Progressive Achilles Loading Via Clinician E-support

NCT ID: NCT06736795

Last Updated: 2025-10-07

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

160 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-08-20

Study Completion Date

2028-07-31

Brief Summary

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This is a randomized controlled trial with individuals who have Achilles tendon pain. This study is designed to identify an effective rehabilitation program for Achilles tendon pain that expands access to care for military personnel and to predict treatment response. Limited or delayed access to healthcare can exacerbate the severity of pain and duration of disability due to AT. This is particularly relevant for individuals deployed to battlefield settings or are being seen in busy military treatment facilities. Therefore, it is crucial to identify efficient and effective treatment pathways that maximize healthcare access and facilitate a rapid and pain-free return to full duty.

Detailed Description

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The objectives of this non-inferiority trial are to identify a rehabilitation program focused on education and exercise for AT that expands access to care for military personnel and to identify factors that predict responses to rehabilitation. The following aims will test our central hypothesis that a single-visit, PT-initiated rehabilitation program will be as effective in improving pain and reducing disability as a multi-visit, PT-guided rehabilitation program for AT and that within two weeks of initiating exercise treatment, early changes in patient-reported outcomes can identify responders.

Specific Aim 1. Determine the efficacy of a single-visit, PT-initiated rehabilitation program vs. a multi-visit, PT-guided rehabilitation program for AT.

Specific Aim 2. Identify early prognostic factors for individuals who experience the greatest improvement in pain and disability by four weeks.

Study Design. A single-blind, two-arm, parallel phase 2 randomized controlled trial is the study approach. Individuals with AT will be randomized to one of two rehabilitation programs: 1) self-guided intervention initiated with a single visit with a physical therapist (PT) via telehealth followed by modules that the participant can complete asynchronously, or 2) PT-guided intervention (standard of care) with six one-on-one telehealth visits. Study will enroll 160 individuals with AT across two sites (University of Iowa Hospitals \& Clinics; Carl R. Darnall Army Medical Center, Fort Cavazos) and obtain baseline variables and immediate response at 2-weeks to characterize the sample. Outcomes will be assessed at 4 weeks (primary endpoint), 8 weeks, 26 weeks, and 1 year.

Conditions

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Achilles Tendon Pain Achilles Tendinopathy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Single-visit, Physical Therapist Initiated and Self-Pace Rehabilitation

Participants will complete 6 online modules, which will take 10 to 20 minutes each. The modules can be completed at their own pace over 8 weeks and include:

1. Exercise participation: Participants will receive instruction on how to progress a home exercise program. Participants will also need to complete a home exercise log.
2. Education: Participants will be given homework to do at home in between online module sessions. Online quizzes will help review the educational material.

Group Type EXPERIMENTAL

Exercise

Intervention Type OTHER

All participants will be instructed in a progressive Achilles tendon loading exercise program.

Education

Intervention Type OTHER

All participants will receive education on Achilles tendinopathy terminology, common symptoms, diagnosis, expected recovery timeline, importance of physical activity, self-management strategies, multiple factors influencing pain, alternative and adjunct treatment options.

Multi-visit, Physical Therapist Guided Rehabilitation

Participants will attend 6 to 7 telehealth sessions over 8 weeks, which will last 30 to 45 minutes each and include:

1. Exercise participation: Instruction from a physical therapist will be provided on how to complete a home exercise program between treatment sessions. Participants will also need to complete a home exercise log.
2. Education: Participants will be given homework and online quizzes to do at home in between treatment sessions. The physical therapist will review the educational material at each visit.

Group Type ACTIVE_COMPARATOR

Exercise

Intervention Type OTHER

All participants will be instructed in a progressive Achilles tendon loading exercise program.

Education

Intervention Type OTHER

All participants will receive education on Achilles tendinopathy terminology, common symptoms, diagnosis, expected recovery timeline, importance of physical activity, self-management strategies, multiple factors influencing pain, alternative and adjunct treatment options.

Interventions

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Exercise

All participants will be instructed in a progressive Achilles tendon loading exercise program.

Intervention Type OTHER

Education

All participants will receive education on Achilles tendinopathy terminology, common symptoms, diagnosis, expected recovery timeline, importance of physical activity, self-management strategies, multiple factors influencing pain, alternative and adjunct treatment options.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Pain localized to the Achilles tendon (insertion or midportion)
* AT pain greater than or equal to 3/10 with tendon-loading exercise

Exclusion Criteria

* Younger than 18 years of age or older than 60 years of age
* BMI \> 45 kg/m2
* Pain primarily due to a differential diagnosis, including paratendonitis, bursitis (retrocalcaneal or subcutaneous), posterior ankle impingement or os trigonum, irritation or neuropathy of the sural nerve, plantaris tendon involvement)
* Presence of a partial Achilles tendon tear or rupture on imaging or a history of Achilles tendon rupture that was verified by surgical or conservative management
* Attended physical therapy for AT in the past 3 months
* History of steroid injection to lower extremity tendons/fascia, ESWT or any injection to the Achilles tendon region in the past 3 months
* History of taking fluoroquinolones in the past 6 months
* History of surgery or invasive procedure for AT on side enrolling for treatment
* Diagnosed systemic conditions affecting the foot and ankle (e.g., rheumatoid arthritis, ankylosing spondylitis), endocrine disorder with complications (e.g., uncontrolled Type I or II diabetes, diabetic peripheral neuropathy), connective tissue disorder (e.g., Marfan's syndrome, Ehlers Danlos), or pregnancy
* At high risk for falls (four step square test \>15 seconds)
* Refusal of randomization or unable or uninterested in completing virtual visits with a webcam or smart phone or completing quizzes and surveys
Minimum Eligible Age

18 Years

Maximum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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C.R.Darnall Army Medical Center

FED

Sponsor Role collaborator

United States Department of Defense

FED

Sponsor Role collaborator

Ruth Chimenti

OTHER

Sponsor Role lead

Responsible Party

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Ruth Chimenti

Associate Professor, Physical Therapy and Rehabilitation Science

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Ruth L Chimenti, PT, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Iowa

Matthew Frazier, PT, DPT, MS, ATC

Role: STUDY_DIRECTOR

Carl R. Darnall Army Medical Center (CRDAMC), Fort Cavazos

Locations

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University of Iowa Health Care - Gait Analysis Laboratory

Iowa City, Iowa, United States

Site Status RECRUITING

Carl R. Darnall Army Medical Center (CRDAMC)

Fort Cavazos, Texas, United States

Site Status NOT_YET_RECRUITING

Countries

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United States

Central Contacts

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Jessica Danielson, DDS

Role: CONTACT

319-356-1722

Jessica F Danielson, DDS

Role: CONTACT

319-356-1722

Facility Contacts

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Jessica Danielson, DDS

Role: primary

319-335-9791

Jessica F Danielson, DDS

Role: backup

319-356-1722

Matthew Frazier, PT, DPT, MS, ATC

Role: primary

254-286-7898

Jessica Danielson, DDS

Role: backup

319-356-1722

Other Identifiers

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HT94252410536

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

202405285

Identifier Type: -

Identifier Source: org_study_id

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