Report #037

#037 – Achilles tendinopathy interventions, NMES parameters on quadriceps strength and Hip fractures management guideline

Estimated reading time: 3 minutes, 28 seconds.

Effectiveness of Achilles tendinopathy interventions

A living systematic review with network meta-analysis, 2021. (Open Access)


  • Evaluate the comparative effectiveness of all available treatments for Achilles tendinopathy in a regularly updated (‘living’) systematic review using NMA.


  • Victorian Institute of Sport Assessment-Achilles (VISA-A) score as the primary outcome.
  • The minimal important difference (MID) for the VISA-A score is 15 points.
  • Return to sports activities was the secondary outcome.
  • 29 RCTs including 1640 participants.
  • Midportion Achilles tendinopathy, active treatment classes seem to have clinically meaningful benefits (mean difference exceeded VISA-A MID of 15 points) at 3 months compared with wait-and-see.
  • For two classes (acupuncture therapy, and shockwave therapy combined with exercise therapy), the credible intervals exceeded the MID of 15 points. However, these results were based on two small trials (64 and 68 included patients, respectively) at high risk of bias.
  • At 12 months, there was no difference between exercise therapy, injection therapies and combined therapies.


  • For mid-portion Achilles tendinopathy, active treatments seem superior to wait-and-see at 3-month follow-up.
  • There was no evidence of a clinically relevant difference in effectiveness between different active treatments at 3-month and 12-month follow-up.
  • Calf-muscle exercise therapy is easy to prescribe in practice, is widely available, and is regarded as safe and cheap.

Neuromuscular Electrical Stimulation Parameters for Postoperative Quadriceps Strength in Patients After Knee Surgery

A systematic review, 2021 (Restricted Access)


  • Investigate the effect of neuromuscular electrical stimulation (NMES) parameters on quadriceps strength after knee surgery.


  • 8 RCTs, with average PEDro score of 5.
  • Grade B evidence exists to support the use of NMES to aid in the recovery of quadriceps strength after knee surgery.

📢Recommended Parameters

  • Implement NMES treatment during the first 2 postoperative weeks
  • Frequency: ≥50 Hz
  • At maximum tolerable intensity, with a biphasic current, with large electrodes
  • Duty cycle ratio: 1:2 to 1:3 (2- to 3-second ramp).

Guideline for physiotherapy management of hip fractures

A guideline, 2021 (Open Access)

Below are some of the recommendations, see the full guideline here

Structured Exercise

  • Physical therapists must provide structured exercise, including progressive high-intensity resistive strength, balance, weight bearing, and functional mobility training, to older adults after hip fracture. (Recommendition grade: A)
  • Clinicians should provide physical therapy/rehabilitation to patients with mild to moderate dementia, using similar interventions and prescriptions as for those without dementia. (Recommendition grade: B)

Frequency of Physical Therapy

  • High-frequency (daily) in-hospital physical therapy following surgery for a hip fracture, with duration as tolerated, including instruction in a home program. (Recommendition grade: B)

Early Assisted Transfers and Ambulation

  • Clinicians must provide assisted transfer out of bed and ambulation as soon as possible after hip fracture surgery and at least daily thereafter, unless contraindicated for medical or surgical reasons. (Recommendition grade: A)

Aerobic Exercise Added to Structured Exercise

  • Physical therapists may provide upper-body aerobic training in addition to progressive resistive, balance, and mobility training in the early postacute period (inpatient setting) for older adults after hip fracture. (Recommendition grade: C)

Electrical Stimulation

  • Physical therapists may use electrical stimulation for quadriceps strengthening if other approaches have not been effective. (Recommendation grade: C)
  • Physical therapists may use electrical stimulation for pain if it is not sufficiently managed with the usual strategies. (Recommendation grade: C)

Postacute Period: Home Care and Community Settings

  • Clinicians must provide opportunities for additional therapies if strength, balance, and functional deficits remain beyond 8 to 16 weeks after fracture. The additional therapies should include strength, balance, functional, and gait training to address existing impairments and activity limitations and fall risk. They may include outpatient services, progressive home exercise programs, or evidence-based community exercise programs. (Recommendation grade: A)
  • Physical therapists must provide recommendations to patients to maximize safe physical activity. (Recommendation grade: A)
  • Physical therapists may provide aerobic training in addition to progressive resistive, balance, and mobility training in the community setting for older adults after hip fracture. (Recommendation grade: C)

🦴Also, in othro

  • Resistance training using elastic bands can be used as a rehabilitative or preventive means for young adults with genu valgus. A double-blinded RCT. (Restricted Access)
  • Extracorporeal shock wave therapy (ESWT) is a valuable and reliable treatment modality for mild-to-moderate carpal tunnel syndrome (CTS). A double-blind RCT. (Open Access)

Thank you for reading, see you in the next one.

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