Research Project

Do working alliance, patient outcome expectations and self-efficacy predict changes in pain and disability from treatment for Achilles tendinopathy?

Principal Investigator
Dr Adrian Mallows
Two feet wearing red and purple trainers. The person is walking away from the camera along a dirt path.

The Achilles tendon connects the heel with the calf muscles. Although some people are more at risk than others, developing a painful Achilles tendon (known as Achilles tendinopathy) can affect anyone. When it becomes painful, it can be difficult to walk, run and work.

Exercise supported by a physiotherapist is a common treatment. But, how much and how quickly treatment changes a patient’s pain and disability varies significantly.

Previously, it was suggested that exercise worked by changing the strength or structure of the tendon. However, it has been shown that changes in pain and disability do not correspond well with change in strength or structure. This suggests that there may be other factors which could be important predictors of treatment success.

This project aims to understand those factors which may predict success, so we can improve patient care.

We have previously completed research to identify factors that might help predict success with treatment from a physiotherapist. These are:

  • the working relationship or ‘alliance’ between the physiotherapist and the patient
  • the patients’ expectations of treatment
  • the patient’s confidence to carry out exercises set by their physiotherapist.

This project builds on this earlier research to further investigate these three potential factors.

We have designed a multi-centre, longitudinal cohort study to assess whether working alliance, patient expectations of treatment success, and confidence to perform exercise (self-efficacy) predict changes in pain and disability from a treatment programme prescribed by a physiotherapist for Achilles tendinopathy at twelve weeks.

Patients, diagnosed with Achilles tendinopathy by their treating physiotherapist, will be referred to our study. They will complete questionnaires on three occasions; baseline, six weeks later and twelve weeks after baseline.

Once we understand whether these factors predict changes in pain and disability from treatment with a physiotherapist, treatment can be adapted to directly benefit patients by improving treatment success.


This project was funded by the Physiotherapy Research Foundation, part of the Chartered Society of Physiotherapy.