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Merry, Kohle

University of British Columbia

Exercise therapy is the gold standard for Achilles tendinopathy (AT) rehabilitation; however, success rates vary considerably due to challenges in exercise selection, dosing, and adherence. This dissertation includes five studies investigating the current evidence base, clinical practice patterns, and perceptions of physical therapists (PTs) and people with AT relating to exercise therapies. It then details the formative development of the 'PhysViz,', a home-based exercise dosing system incorporating biofeedback and remote monitoring technologies. Study one is a narrative review exploring the mechanisms of tendon tissue remodeling in response to resistance exercise, which highlighted the potential of loading intensity for AT rehabilitation. Study two is a scoping review of resistance-based therapeutic exercise which revealed a reliance on eccentric loading programs, and highlighted reporting deficits in program fidelity, adherence, and compliance. Study three is a cross-sectional survey of PTs and people with AT which revealed that clinical practice patterns are well-aligned with AT clinical practice guidelines; however, discrepancies exist in the perceived treatment needs between PTs and people with AT. Study four is a cross-sectional study which assessed the validity and reliability of two commercially available load sensors for inclusion in the PhysViz system. Lastly, study five details the formative development of the PhysViz, situated in the Framework for Accelerated and Systematic Technology-based intervention development and Evaluation Research (FASTER), which found the PhysViz to be well received by PTs and people with AT. The multi-lens approach within this dissertation—combining biological insights, evidence-based practice, and end-user perspectives—contributes to a more comprehensive understanding of exercise therapy for AT. This research contributes to the knowledge base on AT management and can serve as a guide for future rehabilitation technology development grounded in research and contextual evidence. By engaging PTs and people with AT in the PhysViz co-development, this work facilitates knowledge translation from research to clinical practice. Future research, building on insights from this dissertation, has the potential to identify precision exercise dosing, optimize AT exercise therapy, and decrease rehabilitation times and costs.

Text

2024-09-26

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/89305

Rehabilitation Sciences

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/