Study Of Ankle Proprioception And Lower Limb Functional Performance In Patients With Achilles Tendinopathy And The Effect Of Taping Intervention

Objective:Achilles tendinopathy（AT）is a common musculoskeletal disorder that affects motor control and performance,and proprioceptive information plays an important role in motor control.There is evidence of proprioceptive deficits in patients with rotator cuff tendinopathy and patellar tendinopathy,but it has not been reported whether ankle proprioception is affected during ankle plantarflexion in patients with AT,and the relationship between proprioception and motor performance in patients with AT is unclear.Therefore,this study used the Active Movement Extent Discrimination Assessment（AMEDA）to measure ankle plantarflexion proprioception in patients with AT,to verify its reliability and validity in patients with AT and healthy subjects,and to investigate the differences in ankle plantarflexion proprioception and lower limb function between patients with AT and healthy subjects.The study also investigated the differences in ankle plantarflexion proprioception and lower limb function between AT patients and healthy people.AT occurs when the pressure on the Achilles tendon exceeds its own loading capacity.Taping is a commonly used conservative treatment and has been shown to stimulate proprioceptors in the midfoot area and improve plantar fascia stiffness,thereby relieving the load on the Achilles tendon.Previous studies have also shown that anti-pronation taping can reduce pain and improve function,but the clinical evidence for this is low,the mechanism of action of the taping is unclear,and whether there are differences between different orientations of taping has not been investigated.Therefore,this study aims to investigate the effects of different directions of taping on ankle proprioception and lower limb function in AT patients through a controlled trial,and to provide new ideas for injury prevention and clinical treatment of AT.Methods:This study consisted of 3 trials.Trial 1:Test-retest reliability study of the ankle active plantarflexion extent discrimination device.Twelve patients with AT（age:21.6±3.1 years,height:1.7±0.1m,weight:64.6±12.2 kg）and twelve healthy control population（age:22.9±2.9 years,height:1.7±0.1 m,weight:65.8±11.2 kg）were recruited.Basic information on the subjects and the Victorian Institute of Sport Assessment-Achilles tendinopathy questionnaire（VISA-A）were collected.Subjects were asked to complete two AMEDA tests at least 7 days interval and the Area Under the Receiver Operating Characteristic Curve was calculated as the ankle plantarflexion proprioception score.The Intraclass Correlation Coefficient（ICC）was used to examine retest reliability,and Minimal Detectable Change（MDC）with 90%confidence interval was calculated.Trial 2:Validity study of the ankle active plantarflexion extent discrimination device.Seventeen patients with AT（age:22.3±3.0 years,height:1.7±0.1 m,weight:69.4±16.4 kg）and seventeen healthy control population（age:21.5±2.1 years,height:1.8±0.1 m,weight:68.9±12.2 kg）were recruited.At the time of demographic information collection,the VISA-A questionnaire was completed.This was followed in random order by the AMEDA Test,Weight-Bearing Lunge Test（WBLT）,single leg hop test,figure of 8 hop test,Y Balance Test（YBT）and Lower Extremity Functional Test（LEFT）.For discriminant validity,the AUC values of AMEDA were analyzed by independent samples t-test,and the best cut-off values and sensitivity and specificity were calculated by ROC curve analysis.For convergent validity,for analysis of variance,independent samples t-test was used for normally distributed data and Mann Whitney U-test was used for non-normally distributed data;for correlation analysis,AUC values and VISA-A scores for AMEDA,WBLT,single foot jump test values,figure of eight jump test values,YBT standard values,unilateral LEFT scores,and risk of LEFT injury were analyzed by Spearman correlation analysis.The optimal cut-off values and the sensitivity and specificity of unilateral LEFT to differentiate between AT patients and healthy people were also calculated.And the sensitivity and specificity of AMEDA combined with LEFT to differentiate between AT patients and healthy people.Trial 3:Effect of athletic taping intervention in different directions on ankle proprioception and functional performance of the lower limb in patients with Achilles tendinopathy.Thirty patients with AT（age:23.4±5.0 years,height:1.7±0.1 m,weight:68.9±12.8 kg）were recruited.The no taping,pronation taping,and supination taping interventions were performed in randomized order.The AMEDA test,WBLT,single-leg hop test,figure of 8 hop test and LEFT were completed under different taping conditions.The immediate effects of different taping methods on ankle proprioception and lower limb function were compared using repeated measures ANOVA.Results:For trial 1,the ICC_（3,1）value was 0.821（95%CI=0.509,0.944）for the AT group,0.779（95%CI=0.418,0.930）for the healthy control group and 0.837（95%CI=0.658,0.926）for the overall group.There was no significant difference between the ANOVA results for the first and retest AUC values for the AT group（F=0.310,p=0.584）and for the healthy group（F=0.255,p=0.619）.The MDC₉₀ for the AT group was 0.05 and for the healthy control group it was 0.06.For trial 2,the ankle proprioception AUC values were significantly lower in the AT group than in the healthy population controls（t=-2.532,p=0.016,95%CI=-0.091,-0.010,Cohen’s d=0.857）.After diagnostic analysis of the ROC curve,the best cut-off value for AMEDA to differentiate between AT patients and healthy people was 0.755,with an AUC value of 0.737（95%CI=0.565,0.909,p=0.018）,sensitivity of 88%and specificity of 59%.This indicates that AMEDA has good discriminant validity.In terms of convergent validity,the results of the analysis of variance indicated that the AT group’s VISA-A scores（Z=-4.493,p<0.001）,single leg hop test values（t=-3.553,p=0.001,95%CI=-49.493,-13.4243,Cohen’s d=1.218）,figure of 8 hop test values（Z=-3.048,p<0.001）,unilateral LEFT scores（t=-3.969,p=0.001,95%CI=-18.768,-6.038,Cohen’s d=1.362）and risk injury of LEFT were significantly different from healthy population controls,but WBLT test values（p=0.654）and YBT standardized values were not significantly different between groups（p=0.181）;correlation analysis showed that the AUC values for AMEDA were significantly and weakly correlated with the figure of 8 hop test value（rho=-0.342,p=0.048）,the unilateral LEFT score（rho=0.357,p=0.038）,and with the VISA-A score,WBLT,the single leg hop test values,YBT standardized values,and injury risk of LEFT were not significantly correlated.Poor convergent validity of AMEDA and lower extremity function tests.The best cut-off value for the unilateral LEFT score to distinguish between AT patients and healthy people was 73.450,with a sensitivity of76.5%and specificity of 76.5%.The sensitivity of AMEDA combined with LEFT to differentiate between AT patients and healthy people was 70.6%and the specificity was 94.1%.Trial 3,for the results of the ankle plantarflexion proprioception and lower limb function tests in the different taping situations.Regarding AUC values,there was a significant difference in AUC values between AT patients with no taping,pronation taping,and supination taping（F=25.318,p<0.001,partialη²=0.466）.Pairwise comparisons showed that compared to no taping,both pronation taping（p<0.001,95%CI=-0.085,-0.026）and supination taping（p<0.001,95%CI=-0.090,-0.044）significantly increased the AUC values for ankle proprioception,and there was no significant difference in AUC values between pronation taping and supination taping（p=0.729）.Regarding WBLT,there was a significant difference in WBLT values for AT patients with no taping,pronation taping,and supination taping（F=6.265,p<0.05,partialη²=0.309）.Pairwise comparisons showed a significant reduction in ankle dorsiflexion mobility after both pronation taping（p<0.05,95%CI=0.144,0.990）and supination taping（p<0.05,95%CI=0.144,0.916）compared to no taping,and no significant difference between pronation taping and supination taping（p=1.000）.Regarding single leg hop test values,there was no significant difference in single leg hop test values for AT patients with no taping,pronation taping,and supination taping.（F=2.045,p=0.139）.Regarding the figure of 8 hop test values,there was a significant difference in the figure of 8 hop test values between AT patients with no taping,pronation taping,and supination taping（F=12.818,p<0.001,partialη²=0.307）.Pairwise comparisons showed that compared to no taping,both pronation taping（p=0.004,95%CI=0.143,0.665）and supination taping（p<0.001,95%CI=0.345,0.741）significantly increased the figure of 8 hop test values,with no significant difference between the pronation taping and supination taping（p=0.206）.Regarding unilateral LEFT scores,there was a significant difference in unilateral LEFT scores in AT patients between no taping,pronation taping,and supination taping（F=23.505,p<0.001,partialη²=0.448）.Paired comparisons showed that compared to no taping,both pronation taping（p<0.001,95%CI=-12.88,-5.23）and supination taping（p<0.001,95%CI=-12.41,-4.44）significantly improved unilateral LEFT scores,with no significant difference between pronation taping and supination taping（p=1.000）.Regarding the risk injury of LEFT,there was a significant difference in the risk injury of LEFT in patients with AT between no taping,pronation taping,and supination taping（F=22.055,p<0.001,partialη²=0.432）.Pairwise comparisons showed that compared to no taping,both pronation taping（p<0.001,95%CI=0.089,0.185）and supination taping（p<0.001,95%CI=0.066,0.158）significantly reduced the risk of LEFT injury,with no significant difference between pronation taping and supination taping（p=0.207）.Conclusion:（1）The AMEDA had good test-retest reliability in measuring ankle plantarflexion proprioception in patients with AT and healthy people.The MDC₉₀value of the AMEDA in the AT population was 0.05.（2）The AMEDA had good discriminant validity and could effectively differentiate between AT patients and the healthy population,suggesting that ankle plantarflexion proprioception should be added as an assessment index in clinical practice.（3）The correlation between AMEDA and the figure of 8 hop test and LEFT was weak,but LEFT could be used to differentiate AT patients.In clinical practice,the AMEDA and LEFT could be combined to improve the accuracy of identifying patients with AT.（4）Patients with AT had deficits in ankle plantarflexion proprioceptive ability,poor functional performance of the lower extremity,and a higher risk of injury compared to the healthy population,but there were no significant differences in ankle dorsiflexion mobility or balance.（5）Athletic taping in both directions improved immediate ankle proprioception,functional performance of the lower extremity and reduced the risk of injury in patients with AT,but had no significant effect on the explosive strength of the lower extremity.