Exploration of daily load measures using wearable technology in people with Achilles tendinopathy

Sanam Tavakkoli Oskouei1, Dr Peter Malliaras1, Prof. Keith Hill2, Dr. Ross Clark3, Dr. Luke Perraton1

1Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia, 2Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia, 3School of Health and Behavioural Sciences, University of the Sunshine Coast, Sunshine Coast, Australia

Aim: This study aimed to explore daily load measures that can be assessed over time in people with Achilles tendinopathy (AT) and how these measures relate to clinical measures of pain and function. These measures may be important for the management and prevention of AT.

Design: Multiple-case study.

Method: Ten adults (53.10 ± 12.37 years) with AT participated. Clinical severity was assessed with a pain and function questionnaire (VISA-A), single-leg hop, and heel-raise tests at baseline. Daily pain intensity was monitored three times a day using an automated SMS service. Daily load measures (i.e. step counts, stride rate, peak shank angular velocity, and peak acceleration) were monitored using an ankle-worn inertial measurement unit for seven consecutive days.

Results: There were positive moderate to strong associations between VISA-A scores and stride rate (rho = 0.65, p = 0.04), peak shank velocity (rho = 0.67, p = 0.03), and number of fast steps taken (rho = 0.75, p = 0.02). Pain with single-leg heel-raise and hopping had a negative moderate to strong associations with the number of fast steps taken and time spent walking fast (-0.80 < rho, p < 0.04). The worst pain intensity was experienced on the days when the highest number of steps was taken.

Conclusions: Lower daily load is associated with worse VISA-A scores, worse pain intensity with single-leg hopping and heel-raise tests, and less daily pain intensity. Whether daily load measures need to be addressed specifically in AT warrants investigation.


Sanam Tavakkoli graduated from Isfahan University of Medical Sciences with a Masters of Physiotherapy and has worked as a physiotherapist in public musculoskeletal health centres and tutored students at Tabriz University of Medical Sciences. Sanam is currently studying PhD at Monash University. Her PhD research focuses on using wearable technology in people with Achilles tendinopathy. This research aims to explore measures to monitor daily load and physical activity over time and to understand how these measures may affect rehabilitation outcomes in Achilles tendinopathy.

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