Online Physical Therapy Protocol Quality, Variability, and Availability in Achilles Tendon Repair

Area of Science:

• Orthopaedic Surgery
• Physical Therapy
• Rehabilitation Medicine

Background:

• Early functional rehabilitation improves outcomes after Achilles tendon repair (ATR).
• Standardized ATR rehabilitation guidelines are currently unavailable.
• Patients increasingly seek online health information, necessitating accessible, standardized protocols.

Purpose of the Study:

• To evaluate the quality, variability, and accessibility of online ATR rehabilitation protocols from US academic orthopaedic programs.
• To identify trends and inconsistencies in current ATR rehabilitation practices.

Main Methods:

• Review of online ATR physical therapy protocols from US academic orthopaedic programs.
• Development and application of a comprehensive scoring rubric to assess protocol components and timing.
• Study design classified as Level III: Retrospective comparative study.

Main Results:

• Only 22 of 155 US programs (14%) published online ATR protocols (27 total).
• Most protocols (78%) recommended immediate splinting; 96% advised non-weightbearing initially.
• Significant variability exists in the timing of strengthening, stretching, proprioception, and cardiovascular exercises.

Conclusions:

• A minority of US academic orthopaedic programs provide online ATR rehabilitation protocols.
• While traditional casting is declining, many programs lag in adopting accelerated weightbearing and mobilization techniques.
• Considerable variation in rehabilitation component timing and content necessitates standardization for optimal patient outcomes.