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| Name | Class |
|---|---|
| Coordenação de Aperfeiçoamento de Pessoal de NÃvel Superior. | OTHER_GOV |
| Conselho Nacional de Desenvolvimento CientÃfico e Tecnológico | OTHER_GOV |
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The purpose of this study is to evaluate the effects of early mobilization versus traditional immobilization rehabilitation programs after surgical Achilles tendon repair on the mechanical (torque-angle and torque-velocity relationships) and electrical (neuromuscular activation) properties of the plantar- and dorsiflexor muscles, gastrocnemius medialis morphology (muscle architecture), functional performance, and the mechanical and material properties (force-elongation and stress-strain relationships) of the injured and uninjured Achilles tendon.
The hypothesis is that the early mobilization could reduce the deleterious effects of the joint immobilization and improve the tendon healing.
Participants were allocated into one of two intervention groups (traditional immobilization or early mobilization).
Traditional immobilization group (45 days of plaster cast immobilization; after the immobilization period, subjects received instructions on how to perform a home-based exercise program)
Early mobilization (six weeks of physical therapy program; three times per week; one to two hours of exercises for regaining range of motion and muscular endurance)
Control group (subjects had no history of lower limb injury, and were matched in age and anthropometric measurements to subjects that performed physical rehabilitation and to subjects that remained immobilized.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Traditional Immobilization | Experimental | 45 days of plaster cast immobilization After the immobilization period, subjects received instructions on how to perform a home-based exercise program |
|
| Early mobilization | Experimental | Six weeks of physical therapy program |
|
| Control | No Intervention | Subjects had no history of lower limb injury, and were matched in age and anthropometric measurements to subjects that performed physical rehabilitation and to subjects that remained immobilized. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Traditional Immobilization | Other | After surgery subjects were immobilized in a plaster cast, with the ankle positioned in gravitational equinus; weight bearing was not allowed. Two weeks post-operatively, the cast was removed and the patient was immobilized with a new plaster cast, with the ankle in the same position. Four weeks post-operatively, the ankle was plastered in neutral position (i.e. with the sole of the foot perpendicular to the shank), and weight bearing was encouraged. Six weeks post-operatively, the plaster cast was removed The home exercise program consisted of active exercises and stretches to improve ankle range of motion, and resistance and balance exercises |
| Measure | Description | Time Frame |
|---|---|---|
| Heel rise test (HRT) | Heel rise height is an expression of ankle plantarflexor functional performance and was assessed using the HRT. | Heel rise height was measured 3 times during the study: three, six and more than 12 months after surgical repair. |
| Measure | Description | Time Frame |
|---|---|---|
| Muscular torque change | Torque is an expression of the muscular strength and was assessed by dynamometry | Torque was measured 3 times during the study: three, six and more than 12 months after surgical repair. |
| Ankle range of motion change |
| Measure | Description | Time Frame |
|---|---|---|
| Functional performance change | Functional performance was assessed by functional tests (time up and go and jump tests) and AOFAS questionnaire. | Functional performace was measured 3 times during the study: three, six and more than 12 months after surgical repair |
| Muscular electrical activation change |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Marco A Vaz, PhD | Federal University of Rio Grande do Sul | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Exercise Research Laboratory, School of Physical Education, Federal University of Rio Grande do Sul | Porto Alegre | Rio Grande do Sul | 90690-200 | Brazil |
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| ID | Term |
|---|---|
| D046353 | Immobility Response, Tonic |
| D012422 | Rupture, Spontaneous |
| ID | Term |
|---|---|
| D001522 | Behavior, Animal |
| D001519 | Behavior |
| D009043 | Motor Activity |
| D020763 | Pathological Conditions, Anatomical |
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| ID | Term |
|---|---|
| D004434 | Early Ambulation |
| ID | Term |
|---|---|
| D012046 | Rehabilitation |
| D000359 | Aftercare |
| D003266 | Continuity of Patient Care |
| D005791 | Patient Care |
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| Early Mobilization | Other | The physical therapy started two weeks after the surgery and lasted six weeks, during which a removable brace was used. Therapy sessions, three times per week in the six-week period, included one to two hours of exercises for regaining range of motion and muscular endurance. |
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Ankle range of motion was assessed by goniometry during active and passive dorsiflexion and plantar flexion.
| Ankle range of motion was measured 5 times during the study: 15 days, 45 days, three, six and more than 12 months after surgical repair. |
| Muscular architecture change | Muscular architecture (muscle thickness, pennation angle and fascicle length) was assessed by ultrasonography | Muscle architecture was measured 4 times during the study: 45 days, three, six and more than 12 months after surgical repair. |
| Plantarflexor muscle volume change | Plantarflexor muscle volume was estimated from calf muscle thickness and limb length using the equation proposed by Miyatani et al. 2004. | Plantarflexor muscle volume was assessed 4 times during the study: 45 days, three, six and more than 12 months after surgical repair. |
Electrical activation was assessed by electromyography (EMG) |
| Muscular electrical activation was measured 3 times during the study: three, six and more than 12 months after surgical repair |
| Tendon mechanical and material properties change | Tendon mechanical and material properties were assessed by Achilles tendon elongation (measured by ultrasound) during isometric plantar flexion ramp contraction as a function of ankle joint torque. | Tendon mechanical and material properties were measured 3 times during the study: three, six and more than 12 months after surgical repair. |
| D013568 |
| Pathological Conditions, Signs and Symptoms |
| D013812 |
| Therapeutics |