optimize the rehabilitation after an ATR.
Since there might be an increased risk for overuse injuries in the healthy limb, there will also be focus on how the non- injured limb may be affected of an ATR.
Taken together, this new knowledge can be helpful in the clinical setting to individualize and optimize patients' treatment and rehabilitation with the goal to guide the patient return to the same, or higher level of, physical activity as before the injury.
Condition or disease | Intervention/treatment | Phase |
---|---|---|
Achilles Tendon Rupture Physical Disability | Device: Neuromuscular electrical stimulation (NMES) | Not Applicable |
Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 70 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Masking: | None (Open Label) |
Primary Purpose: | Treatment |
Official Title: | The Effect of Early Treatment With Neuromuscular, Electrical Stimulation (NMES) After Achilles Tendon Rupture |
Actual Study Start Date : | November 1, 2023 |
Estimated Primary Completion Date : | December 2025 |
Estimated Study Completion Date : | December 2026 |
Arm | Intervention/treatment |
---|---|
Active Comparator: Additional treatment with NMES after Achilles Tendon rupture
Neuromuscular electrical stimulation 2 times a day á 15 minutes during the week 3-8 after the Achilles Tendon rupture. Patients will also follow ordinary standard rehabilitation for Achilles Tendon rupture |
Device: Neuromuscular electrical stimulation (NMES)
Neuromuscular electrical stimulation (NMES) 2 times a day á 15 minutes from the third to the eight week after injury. The additional treatment will be perform in the patients home by themselves |
No Intervention: Control group
Patients will follow ordinary standard rehabilitation for Achilles Tendon rupture
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- Heel-rise height during heel-rise work test [ Time Frame: 12 months ]Evaluation of heel-rise height during heel-rise work test. Comparison between groups in heel-rise height Limb Symmetry Index (LSI) - injured side/healthy side *100 expressed in percent. The range in LSI is between 0-100% and the higher value, the better outcome
- Heel-rise height during heel-rise work test [ Time Frame: 6 months ]Evaluation of heel-rise height during heel-rise work test. Comparison between groups in heel-rise height (LSI)- injured side/healthy side *100 expressed in percent.The range in LSI is between 0-100% and the higher value, the better outcome
- Heel-rise height during heel-rise work test [ Time Frame: 3 months ]Evaluation of heel-rise height during heel-rise work test using. Comparison between groups in heel-rise height (LSI)- injured side/healthy side *100 expressed in percent. The range in LSI is between 0-100% and the higher value, the better outcome
- Tendon length [ Time Frame: 12 months ]Comparison between groups and limbs in Length measured with ultrasound from insertion to myotendinous junction in both limbs.
- Tendon length [ Time Frame: 6 months ]Comparison between groups and limbs in Length measured with ultrasound from insertion to myotendinous junction in both limbs.
- Tendon length [ Time Frame: 3 months ]Comparison between groups and limbs in Length measured with ultrasound from insertion to myotendinous junction in both limbs.
- Gastrocnemius Cross-sectional area [ Time Frame: 12 months ]Comparison between groups and limbs in Area of medial and lateral gastrocnemius in both limbs
- Gastrocnemius Cross-sectional area [ Time Frame: 6 months ]Comparison between groups and limbs in Area of medial and lateral gastrocnemius in both limbs
- Gastrocnemius Cross-sectional area [ Time Frame: 3 months ]Comparison between groups and limbs in Area of m medial and m lateral gastrocnemius in both limbs
- Soleus cross-sectional area [ Time Frame: 12 months ]Comparison between groups and limbs in Area of m soleus in both limbs
- Soleus cross-sectional area [ Time Frame: 6 months ]Comparison between groups and limbs in Area of m soleus in both limbs
- Soleus cross-sectional area [ Time Frame: 3 months ]Comparison between groups and limbs in Area of m soleus in both limbs
- Biomechanical data; kinematic data will be evaluated during walking, running and jumping. [ Time Frame: 12 months ]16 7+ cameras and 4 force plates will be used. 55 reflectors will be attached on the patients´body to be able to detect segmental movements. Kinematic data will be evaluated in degrees in ankle, knee and hip. Comparison will be performed between groups and limbs in degrees (LSI)- injured side/healthy side *100 expressed in percent.The range in LSI is between 0-100% and the higher value, the better outcome.
- Biomechanical data; kinetic data will be evaluated during walking, running and jumping. [ Time Frame: 12 months ]16 7+ cameras and 4 force plates will be used. 55 reflectors will be attached on the patients´body to be able to detect segmental movements. Kinetic data will be evaluated in power (watt) in ankle, knee and hip. Comparison will be performed between groups and limbs in power (LSI)- injured side/healthy side *100 expressed in percent.The range in LSI is between 0-100% and the higher value, the better outcome.
- Electro Myography (EMG) will be evaluated during walking, running and jumping. [ Time Frame: 12 months ]EMG electrodes on the medial and lateral Gastrocnemius, Soleus and Tibialis anterior, Quadriceps and trunk muscles will be attached on the patient in order to measure how the muscles are recruited during walking running and jumping. Both healthy and injured sides will be analyzed. The electrical activity in the muscles will be evaluated. Comparison will be performed between groups and limbs in power (LSI)- injured side/healthy side *100 expressed in percent.The range in LSI is between 0-100% and the higher value, the better outcome.
- Achilles tendon Total Rupture Score (ATRS) [ Time Frame: 3 months ]A valid and reliable questionnaire developed for patients with an Achilles Tendon rupture with a purpose to evaluate patient reported outcome in terms of symptoms and function. The values can be between 0 and 100 and the higher score, the better outcome.
- Achilles tendon Total Rupture Score (ATRS) [ Time Frame: 6 months ]A valid and reliable questionnaire developed for patients with an Achilles Tendon rupture with a purpose to evaluate patient reported outcome in terms of symptoms and function.The values can be between 0 and 100 and the higher score, the better outcome.
- Achilles tendon Total Rupture Score (ATRS) [ Time Frame: 12 months ]A valid and reliable questionnaire developed for patients with an Achilles Tendon rupture with a purpose to evaluate patient reported outcome in terms of symptoms and function.The values can be between 0 and 100 and the higher score, the better outcome.
- Physical Activity Scale (PAS) [ Time Frame: 12 months ]A patient reported outcome used for the purpose to evaluate the patients self estimated physical activity level. The scale is from 1 to 6 and the higher score, the better outcome.
- Physical Activity Scale (PAS) [ Time Frame: 6 months ]A patient reported outcome used for the purpose to evaluate the patients self estimated physical activity level.The scale is from 1 to 6 and the higher score, the better outcome.
- Physical Activity Scale (PAS) [ Time Frame: 3 months ]A patient reported outcome used for the purpose to evaluate the patients self estimated physical activity level.The scale is from 1 to 6 and the higher score, the better outcome.
- Drop Countermovement Jump [ Time Frame: 6 months ]Drop Countermovement Jump: Evaluation of vertical jumping height after jumping from a 20 cm high box. The outcome will be measured as the height the patient can perform in jump height after landing in cm. Comparison between groups and limbs in jump height will be presented as Limb Symmetry Index (LSI)- injured side/healthy side *100 expressed in percent. The range in LSI is between 0-100% and the higher value, the better outcome.
- Drop Countermovement Jump [ Time Frame: 12 months ]Drop Countermovement Jump: Evaluation of vertical jumping height after jumping from a 20 cm high box. The outcome will be measured as the height the patient can perform in jump height after landing in cm. Comparison between groups and limbs in jump height will be presented as Limb Symmetry Index (LSI)- injured side/healthy side *100 expressed in percent. The range in LSI is between 0-100% and the higher value, the better outcome.
- Hopping [ Time Frame: 6 months ]Evaluation of series of jumps as in jumping ropes. The outcome measurement will be mean jumping height in cm and elasticity ratio in 20 jumps. Comparison between groups and limbs in jump height and elasticity ratio will be presented as Limb Symmetry Index (LSI)- injured side/healthy side *100 expressed in percent. The range in LSI is between 0-100% and the higher value, the better outcome.
- Hopping [ Time Frame: 12 months ]Evaluation of series of jumps as in jumping ropes. The outcome measurement will be mean jumping height in cm and elasticity ratio in 20 jumps. Comparison between groups and limbs in jump height and elasticity ratio will be presented as Limb Symmetry Index (LSI)- injured side/healthy side *100 expressed in percent. The range in LSI is between 0-100% and the higher value, the better outcome.
- Calf muscle power [ Time Frame: 6 months ]Evaluation of calf muscle power in a weight training machine expressed in watt (Newton x meter /seconds). Comparison will be performed between groups and limbs in power (LSI)- injured side/healthy side *100 expressed in percent.The range in LSI is between 0-100% and the higher value, the better outcome.
- Calf muscle power [ Time Frame: 12 months ]Evaluation of calf muscle power in a weight training machine expressed in watt (Newton x meter /seconds). Comparison will be performed between groups and limbs in power (LSI)- injured side/healthy side *100 expressed in percent.The range in LSI is between 0-100% and the higher value, the better outcome
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Ages Eligible for Study: | 18 Years to 65 Years (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Achilles Tendon rupture
- The injury should have been treated within two days from the trauma
- The rupture is located in the mid portion of the tendon
Exclusion Criteria:
- Pregnancy
- Having a pace maker, intra cardiac defibrillator or other active implant
- Having had an Achilles Tendon rupture before, regardless of side
- Having an earlier injury that will have an impact on lower leg function, regardless of side
- Diabetes
- Neuro vascular disease
- Immunosuppressive treatment
- Difficulties to understand the language or difficulties in understand instructions.
- Unable to consent
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT06009978
Contact: Katarina Nilsson Helander, Ass.prof. | +46 70-3218420 | katarina.nilsson.helander@vgregion.se | |
Contact: Annelie Brorsson, PhD | +46 70-4005508 | annelie.brorsson@orthop.gu.se |
Sweden | |
Forskningsenhet Ortopedi, Sahlgrenska universitetssjukhuset, Mölndal | Recruiting |
Mölndal, VGregion, Sweden, 43180 | |
Contact: Pernilla Eliasson, Ass.prof. +46 73-9864982 pernilla.eliasson@vgregion.se | |
Contact: Roy Tranberg, Ass.prof +46 70-8105401 roy.tranberg@vgregion.se | |
Principal Investigator: Katarina Nilsson Helander, Ass.prof. | |
Sub-Investigator: Annelie Brorsson, PhD |
Principal Investigator: | Katarina Nilsson Helander, Ass.Prof | VGregion |
Responsible Party: | Vastra Gotaland Region |
ClinicalTrials.gov Identifier: | NCT06009978 |
Other Study ID Numbers: |
2022-00921-02 |
First Posted: | August 24, 2023 Key Record Dates |
Last Update Posted: | April 24, 2024 |
Last Verified: | May 2023 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | No |
Studies a U.S. FDA-regulated Drug Product: | No |
Studies a U.S. FDA-regulated Device Product: | No |
Achilles Tendon Rupture Rehabilitation Neuromuscular Electrical Stimulation |
Rupture Wounds and Injuries |