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Are patients satisfied? A systematic review and meta-analysis of patient ratings in exercise therapy for the management of tendinopathy.

Shim, Joanna; Pavlova, Anastasia V.; Moss, Rachel A.; MacLean, Colin; Brandie, David; Mitchell, Laura; Greig, Leon; Parkinson, Eva; Tzortziou Brown, Victoria; Morrissey, Dylan; Alexander, Lyndsay; Cooper, Kay; Swinton, Paul A.


Rachel A. Moss

Colin MacLean

David Brandie

Laura Mitchell

Victoria Tzortziou Brown

Dylan Morrissey


Outcomes measuring patient rating of overall condition, including patient satisfaction, are associated with improved general health and higher quality of life. However, this outcome domain is under-explored in the management of tendinopathy. The purpose of this systematic review and meta-analysis was to synthesise intervention data investigating patient satisfaction and perceived improvement or deterioration following engagement in exercise therapy for the management of tendinopathy. A search of randomised controlled trials investigating exercise therapy interventions across all tendinopathies was conducted, extracting data assessing patient rating of overall condition. Outcomes were split into those measuring satisfaction (binary) and those measuring global rating of change (GROC). Bayesian hierarchical models were used to meta-analyse proportions and mean effect size (percentage of maximum) for the two outcome categories. From a total of 124 exercise therapy studies, 34 (Achilles: 41%, rotator cuff: 32%, patellar: 15%, elbow: 9% and gluteal: 3%) provided sufficient information to be meta-analysed. The data were obtained across 48 treatment arms and 1246 participants. The pooled estimate for proportion of satisfaction was 0.63 [95% CrI: 0.53 to 0.73], and the pooled estimate for percentage of maximum GROC was 53 [95% CrI: 38 to 69%]. Evidence was also obtained that the proportion of patients reporting positive satisfaction and perception of change increased with longer durations relative to treatment onset. The study concluded that patient satisfaction is not commonly reported in tendinopathy research and, in those studies where it is reported, satisfaction and GROC appear similar and are ranked moderately high, demonstrating that patients generally perceive exercise therapy for tendinopathy management positively. Further research including greater consistency in measurement tools is required to explore, and where possible identify patient and exercise moderating factors that can be used to improve person-centred care.


SHIM, J., PAVLOVA, A.V., MOSS, R.A., MACLEAN, C., BRANDIE, D., MITCHELL, L., GREIG, L., PARKINSON, E., TZORTZIOU BROWN, V., MORRISSEY, D., ALEXANDER, L., COOPER, K. and SWINTON, P.A. 2022. Are patients satisfied? A systematic review and meta-analysis of patient ratings in exercise therapy for the management of tendinopathy. SportRxiv [online]. Available from:

Deposit Date May 26, 2022
Publicly Available Date May 26, 2022
Keywords Tendinopathy; Exercise therapy; Physiotherapy
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