Progressive Achilles Loading via Clinician e-Support (PACE): Protocol for a Dual-Site Randomized Controlled Trial.

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.