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Introduction
Medical research indicates that there is an increase in the incidence of Achilles tendon pain (Calder, Freeman, & Pollock, 2014). Traditionally, Achilles tendon pain was believed to be a common problem affecting athletes and especially jumping athletes (Rudavsky & Cook, 2014). However, according to the assertions of Sussmilch-Leitch, Collins, Bialocerkowski, Warden, and Crossley (2012) and Chimenti, Chimenti, Buckley, Houck, and Flemister (2016), the problem is now common in non-active individuals as well. In most of the cases, 55-65% of individuals suffering from Achilles tendon pain cite the middle part of the Achilles tendon while 20-25% feel pain in the insertion (Alfredson & Isaksson, 2014).
According to a study carried out by Alfredson and Isaksson (2014), insertional Achilles tendinopathy (or insertional Achilles tendon problem) is a characteristic of pain in the posterior heel as well as the tendon insertion. Increased activity of the affected individual aggravates the symptoms (Masci, Spang, Schie, & Alfredson, 2016). Even though Achilles tendon insertion problem is a difficult problem to treat, the introduction of ultrasound and color Doppler-guided technology is considered to have significant impact on effective diagnoses and treatment of patients suffering from insertional Achilles tendinopathy (Alfredson & Isaksson, 2014; Ettinger et al., 2015).
Ultrasound technique is useful in this case because it allows the examination of the Achilles tendon insertion, the bone as well as the bursa (Kang, Thordarson, & Charlton, 2012). Also, a Realtime Achilles Ultrasound Thompson (RAUT) Test is rather beneficial in providing the examination of patients (Griffin, Olson, Heckmann, & Charlton, 2016). For example, empirical research on the application of ultrasound alongside color Doppler has revealed that individuals with painful tendons experience a high flow of blood in the affected areas as opposed to pain free-individuals (Plas et al., 2012).
Patients suffering from insertional tendon pain are manageable without operation (Stasinopoulos & Manias, 2013). Primarily, extracorporeal shockwave therapy (Gerdesmeyer et al., 2015; Maffulli, Furia, & Rompe, 2012) or even enough rest and modification of eccentric calf muscle exercises can be used as basic treatment (Mccormack, Underwood, Slaven, & Cappaert, 2016; Notarnicola et al., 2013; Ooi, Schneider, Malliaras, Chadwick, & Connell, 2015; Pearce, Carmichael, & Calder, 2012). However, in a case of failure in conservative treatment, various surgical techniques like upper calcaneus’ resection and retrocalcaneal bursa’s extirpation can be adopted (Sánchez-Ibáñez et al., 2013; Oshri et al., 2012).
In spite of this, most methods take the consideration of tendon invasive processes which necessitate long periods of postoperative rehabilitation (Sànchez-Ibàñez & Fernàndez, 2015; Tallerico, Greenhagen, & Lowery, 2014; Waldecker, Hofmann, & Drewitz, 2012). In addition, several researchers have pointed out that no consensus has been reached as far as effective methods of treating insertional Achilles tendinopathy are concerned (Plas et al., 2012; Santomi & Harold, 2012; Wiegerinck, Kerkhoffs, Sterkenburg, Sierevelt, & Dijk, 2012). Therefore, evaluation of the diagnoses and treatment of patients suffering from insertional Achilles tendinopathy is a subject worth investigating. This qualitative study examines the efficiency of ultrasound and color Doppler-guided technology in diagnosis and treatment of patients suffering from insertional Achilles tendinopathy.
Methodology and Research Design
Introduction
Creswell (2014) defined study design as the systematic process that involves an effective plan of proposed actions to be used for the purpose of collecting and logically analyzing data in order to understand a given study phenomenon. Thus, research methodology is considered to be any procedures and principles adopted to promote the collection and analysis of data on the given study phenomenon (Abbott & McKinney, 2013; Chesnay, 2015). This section covers the research design, the study of population, and techniques used in sampling as well as methods of collecting and analyzing data on the use of ultrasound and color Doppler-guided technology in diagnoses and treatment of patients suffering from insertional Achilles tendinopathy.
Research design
As it was stated above, insertional Achilles tendinopathy is a difficult problem to diagnose as well as treat. For this reason, the study on ultrasound and color Doppler-guided technology in diagnosis and treatment of patients suffering from insertional Achilles tendinopathy requires effective research design that would ensure collection and analysis of valid and reliable data. This research will use qualitative data on insertional Achilles tendinopathy. Therefore, for comprehensive analysis of the research topic, the study will adopt two study designs which include the cross-sectional case study design and the descriptive study design.
Both descriptive and case study designs are preferable in this study. This is attributed to the fact that there is a need to provide tangible effects and impacts of ultrasound and color Doppler as effective methods of diagnosis and treatment of tendon Achilles pain in patients. On the other hand, the case study design allows effective examination of study variables (LoBiondo-Wood & Haber, 2014). In this research, the case study approach is applicable due to the fact that various patients suffering from tendon Achilles problem will be used as a basis for gauging the effectiveness of the method of ultrasound and color Doppler in diagnosis and treatment of patients suffering from insertional Achilles tendinopathy.
On the other hand, the cross-sectional study design’s use in this study is primarily for complementary purposes given that descriptive research design is affected by the problem of overlying on instrumentation of measurements as well as observation (Chesnay, 2015; Creswell, 2014). As such, the design will not only give the snapshots on the possible success rate of ultrasound and color Doppler method but also will help to examine the conditions of patients under examination for the purpose of ascertaining the efficacy of this method.
Target Population
The population targeted in a study can be defined as the entire people or units for whom a researcher focuses on collecting data for the purpose of drawing meaningful inferences about the given research design (Chesnay, 2015). There are numerous people suffering from insertional Achilles tendinopathy in the US and a high percentage of reported cases related to both athletes and non-athletes. The identification of the targeted individuals will be based on the sampled patients. The research will focus on patients who have a long history of insertional Achilles tendon problem.
Sampling Design and Criteria
A sample is described as a percentage section of the entire population targeted in a study (LoBiondo-Wood & Haber, 2014). As such, a sample of a study ought to be highly representative in the context of the entire population (Creswell, 2014; LoBiondo-Wood & Haber, 2014). For this reason, suitable sampling technique ought to be applied for the purpose of ensuring that the selected sample is representative of the target population.
The sampling frame used for this study will focus on both active and non-active patients with a history of insertional Achilles tendinopathy. Such individuals are the beneficiaries of any technology adopted for effective diagnosis and treatment of insertional Achilles tendinopathy. In spite of this, the sampling criteria in this study will focus on patients who have a long history of insertional Achilles tendinopathy. As such, patients with history of insertional Achilles tendinopathy of less than a year will be excluded. According to Johnson (2015), if a sample frame is taken correctly it will lead to a sample that can be used for the population as a whole. In other words, the results of the study would be sufficient and credible enough to be generalized for the broader understanding of the issue.
Sampling Technique
This study will use the simple random sampling technique for the purpose of identifying the number of patients to be included in the sample. The rationale for the choice of the simple random sampling technique is based on the fact that such an approach is suitable in ensuring inclusivity of the study sample (Chesnay, 2015). Additionally, Johnson (2015) pointed out that the use of the random sampling technique is appropriate due to the fact that it gives study units and people equal chance of being included in the study sample. Furthermore, the author claimed that the simple random sampling technique is effective in that it is free from human bias and has the capability to avoid error classification (Johnson, 2015). For this reason, the adoption of simple random sampling technique in this study will ensure an all-inclusive sample size.
The sample frame chosen comprises numerous individuals suffering from insertional Achilles tendinopathy. However, the use of the simple random sampling technique is expected to provide comprehensive data that can be relied for drawing inferences (LoBiondo-Wood & Haber, 2014).
Sample Size
Various factors affect the process of determining the size of sample used in any study including the replication number which determines the extent of data needed for comprehensive conclusion on the given study phenomenon (Creswell, 2014). As for this study, the sample size depends on the type of data required as well as precision of collected data (Abbott & McKinney, 2013; Yin, 2013). This study upon the use of the simple random sampling technique will use a sample size of 24 patients with long term history of insertional Achilles tendinopathy.
Data Collection and Analysis
Given that the research focuses on examination of the possibility of using the ultrasound and color Doppler technology in the diagnosis and treatment of insertional Achilles tendinopathy, qualitative approach will be used. For this reason, effective methods of collecting qualitative data are applicable in this study. The study cross-sectional case study approach will be used to analyze the level of pain for all patients sampled within the insertional Achilles tendon period.
In addition, structured questionnaire will be used to collect data for the purpose of quantifying the quality of life of the patients suffering from insertional Achilles tendinopathy based on a mental and a physiological perspectives. The data collected from this study will be recorded and stored for analysis (Maxwell, 2013). For example, the data on the quality of life will be expressed through a scale for the purpose of determining the level of quality of life based on the patients’ responses. All collected data will be analyzed using advanced spreadsheets and other statistical methods of analysis such as correlation and regression analysis for the purpose of providing more details on the study phenomenon.
References
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