Effectiveness of Telehealth for Achilles Tendinopathy on Pain, Function, and Pain-Related Psychological Outcomes During COVID-19

SARS-CoV-2 (COVID-19) disrupted accessibility of in-person healthcare and required telehealth to provide continued services remotely. While encouraging evidence on the effectiveness of physical therapy (PT) via telehealth is emerging, limited literature exists on telehealth for Achilles tendinopathy (AT), a common painful condition of the hindfoot. The purpose of this study was to examine the effectiveness of PT for AT pain through varying modes of delivery (in-person, telehealth, hybrid). We hypothesized that all participants would improve with time and there would be no between-group effect for mode of delivery. Sixty-six participants were enrolled. All participants completed 6-7 PT visits over 8 weeks and received patient education and a tendon loading exercise program consisting of 3 phases (isometrics heel-raises, concentric-eccentric heel-raises, spring-phase). Outcomes including movement-evoked pain with heel-raises (NRS, 0-10), TSK-17, and PROMIS-physical function (PROMIS-pf) were assessed at baseline and 8 weeks. Participants completed all in-person visits from September 1st, 2019 to March 16th, 2020. From March 17th to July 15th, 2020 participants completed all telehealth visits, and from July 16th, 2020 to study closeout participants completed either in-person or telehealth visits based on their preference and comfort level. Mixed-effects ANOVAs were utilized to examine for between-group factors (mode of delivery) and within-group factors (time) on all outcomes with post-hoc analyses as appropriate. No significant differences were found between groups at baseline for all outcomes and demographics. All groups demonstrated improvement for movement-evoked pain (5.01/10 at baseline to 1.69/10 at 8-weeks), TSK-17 (37.44 at baseline to 30.99 at 8-weeks), and PROMIS-pf (48.32 at baseline to 50.51 at 8-weeks) with a significant effect for time (p<0.05) but not for mode of PT delivery found. Varying modes of PT delivery for individuals with AT did not have a significant effect on pain, functional, or pain-related psychological outcomes. Grant support from NIH-NIAMS ROO ARR071517.