Mathew Frazier

Background: Achilles tendinopathy (AT) is a common condition that limits activity participation in both active and sedentary populations. While exercise and education are well-established treatments for AT, information is lacking on the amount of intervention required and the prognostic factors associated with response to noninvasive treatments. Objective: This noninferiority randomized controlled trial will determine the efficacy of a single-visit, physical therapist (PT)–initiated rehabilitation program compared to a multivisit, PT-guided telehealth rehabilitation program for AT and will identify early prognostic factors for individuals who experience the greatest improvement in pain and disability by 4 weeks. Methods: In this single-blind, 2-arm, parallel-group trial, 160 individuals with AT will be randomized to either a single-visit PT-initiated rehabilitation program or a multivisit, PT-guided telehealth rehabilitation program. Primary outcomes will be the numeric rating scale for movement pain and the Victorian Institute of Sport Assessment–Achilles score for disability. Secondary outcomes will include measures of tendon health, measures within the psychosocial health domain, and military readiness. Results: This research was funded in July 2024. Participant enrollment began in August 2025 and is expected to conclude in 2028. As of January 2026, 15 participants have been enrolled at the University of Iowa Hospitals and Clinics, meeting the recruitment goals. Conclusions: The PACE (Progressive Achilles Loading via Clinician e-Support) trial will identify a rehabilitation program focused on education and exercise for AT that expands access to care and will identify factors that predict responses to exercise and education.

BACKGROUND Achilles tendinopathy is a widespread condition that limits activity participation in active and sedentary populations. While exercise and education are well established treatments for Achilles tendinopathy, information is lacking on the amount of intervention required and prognostic factors for responders to non-invasive treatments. OBJECTIVE This non-inferiority, randomized controlled trial will determine the efficacy of a single-visit, physical therapist initiated rehabilitation program compared to a multi-visit, physical therapist guided rehabilitation program for Achilles tendinopathy, and identify early prognostic factors for individuals who experience the greatest improvement in pain and disability by four weeks. METHODS In this single-blind, two-arm, parallel-group, trial, 160 individuals with Achilles tendinopathy will be randomized to a single visit physical therapist-initiated rehabilitation program or to a multi-visit, physical therapist-guided telehealth rehabilitation program. Primary outcomes will be the numeric rating scale for movement pain and the Victorian Institute of Sport Assessment- Achilles for disability. Secondary outcomes will include measures of tendon health, psychosocial health domain measures, and military participation. RESULTS This research was funded in July 2024. Participant enrollment began August 2025 and is expected to conclude in 2028. As of January 2025, 15 participants have been enrolled at UIHC, meeting recruitment goals. CONCLUSIONS The PACE trial will identify a rehabilitation program focused on education and exercise for Achilles tendinopathy that expands access to care and will identify factors that predict responses to exercise and education. CLINICALTRIAL ClinicalTrials.gov NCT06736795; https://clinicaltrials.gov/study/NCT06736795 and OSF Registries osf.io/sgj47; https://osf.io/sgj47