Sayak Banerjee, Amity University Kolkata
Linking the heel bone and the calf muscles, the Achilles tendon is found as a tough band of fibrous tissue. The calf muscles come together to form a band of tissue, the Achilles tendon, at the lower end of the calf. It then inserts itself into the heel bone where small sacs of fluid known as bursae cushion the tendon.
The Achilles tendon is known as the largest and the strongest tendon in the body. The tendon pulls on the heel when the calf muscles are subjected to flexion. This movement enables us to stand on our toes while jumping, walking, or running. Although being very strong it is susceptible to injury and it can be due to its restricted blood supply and high tensions placed on it. An Achilles tendon tear occurs abruptly and might be tiny or large causing pain, swelling, and impaired movement. A complete rupture of the Achilles tendon requires surgery or long-term immobilization of the ankle.
Treatment management of Achilles tendon rupture:
Generally, patients with an acute Achilles tendon rupture face a decisional conflict whether to have surgery or conservative management. It has been seen that non-operative care is often associated with a higher rate of tendon re-rupture. Whereas, its surgery is associated with the risks of surgical complications which include wound healing problems, infections, and subsequent surgery. Each of these treatment approaches exists with varying non-operative and surgical treatment options. Initially, the non-operative management involved a period of prolonged immobilization for the facilitation of tendon healing.
Now it has been evolved to early motion and rehabilitation protocols, which in turn has resulted in reduced re-rupture rates. Surgical care, on the other hand, has evolved from traditional open surgery to more percutaneous and less invasive options. Although these surgical techniques aim to reduce wound healing problems, there is an increased risk of other harms including nerve injury.
A Decision support tool to prevent decisional conflict:
The decision is made more complex by the varying harms and benefits of the treatment options. This decisional conflict can lead to worry, physical stress, questioning of personal values, and eventually, decision delay. The patient-clinician relationship is shifting from a unilateral discussion to more of a patient-centered approach. This approach is mainly focused on the concept of shared decision-making (SDM). SDM facilitates patients to make a more value-based, personal decision by supplementing the patient-clinician discussion.
A research team from the University of Ottawa developed a Patient Decision-Aids (PtDA) tool. This helped the patients make a more informed, value-based decision when considering treatment options for acute Achilles tendon rupture. PtDA can be used by patients when they are preparing for or within a consultation with their physician. These tools not only state the decision to be made but also provide patient-friendly information on decision options, their harms, and benefits. This allows them to clarify what matters to them most.
The effectiveness of Patient Decision Aid (PtDA) in decreasing decisional conflict, enhancing patient knowledge, and increasing patient participation has been demonstrated. It is a facilitator of SDM, which has led to improved satisfaction with their patient experience. The researchers mentioned that the PtDA will be formatted to include information about Achilles tendon ruptures and indicate which patients are eligible for the Patient Decision Aid (PtDA). It will include the treatment approach to consider and a summarized version of the harms and benefits of each. There will be a values clarification exercise and a space to specify the preferred treatment option. Finally, it will include a SURE test which is a questionnaire, with 4-6 questions, that will be used to screen patients with decisional conflicts.
Inference from the PtDA testing:
The scientists regarded this to be the first of a series of orthopaedic PtDAs developed for facilitating SDM for patients receiving musculoskeletal care. This approach will raise awareness regarding the existence of PtDA, thus gaining national dissemination and public availability. They stated that there were a few qualitative endpoints concerning the outcomes of the PtDA testing. Further research is necessary for a better understanding of the endpoints.
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Reference:
- Meulenkamp, Brad, et al. “Development and Field Testing of a Patient Decision Aid for Management of Acute Achilles Tendon Rupture: A Study Protocol.” BMC Medical Informatics and Decision Making, vol. 21, no. 1, Dec. 2021, p. 225. doi:10.1186/s12911-021-01589-5. https://doi.org/10.1186/s12911-021-01589-5
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Author info:
Sayak Banerjee is a 3rd year Biotechnology Engineering Student with great interest in Immunology and Molecular genetics. He is a creative scientific writer in Bioxone with an inclination towards gaining knowledge regarding vast sections of Biotechnology and emphasizing himself in various wet lab skills.
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- https://bioxone.in/news/worldnews/car-t-cells-scientists-discover-on-off-switches-for-cell-immunotherapy/
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