Olika träningsprogram används vid rehabilitering av Akillestendinopati och skiljer sig åt avseende frekvens, intensitet, typ av träning och hur patienter skall förhålla sig till smärta när de tränar. Vilken nivå av smärta som är mest effektiv vid träning är ej tidigare utforskat. Syftet med denna litteraturöversikt är därför att jämföra träningsprogram som skall utföras med smärta med program som tillåter viss smärta samt med program som skall utföras smärtfritt vid rehabilitering av Akillestendinopati i senans mellanportion. Litteraturöversikten utfördes systematiskt och följde riktlinjerna enligt PRISMA. Studier från PubMed och Web of Science inkluderades. Endast studiedeltagare med Akillestendinopati i senans mellanportion som utförde träningsterapi som behandling och utvärderades med VISA-A inkluderades. Risk för bias bedömdes enligt Rob 2 tool för RCT-studier och ROBINS-1 tool för CCT-studier. En narrativ syntes användes som analysmetod och evidensgraderingen utfördes med GRADE. Åtta studier inkluderades i litteraturöversikten och samtliga av dessa innehöll träningsprogram som skulle utföras med smärta. Två studier involverade träningsprogram som tillät viss typ av smärta och ingen studie involverade träning som skulle utföras smärtfritt. Träningsterapi oavsett typ av träningsprogram visade sig vara associerat med förbättrade VISA-A värden och det går ej att avgöra vilken av dessa träningsprogram som är mest effektiv. Den här litteraturöversikten pekar mot att träning med smärta, som gäller vid Alfredsons standardprogram från 1998, är effektivt och har bäst evidens av de träningsprogram som presenteras i litteraturöversikten. Fler högkvalitativa interventionsstudier behövs för att öka evidensen för att träna utan krav på smärta vid Akillestendinopati i mellanportionen. / Different loading programs are used when rehabilitating Achilles tendinopathy varying regarding frequency, intensity, type of training and how to approach pain. The level of pain which is most effective in training, when rehabilitating Achilles tendinopathy, has not yet been explored. Therefore, the purpose of this review is to compare loading programs when inducing pain is a criterion with loading programs allowing some pain and with loading programs inducing no pain when rehabilitating midportion Achilles tendinopathy. The review was conducted systematically and followed the guidelines presented by PRISMA. Studies from PubMed and Web of Science were included. Only participants with midportion Achilles tendinopathy that rehabilitated with a loading program and were evaluated with VISA-A were included. Risk of bias was evaluated with the Rob 2 tool for RCT-studies and with ROBINS-1 tool for CCT-studies. A narrative synthesis was conducted, and the level of evidence was set with GRADE. Eight studies were included and all of them involved training with pain. Two studies included loading programs that allowed some pain and no study included training without pain. All loading programs included are associated with improved VISA-A scores and none are more superior than the others. This review shows that training with pain, as in Alfredsons eccentric loading program from 1998, is effective and has the best level of evidence of the different loading programs presented in this review. More high-quality studies are needed to increase the evidence for training when pain is not a criterion in midportion Achilles tendinopathy.

As an innovation Evidence-Based Practice (EBP) is designed as a tool for clinical problem solving. According to its theory of use EBP will bring a difference for policy makers, for professionals, for researchers and for service users. One question to be asked is whether EBP actually leads to the radical social change it is designed to accomplish. The aim of the study is to describe and analyse the outcome of the effort to establish EBP, with a focus on the case of social work in Sweden. The research questions are: What is EBP? Why are efforts made to establish EBP? What is the outcome of the EBP project? How can the outcome of the EBP project be explained? The case study was conducted on a critical realistic meta-theoretical ground with a focus on explanation of social change with an explicit actor-structure perspective. Methodologically, a narrative synthesis of studies was made. As a complement primary data were collected to fill empirical gaps. The state of things was described before and after the EBP-initiatives. Several helping theories – Kuhn’s theory of paradigm, program theory, neo-institutional theory and theory of diffusion – were used to analyse the empirically mapped outcome of the EBP project. The results show that the import of the original model of Evidence-Based Medicine (EBM) to social work is a part of a wider social movement in the helping and educational professions. The new model has influenced social work as a discipline, as a field of practice and as a field of policy. There are examples of full-scale implementations of EBP, although EBP has not reached a general status as daily practice. Some obstacles remain. The gradual adaption of EBP corresponds to criteria hold by Kuhn for a paradigm shift. Acceptance of the model has contributed to change the structure and function of social systems. At an organizational level, this change means on-going institutionalization. The innovation is influencing the way institutional actors conduct their work. Although the structural conditions have been optimal, the EBP-model has been debated with heat. The EBP-debate and policy-driven infrastructural efforts have brought a more in-depth examination of the model. So-called coercive, normative, and regulative isomorphisms were used to change organizations. The degree of institutionalization depended on the individuals and the organizations willingness and preparedness to change, to understand, and to put the model into practice. When actors used a less strict version of the original EBP model, the pace of cultural and institutional change slowed down.

As an innovation Evidence-Based Practice (EBP) is designed as a tool for clinical problem solving. According to its theory of use EBP will bring a difference for policy makers, for professionals, for researchers and for service users. One question to be asked is whether EBP actually leads to the radical social change it is designed to accomplish. The aim of the study is to describe and analyse the outcome of the effort to establish EBP, with a focus on the case of social work in Sweden. The research questions are: What is EBP? Why are efforts made to establish EBP? What is the outcome of the EBP project? How can the outcome of the EBP project be explained? The case study was conducted on a critical realistic meta-theoretical ground with a focus on explanation of social change with an explicit actor-structure perspective. Methodologically, a narrative synthesis of studies was made. As a complement primary data were collected to fill empirical gaps. The state of things was described before and after the EBP-initiatives. Several helping theories – Kuhn’s theory of paradigm, program theory, neo-institutional theory and theory of diffusion – were used to analyse the empirically mapped outcome of the EBP project. The results show that the import of the original model of Evidence-Based Medicine (EBM) to social work is a part of a wider social movement in the helping and educational professions. The new model has influenced social work as a discipline, as a field of practice and as a field of policy. There are examples of full-scale implementations of EBP, although EBP has not reached a general status as daily practice. Some obstacles remain. The gradual adaption of EBP corresponds to criteria hold by Kuhn for a paradigm shift. Acceptance of the model has contributed to change the structure and function of social systems. At an organizational level, this change means on-going institutionalization. The innovation is influencing the way institutional actors conduct their work. Although the structural conditions have been optimal, the EBP-model has been debated with heat. The EBP-debate and policy-driven infrastructural efforts have brought a more in-depth examination of the model. So-called coercive, normative, and regulative isomorphisms were used to change organizations. The degree of institutionalization depended on the individuals and the organizations willingness and preparedness to change, to understand, and to put the model into practice. When actors used a less strict version of the original EBP model, the pace of cultural and institutional change slowed down.