Psychological factors as predictors of compliance and outcome in non-operative management of Achilles tendon rupture: a systematic review.

Achilles tendon ruptures can often be managed without surgery using early functional rehabilitation, but this approach only works if patients actually stick with bracing, weight-bearing rules and physiotherapy. This review asked whether psychological factors like motivation, fear of movement, and social support help explain who complies and who recovers well, pulling together six studies covering 797 non-operative patients plus two trials used only for benchmarking functional outcomes. The review found that functional scores after non-operative treatment were broadly comparable to surgery, and that psychological struggles such as kinesiophobia, anxiety and depression were common during the first year of recovery, with motivation and social support emerging as helpful factors in qualitative accounts. The notable gap is that no study actually measured compliance as a formal outcome or linked it statistically to any psychological measure, so the proposed connection between psychology and compliance remains unverified rather than demonstrated.

If you've torn your Achilles tendon, you may have been offered non-surgical treatment with a brace and a structured rehab plan instead of surgery. Research shows this approach can produce recovery scores similar to surgery, but it depends heavily on sticking closely to the plan.

This review looked at whether things like motivation, fear of re-injury, and support from others affect how well people follow through and how they recover. The review, based on a small number of studies covering about 797 people, found that fear of movement, anxiety and low mood were common during the first year after injury, and that motivation and social support seemed to help people through recovery in their own accounts of the experience. However, none of the studies actually measured whether people followed their treatment plan and linked that directly to these psychological factors, so it's not yet established whether addressing these feelings would change how well someone sticks with treatment or their eventual outcome.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This review addresses whether psychological factors, such as motivation, self-efficacy, kinesiophobia and social support, help explain variation in compliance and outcome among patients managed non-operatively for acute Achilles tendon rupture, a question relevant given that functional rehabilitation outcomes (Achilles Tendon Total Rupture Score of 72-86 at 6-12 months, re-rupture rates of 5%-12%) depend on adherence to bracing and weight-bearing protocols. Synthesising six studies (797 non-operative patients, narrative synthesis using the SWiM framework), the review found that kinesiophobia, anxiety and depression were present throughout the first year of rehabilitation, with kinesiophobia above clinical thresholds in most participants of the single dedicated non-operative cohort, and that kinesiophobia and readiness-to-return scores did not clearly differ from operative cohorts.

Qualitative findings pointed to motivation and social support as facilitators, though these illuminate patient experience rather than demonstrate treatment effect. Critically, no included study measured compliance as a formal outcome or tested its association with psychological variables, so the central hypothesis linking psychological profile to adherence and re-rupture remains unvalidated. The authors call for future trials to incorporate validated kinesiophobia, motivation and readiness measures alongside guideline-based compliance definitions, and for a prospective cohort study before considering psychological screening in treatment-selection pathways.