A systematic review of early rehabilitation methods following a rupture of the Achilles tendon

Objectives Rupture of the Achilles tendon is a debilitating injury. Advances have led to the development of immediate weight bearing rehabilitation. A range of early rehabilitation methods exist, but further research is required into this new area. The first stage in the investigation of a complex intervention is to identify its defining components. The aim of this review was to systemically identify and summarise, from clinical studies, the individual components that define immediate weight bearing rehabilitation protocols for the treatment of acute Achilles tendon rupture's. Data sources The electronic databases MEDLINE, EMBASE, CINAHL, AMED and the register of current controlled trials were searched up to March 2010. Review methods All study designs and languages were included. Two independent reviewers used pre-defined inclusion and exclusion criteria to identify all eligible articles. Eligible articles were summarised and critically reviewed, using the extension of the CONSORT statement for non-pharmacological interventions. Results Two hundred and fifteen articles were screened, nine were included. These studies, presented the results of 424 patients; 236 who had surgery and 188 who were managed non-operatively. There were a range of rehabilitation protocols that were defined by four components. These components consisted of the degree of maintained plantarflexion, whether daily range of movement exercises were permitted, the type of orthotic and for how long it was worn. Conclusions The efficacy of different immediate weight bearing rehabilitation protocols following an acute rupture of the Achilles tendon remains unclear. Further research is required to evaluate the identified components to optimise rehabilitation. (C) 2011 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.