Clinical Trial Details
— Status: Enrolling by invitation
Administrative data
NCT number |
NCT05614908 |
Other study ID # |
AarhusUH-MFenger |
Secondary ID |
|
Status |
Enrolling by invitation |
Phase |
|
First received |
|
Last updated |
|
Start date |
November 1, 2022 |
Est. completion date |
August 1, 2026 |
Study information
Verified date |
July 2023 |
Source |
Aarhus University Hospital |
Contact |
n/a |
Is FDA regulated |
No |
Health authority |
|
Study type |
Observational
|
Clinical Trial Summary
The main purpose of the study is to investigate self-reported functional ability of patients
undergoing conservatively treated achilles tendon rupture at 6, 12 and 24 months from the
date of injury.
Description:
Background:
The achilles tendon is the most injured tendon in the lower extremity. An achilles tendon
rupture (ATR) is treated either surgically or non-surgically. Previous studies have
investigated early controlled motion and weight-bearing for non-surgically treated ATR. Early
motion may cause tendon elongation, which leads to decrease in push off strength, and thus
potentially a poorer functional outcome. Conversely, delayed initiation of mobilisation and
weight-bearing may similarly hinder or delay optimal recovery of function and return to work
and sports. The correct treatment and rehabilitation, including the timing of rehabilitation
initiation, may therefore be crucial to ensure the patients' functional ability.
Most hospitals in Denmark treating patients with ATR, provide a regime of 8 weeks
immobilization for conservatively treated patients with ATR. At Aarhus University Hospital
(AUH), however, a more restrictive regime is provided for these patients, requiring
immobilization for 11 weeks after injury. Typically, a late initiation of mobilization is
defined as mobilization beginning in week 8, i.e. 3 weeks sooner than the standard regime at
AUH. Furthermore, many "late" mobilization regimes allows for some non-weightbearing
exercises prior to week 8, but at AUH patients are recommended to limit any movement during
the first 11 weeks after injury. This is primarily to reduce the risk of a re-rupture, the
rate of which is lower at AUH than on a national level (i.e. <5% versus 7-8% re-rupture
rate). However, this delayed onset of mobilization and weight-bearing may have a negative
effect on return to normal function, sports and work.
Since 2012, a number of Danish hospitals, treating patients with ATR, have reported
re-rupture rates, and self-reported functional ability and working status, etc. is reported
at 6, 12 and 24 months. This data are published in a report, enabling comparison with other
populations. At present, AUH does not report these data into to the database, and the data
published in the early report may therefore serve as comparison group in this quality
assurance study.
Purpose: The aim of this quality assurance study is therefore to investigate to what extent
the stricter regime at AUH following conservatively treated ATR affects the patients'
functional ability after 6, 12 and 24 months after injury, compared to patients treated at
other Danish hospitals with less strict regimes.
Materials and methods:
Study design and participants:This is a cohort study, using self-reported data collected
prospectively from approximately 100 consecutive patients (18+) recruited at AUH with a
non-surgically treated ATR. These data will be compared with self-reported data from the
Danish Achilles tendon Database (DAB) i.e. an existing cohort of patients with ATR treated at
other Danish Hospitals. The data is freely available in yearly reports at
(https://www.hvidovrehospital.dk/sorc-c/projects/Pages/The-Danish-Achilles-tendon-Database-(D
ADB).aspx).
Standard mobilization procedure: As part of standard care at AUH, all patients treated
non-surgically for ATR are immobilized in scotch cast during weeks 0-4. Next, the scotch cast
is replaced by a ROM-WALKER for the next 7 weeks (week 5-11 after injury), but without weight
bearing weeks 5-10. At week 11 the patients are allowed weight bearing up to 30 kg, after
which there is no longer weight bearing restrictions.
Data collection: Patients will receive a digital letter with a link to an online
questionnaire to be completed at 6 months, 12 months and 24 months from the date of injury.
Patients are asked to fill out the patient-reported outcome measure Achilles tendon Total
Rupture Score, as well as additional questions regarding job status, return to sport,
incidence of deep venous thrombosis, if they have had a re-rupture of the same achilles
tendon and their satisfaction with treatment they received at the hospital.
The ATRS is a 10-item questionnaire, with a score of 0 to 10 (worst-best), which has been
found valid, reliable and responsive in this population.
Statistical analysis:
The primary outcome is ATRS score at 12 months, which will be compared to the 12 month ATRS
score in the 2021 report of the Danish Achilles Tendon Database (DADB), including app. 2000
patients.
The needed sample size to find a minimal clinical important difference of 10 points (SD 18)
between our population and the population of DADB is 51 patients in each group, to achieve a
power of 80% and alpha set at 5%.
Expected outcomes and perspectives: this study will bring knowledge about patient-reported
outcomes on achilles function, physical acitivity and work status in patients with
conservatively treated ATR, following an immobilization protocol of 11 weeks duration.