Changes

Update

Goals

To support primary healthcare professionals to:

• Make a diagnosis of Achilles tendinopathy.
• Manage people with Achilles tendinopathy in primary care.
• Refer people with Achilles tendinopathy to physiotherapy or an orthopaedics specialist, if needed.
• Recognize the potential complication of Achilles tendon rupture and arrange orthopaedics referral if suspected.

Outcome measures

Audit criteria

QOF indicators

QIPP - Options for local implementation

No QIPP indicators were found during the review of this topic.

NICE quality standards

No NICE quality standards were found during the review of this topic.

What is it?

• Achilles tendinopathy describes a painful overuse injury affecting the Achilles tendon [Chimenti, 2024].
  • The Achilles tendon is the thickest and strongest tendon in the human body, and it can be affected by degenerative and traumatic processes. It connects the gastrocnemius and soleus muscles to the calcaneus to allow ankle plantar flexion [Maffulli, 2019; Knapik, 2020]. It is the most commonly affected tendon in tendinopathy cases [Tarantino, 2023].
• The International Scientific Tendinopathy Symposium consensus statement recommends use of the term 'Achilles tendinopathy' for persistent Achilles tendon pain and loss of function related to mechanical loading, over terms such as 'tendinitis' or 'tendinosis' [Scott, 2020].
  
  • The term 'Achilles tendinitis' is no longer used as it suggests inflammation of the tendon tissue, which may not be a feature of the tendon injury [Ackermann, 2018a; Silbernagel, 2020]. The term 'tendinosis' refers to chronic degenerative tendon disease, causing localized or diffuse tendon thickening, which may occur before Achilles tendinopathy develops [Maffulli, 2019; Silbernagel, 2020].
• Achilles tendinopathy is largely categorized as non-insertional or insertional depending on the affected anatomical site. The mid-tendon and the insertion are morphologically, functionally, and physiologically different in the 'normal state' [Maffulli 2020]. Non-insertional Achilles tendinopathy may coexist with insertional Achilles tendinopathy [Maffulli, 2019].
  • Non-insertional (or mid-portion, or mid-substance) tendinopathy — affects an area of the Achilles tendon approximately 2–6 cm above its insertion on the calcaneus [Ackermann, 2018a]. This area may be vulnerable to damage because it has a relatively poor blood supply [Asplund, 2013]. Non-insertional tendinopathy is the most common site of Achilles tendinopathy, occurring in about 55–60% of cases [Maffulli, 2019].
  • Insertional tendinopathy — affects the insertion of the Achilles tendon on the calcaneum, occurring in about 20–25% of cases [Maffulli, 2019].
  • Proximal tendinopathy — occurs in a minority of about 15% of cases [Maffulli, 2019].

What causes it?

The exact cause of Achilles tendinopathy is not known, but it is thought that excessive, repetitive, and/or abnormal loading during physical activity disrupts tendon repair mechanisms and contributes to degenerative changes [Knapik, 2020] [Silbernagel, 2020] [Matsui, 2025].

• The pathophysiology of Achilles tendinopathy may be considered a continuum of changes affecting tenocytes, proteins, and collagen organization, with inflammation present in the early stages in some people [Knapik, 2020]. It is likely to involve a complex interplay of mechanical stress, vascular impairment, inflammatory responses, and extracellular matrix dysregulation involving remodelling and 'fibrocartilagenous adaptation' [Matsui, 2025].
• Expert opinion in a review article states that 'tendinopathy can be seen as a failure in the adaptation of the cell matrix to different stresses because of an imbalance between matrix degradation and synthesis'. Histological changes include intratendinous collagen fibre degeneration, with altered orientation and a reduction in fibre thickness [Tarantino, 2023]. Similarly, expert opinion in another review article states that Achilles tendinopathy is caused by a 'failed healing response with haphazard proliferation of tenocytes, abnormalities in tenocytes with disruption of collagen fibres, and subsequent increase in non-collagenous matrix' [Maffulli, 2020].

What are the risk factors?

The risk of developing Achilles tendinopathy is likely to be multifactorial and related to an interaction of intrinsic and extrinsic factors that lead to decreased tendon load tolerance, or movements that lead to tendon overloading [Maffulli, 2020] [Silbernagel, 2020] [Chimenti, 2024]. Risk factors include:

• Intrinsic factors
  • Biomechanical — such as leg length discrepancy, decreased plantar flexor strength, deficits in hip neuromuscular control, abnormal ankle dorsiflexion and limited mobility of the subtalar joint, pes cavus, forefoot varus, increased foot pronation, and increased body mass index (BMI) and obesity [Ackermann, 2018b; Maffulli, 2020; Silbernagel, 2020; Tarantino, 2023].
  • Systemic — such as diabetes mellitus, hypercholesterolaemia, hyperuricaemia, and inflammatory arthropathies such as rheumatoid arthritis and psoriatic arthropathy [Ackermann, 2018b; Maffulli, 2020; Tarantino, 2023].
  • Increasing age — increased risk of tendon degeneration and impaired healing as the tendon ages in insertional Achilles tendinopathy [Maffulli, 2019; Maffulli, 2020; Chimenti, 2024].
• Extrinsic factors
  • Athletes, running and jumping sports — increased interval training, abrupt changes in training schedule, excessive hill training, training on hard or sloping surfaces, increased training distances, increased repetitive loading, poor shock absorption [Maffulli, 2019; Ackermann, 2018b; Silbernagel, 2020; Chimenti, 2024].
  • Mechanical injury — for example, previous lower limb tendinopathy or fracture [Maffulli, 2019; Maffulli, 2020; Silbernagel, 2020; Malliaras, 2022; Tarantino, 2023].
  • Footwear — inappropriate footwear causing compressive forces on the Achilles tendon and calcaneus [Maffulli, 2019; Silbernagel, 2020; Chimenti, 2024].
  • Drugs — such as systemic corticosteroids, statins, aromatase inhibitors, and fluoroquinolone antibiotics may reduce collagen and matrix synthesis [Ackermann, 2018b; Silbernagel, 2020; Malliaras, 2022; Tarantino, 2023; MHRA, 2024].

How common is it?

The reported prevalence and incidence rate of Achilles tendinopathy vary in different studies.

• Expert opinion in a review article cites evidence that 6–10% of runners are affected by Achilles tendinopathy at any one time. It states the lifetime prevalence is 52% for middle- and long-distance runners, 36% for short-distance runners, 24% for athletes in general, and 6% for the general population [Malliaras, 2022].
• A large US database study (analysis of 20 million primary and secondary care records) of people aged 20–69 years found [Yasui, 2017]:
  • A total of 898 per 100,000 people were diagnosed with Achilles tendinopathy, and men and women were equally affected.
  • The peak age for incidence was in the 40–59 years age-group.
• An international systematic review and meta-analysis of 16 observational studies (n = 14,858 participants) assessing the prevalence of Achilles tendinopathy with different forms of exercise found [Wang, 2022]:
  • The overall pooled prevalence of Achilles tendinopathy was 6%, and the prevalence of Achilles tendon rupture was 3%.
  • The prevalence increased with age, with the highest prevalence seen in people aged over 45 years and in athletes.
  • There was no difference in prevalence rates between men and women in the population sample.
• A Dutch cross-sectional cohort study in primary care (n = 57,725 patients) found [de Jonge, 2011]:
  • The incidence rate of non-insertional Achilles tendinopathy was 1.85 per 1000 patients. In adults aged 21–60 years, the incidence rate was 2.35 per 1000 patients.
  • In 35% of cases, a relationship to sporting activity was recorded.
• Another Dutch cross-sectional study in a general practice population (n = 10,651 person-years) found an Achilles tendinopathy prevalence rate of 2.35 and an incidence rate of 2.16 per 1000 person-years [Albers, 2016].

What are the complications?

• Possible complications of Achilles tendinopathy include:
  • Reduced quality of life — a negative impact on the person’s quality of life and daily functioning, including work, exercise and sporting performance, and social activities [Silbernagel, 2020; Malliaras, 2022].
  • Psychosocial impact — including possible anxiety and depression, and fear of pain with movement [Silbernagel, 2020; Malliaras, 2022].
  • Partial tear or complete Achilles tendon rupture — may present with sudden severe pain in the calf, an audible snap, and difficulty with weight-bearing. Most cases are traumatic sports injuries occurring during sprinting or an explosive jumping activity [Asplund, 2013; Boyd, 2015; Malliaras, 2022; Chimenti, 2024]. If suspected, see the section on Management for more information on immediate management.
    • The majority of people with complete tendon rupture do not report previous Achilles symptoms [Boyd, 2015].
    • On examination, Achilles tendon rupture may lead to greater dorsiflexion of the injured ankle and foot compared with the uninjured limb. A defect in the tendon may be palpable within the first few hours after rupture, but is not always present due to localized swelling [Asplund, 2013; Boyd, 2015]. There may be bruising and swelling of the calf, but this is not always present. The ankle will typically remain in the neutral position when the calf is squeezed [Boyd, 2015].

What is the prognosis?

The prognosis of Achilles tendinopathy relates to the severity of injury and intrinsic factors that may affect tendon healing and recovery [Chimenti, 2024].

• The American Physical Therapy Association (APTA) clinical practice guidelines cite evidence that people with acute non-insertional Achilles tendinopathy for less than 3 months' duration had a similar level of improvement in symptoms, function, tendon structure, and psychological factors as people with chronic non-insertional Achilles tendinopathy of more than 3 months' duration. They note that most cases of Achilles tendinopathy are self-limiting and will improve over time, but the time to and extent of recovery varies between people [Chimenti, 2024].
• Expert opinion in a review article notes that full recovery from Achilles tendinopathy can take a year or longer, and re-injury is common, particularly if a person returns to sporting activities too soon. It cites evidence from different studies of high re-injury rates (27–44%) for Achilles tendinopathy in amateur and elite athletes [Silbernagel, 2020].
• Similarly, expert opinion in another review article cites evidence from studies that exercise interventions over 12 weeks can provide a clinically significant improvement in symptoms and function, and further improvements are likely between 12 and 52 weeks. It cites additional evidence from cohort studies that mild symptoms may persist among 60% and 25% of people with non-insertional Achilles tendinopathy at 5 and 10 years, respectively [Malliaras, 2022].
• A prospective, observational study of people with conservatively managed Achilles tendinopathy followed up for 8 years after initial assessment (n = 83) found [Paavola, 2000]:
  • 84% of people had completely returned to their normal activity level, and 94% were asymptomatic or had only mild pain with strenuous exercise.
  • 41% developed 'overuse symptoms' affecting the contralateral Achilles tendon.
  • 29% of people needed surgical intervention during the follow-up period.

When should I suspect Achilles tendinopathy?

Suspect a diagnosis of Achilles tendinopathy if there are suggestive clinical features, such as:

• Typical symptoms:
  • Gradual onset of localized pain and swelling of the posterior aspect of the heel in and around the Achilles tendon, associated with stiffness and reduced function. 
    • Symptoms are typically worse at night, at rest, or when restarting activity.
    • Symptoms are provoked by tendon-loading activities and movement such as walking, running, and jumping. 
    • There may be associated risk factors.
• Typical findings on examination:
  • Tenderness 2–6 cm proximal to the Achilles tendon insertion on palpation that decreases when the ankle is dorsiflexed, and possible localized thickening on palpation, suggests non-insertional Achilles tendinopathy.
  • Tenderness over the distal 2 cm of the Achilles tendon on palpation suggests insertional Achilles tendinopathy. There may also be redness, swelling, and nodularity at the tendon insertion.
  • There may be signs at both the insertion and mid-portion of the Achilles tendon in some people. 30% of people may have bilateral ankle involvement.

How should I assess suspected Achilles tendinopathy?

Achilles tendinopathy is usually a clinical diagnosis based on history and examination findings. If a diagnosis of Achilles tendinopathy is suspected:

• Ask about red flag symptoms suggesting a serious or alternative cause for symptoms, such as inflammatory arthropathy or Achilles tendon rupture, and manage appropriately. See the section on Management for more information on immediate management of Achilles tendon rupture.
• Ask about: 
  • Typical symptoms of gradual onset of localized pain and swelling of the posterior aspect of the heel in and around the Achilles tendon, associated with stiffness and reduced function.
    • Symptoms are typically worse at night, at rest, or when restarting activity after a period of rest.
    • Symptoms are provoked by tendon-loading activities and movement such as walking, running, and jumping. They may initially improve after a few minutes of activity, but may progress to affect all activity.
    • 30% of people may have bilateral ankle involvement.
  • Symptom severity and the impact on function, including walking, running, work, leisure and sporting activities, and psychological wellbeing.
  • The person's fitness level and any change or increase in training schedule (intensity, duration, and/or environment).
  • Any recent change in footwear.
  • Any associated risk factors, including comorbidities or medications such as fluoroquinolone antibiotics.
  • Any history of previous lower limb tendinopathy or fracture.
  • Any family history of tendinopathy.
  • Any previous or current treatments, including medication, physiotherapy, and/or surgery.
• Examine both legs exposed from above the knees, while the person is standing and prone, to assess for:
  • Any signs of Achilles tendon rupture, and manage appropriately. See the section on Management for more information.
  • Height, weight, and body mass index (BMI).
  • Gait and biomechanical abnormalities (such as leg deformity, leg length discrepancy, leg malalignment, pes cavus, asymmetry in tendon size, varus deformity of the forefoot, and limited mobility of the subtalar joint).
  • Signs of wear on footwear.
  • Palpate along the length of the Achilles tendon with the ankle in neutral position for typical signs of localized tenderness, swelling, heat, crepitus, thickening, and nodularity. Assess the range of movement (passive and active) of the ankle joint and strength testing to plantar flexion, dorsiflexion, eversion, and inversion, and subtalar mobility, for signs of restricted ankle dorsiflexion or muscle weakness of the gastrocnemius-soleus complex.
    • Tenderness 2–6 cm proximal to the Achilles tendon insertion on palpation, which moves with the tendon and which decreases or is reduced when the ankle is actively dorsiflexed, with possible localized thickening on palpation, suggests non-insertional Achilles tendinopathy.
    • Tenderness over the distal 2 cm of the Achilles tendon on palpation suggests insertional Achilles tendinopathy. There may also be redness, swelling, and nodularity at the tendon insertion.
    • There may be signs of both insertional and non-insertional Achilles tendinopathy, and 30% of people may have bilateral ankle involvement.
  • Assess function by asking the person to perform loading tests such as hopping, jumping, calf raise, and heel raise.
• Imaging with ultrasound or MRI is not routinely needed to diagnose Achilles tendinopathy in primary care. Consider arranging a heel X-ray and/or ultrasound scan if clinical features are atypical or there is a suspected alternative diagnosis, depending on clinical judgement.
  • X-ray may show intratendinous calcification and ossification. The presence of posterior calcification of the calcaneus ('posterior heel spur') is diagnostic of insertional Achilles tendinopathy.
  • Ultrasound scan can assess tendon length, thickness, and cross-sectional area, and identify signs of intratendinous calcification, bursitis, and bony deformity.
• Consider arranging additional investigations (such as blood lipid profile, HbA1c, or urate level) if an underlying cause is suspected, depending on clinical judgement.

Differential diagnosis

True tendon pain (from rupture or tendinopathy) is usually confined to the tendon itself. Other conditions which may cause pain in and around the Achilles tendon and posterior ankle include:

• Partial tears and Achilles tendon rupture — there is an increased risk if a person has asymptomatic rather than painful Achilles tendinopathy. It does not always result in a complication of Achilles tendinopathy. See the section on Complications for more information.
• Peritendonitis or paratenonitis of the Achilles tendon — due to inflammation of the connective tissue sheath surrounding the tendon, causing diffuse pain over the Achilles tendon or posterior heel region. On examination, the swelling and tenderness over the Achilles tendon do not move when the ankle is dorsiflexed. There may be crepitus with active movement. May co-exist with non-insertional Achilles tendinopathy.
• Retrocalcaneal bursitis — causes pain and erythema over the posterior heel region. There may be fluctuation on examination, suggesting an effusion of the retrocalcaneal bursa. May co-exist with insertional Achilles tendinopathy.
• Achilles tendon calcification — may cause heel pain and difficulty with weight-bearing, with areas of calcification seen within the Achilles tendon on X-ray.
• Osteomyelitis of the tibia and calcaneus — may cause systemic symptoms with heel pain and difficulty bearing weight.
• Neoplasms of the tibia and calcaneus — may cause fever, night pain, and difficulty with weight-bearing. See the CKS topic on Bone and soft tissue sarcoma - recognition and referral for more information on bone and soft tissue malignancy.
• Flexor hallucis longus tendinopathy — may cause pain on toe-off or forefoot weight-bearing, particularly around the posteromedial aspect of the calcaneus. On examination, there may be pain aggravated by resisted flexion of the great toe or stretch into full dorsiflexion of the hallux.
• Posterior tibialis tendinopathy — causes medial ankle pain behind the medial malleolus and extending towards the insertion of the tendon, with tenderness along the posterior tibialis tendon.
• Peroneal tendinopathy — causes lateral ankle or heel pain and swelling, which is aggravated by activity, with local tenderness over the peroneal tendons.
• Os trigonum syndrome — causes pain with mild swelling posterior to the ankle. Pain is worsened by resisted plantar flexion and dorsiflexion of the great toe.
• Retrocalcaneal exostosis — an intratendinous exostosis which may be associated with insertional tendinopathy.
• Tibial, talar, or calcaneal fracture.
• Haglund's deformity — a calcaneal prominence of the posterior or posterolateral aspect of the calcaneus. May co-exist with insertional Achilles tendinopathy.
• Posterior ankle impingement — causes pain in the posterior ankle, which increases with passive plantar flexion of the ankle.
• Sural nerve impingement or entrapment — may cause pain in the posterior distal leg. May co-exist with Achilles tendinopathy.
• Plantaris tendinopathy. May co-exist with Achilles tendinopathy.
• Dislocation of the peroneal or other plantar flexor tendons.
• Fascia cruris tears.
• Fat pad irritation.
• Lumbar radiculopathy. See the CKS topic on Sciatica (lumbar radiculopathy) for more information.
• Systemic inflammatory arthropathy — may present with sudden, severe bilateral symptoms with no significant change in activity levels, and/or no or limited response to exercise intervention. See the CKS topics on Rheumatoid arthritis and Spondyloarthritis and psoriatic arthropathy for more information.

Scenario: Management

From age 18 years onwards.

Search strategy

Scope of search

A literature search was conducted for guidelines and systematic reviews on primary care management of achilles tendinopathy.

Search dates

June 2020 - November 2025

Key search terms

The terms listed below are the core search terms that were used for EBSCOhost MEDLINE (searched 22nd June 2020). These were combined with filters to identify guidelines, systematic reviews and primary care relevant literature in EBSCOhost MEDLINE. The strategy was adapted for The Cochrane Library databases.

S6    S3 OR S4 OR S5 
S5    AB ( achille* N3 (tendinopath* or tendinitis or tendonitis or tendinosis or rupture* or injur* or tear*) ) OR TI ( achille* N3 (tendinopath* or tendinitis or tendonitis or tendinosis or rupture* or injur* or tear*) ) 
S4    (MH "Achilles Tendon/IN") 
S3    S1 AND S2 
S2    (MH "Tendinopathy+") 
S1    (MH "Achilles Tendon") 

Sources of guidelines

• National Institute for Health and Care Excellence (NICE)
• Scottish Intercollegiate Guidelines Network (SIGN)
• Royal College of Physicians
• Royal College of General Practitioners
• Royal College of Nursing
• NICE Evidence
• World Health Organization
• Guidelines International Network
• TRIP database
• Agency for Healthcare Research and Quality
• National Health and Medical Research Council (Australia)
• Royal Australian College of General Practitioners
• British Columbia Medical Association
• Canadian Medical Association
• Alberta Medical Association
• Michigan Quality Improvement Consortium
• Singapore Ministry of Health
• National Resource for Infection Control
• RefHELP NHS Lothian Referral Guidelines
• Medline (with guideline filter)
• Driver and Vehicle Licensing Agency
• NHS Health at Work (occupational health practice)

Sources of systematic reviews and meta-analyses

• The Cochrane Library:
  • Systematic reviews
  • Protocols
  • Database of Abstracts of Reviews of Effects
• Medline (with systematic review filter)
• EMBASE (with systematic review filter)

Sources of health technology assessments and economic appraisals

• NIHR Health Technology Assessment programme
• The Cochrane Library:
  • NHS Economic Evaluations
  • Health Technology Assessments
• Canadian Agency for Drugs and Technologies in Health
• International Network of Agencies for Health Technology Assessment

Sources of randomized controlled trials

• The Cochrane Library:
  • Central Register of Controlled Trials
• Medline (with randomized controlled trial filter)
• EMBASE (with randomized controlled trial filter)

Sources of evidence based reviews and evidence summaries

• Drug and Therapeutics Bulletin
• TRIP database
• Central Services Agency COMPASS Therapeutic Notes

Sources of national policy

• Department of Health
• Health Management Information Consortium (HMIC)

Patient experiences

• Healthtalk
• BMJ - Patient Journeys

Sources of medicines information

The following sources are used by CKS pharmacists and are not necessarily searched by CKS information specialists for all topics. Some of these resources are not freely available and require subscriptions to access content.

• British National Formulary (BNF)
• electronic Medicines Compendium (eMC)
• European Medicines Agency (EMEA)
• Medicines and Healthcare products Regulatory Agency (MHRA)
• REPROTOX
• Scottish Medicines Consortium
• Stockley's Drug Interactions
• TERIS
• TOXBASE
• Micromedex
• UK Medicines Information

Stakeholder engagement

Our policy

The external review process is an essential part of CKS topic development. Consultation with a wide range of stakeholders provides quality assurance of the topic in terms of:

• Clinical accuracy.
• Consistency with other providers of clinical knowledge for primary care.
• Accuracy of implementation of national guidance (in particular NICE guidelines).
• Usability.

Principles of the consultation process

• The process is inclusive and any individual may participate.
• To participate, an individual must declare whether they have any competing interests or not. If they do not declare whether or not they have competing interests, their comments will not be considered.
• Comments received after the deadline will be considered, but they may not be acted upon before the clinical topic is issued onto the website.
• Comments are accepted in any format that is convenient to the reviewer, although an electronic format is encouraged.
• External reviewers are not paid for commenting on the draft topics.
• Discussion with an individual or an organization about the CKS response to their comments is only undertaken in exceptional circumstances (at the discretion of the Clinical Editor or Editorial Steering Group).
• All reviewers are thanked and offered a letter acknowledging their contribution for the purposes of appraisal/revalidation.
• All reviewers are invited to be acknowledged on the website. All reviewers are given the opportunity to feedback about the external review process, enabling improvements to be made where appropriate.

Stakeholders

• Key stakeholders identified by the CKS team are invited to comment on draft CKS topics. Individuals and organizations can also register an interest to feedback on a specific topic, or topics in a particular clinical area, through the Getting involved section of the Clarity Informatics website.
• Stakeholders identified from the following groups are invited to review draft topics:
  • Experts in the topic area.
  • Professional organizations and societies (for example, Royal Colleges).
  • Patient organizations, Clarity has established close links with groups such as Age UK and the Alzheimer’s Society specifically for their input into new topic development, review of current topic content and advice on relevant areas of expert knowledge.
  • Guideline development groups where the topic is an implementation of a guideline.
  • The British National Formulary team.
  • The editorial team that develop MeReC Publications.
• Reviewers are provided with clear instructions about what to review, what comments are particularly helpful, how to submit comments, and declaring interests.

Patient engagement

Clarity Informatics has enlisted the support and involvement of patients and lay persons at all stages in the process of creating the content which include:

• Topic selection
• Scoping of topic
• Selection of clinical scenarios
• First draft internal review
• Second draft internal review
• External review
• Final draft and pre-publication

Our lay and patient involvement includes membership on the editorial steering group, contacting expert patient groups, organizations and individuals.

Evidence exclusion criteria

Our policy

Scoping a literature search, and reviewing the evidence for CKS is a methodical and systematic process that is carried out by the lead clinical author for each topic. Relevant evidence is gathered in order that the clinical author can make fully informed decisions and recommendations. It is important to note that some evidence may be excluded for a variety of reasons. These reasons may be applied across all CKS topics or may be specific to a given topic.

Studies identified during literature searches are reviewed to identify the most appropriate information to author a CKS topic, ensuring any recommendations are based on the best evidence. We use the principles of the GRADE and PICOT approaches to assess the quality of published research. We use the principles of AGREE II to assess the quality of published guidelines.

Standard exclusions for scoping literature:

• Animal studies
• Original research is not written in English

Possible exclusions for reviewed literature:

• Sample size too small or study underpowered
• Bias evident or promotional literature
• Population not relevant
• Intervention/treatment not relevant
• Outcomes not relevant
• Outcomes have no clear evidence of clinical effectiveness
• Setting not relevant
• Not relevant to UK
• Incorrect study type
• Review article
• Duplicate reference

Organizational, behavioural and financial barriers

Our policy

The CKS literature searches take into consideration the following concepts, which are discussed at the initial scoping of the topic.

• Feasibility
  • Studies are selected depending on whether the intervention under investigation is available in the NHS and can be practically and safely undertaken in primary care.
• Organizational and Financial Impact Analysis
• Studies are selected and evaluated on whether the intervention under investigations may have an impact on local clinical service provision or national impact on cost for the NHS. The principles of clinical budget impact analysis are adhered to, evaluated and recorded by the author. The following factors are considered when making this assessment and analysis.
  • Eligible population
  • Current interventions
  • Likely uptake of new intervention or recommendation
  • Cost of the current or new intervention mix
  • Impact on other costs
  • Condition-related costs
  • In-direct costs and service impacts
  • Time dependencies
• Cost-effectiveness or cost-benefit analysis studies are identified where available. 

We also evaluate and include evidence from NICE accredited sources which provide economic evaluations of recommendations, such as NICE guidelines. When a recommended action may not be possible because of resource constraints, this is explicitly indicated to healthcare professionals by the wording of the CKS recommendation.

Declarations of interest

Our policy

Clarity Informatics requests that all those involved in the writing and reviewing of topics, and those involved in the external review process to declare any competing interests. Signed copies are securely held by Clarity Informatics and are available on request with the permission of the individual. A copy of the declaration of interest form which participants are asked to complete annually is also available on request. A brief outline of the declarations of interest policy is described here and full details of the policy is available on the Clarity Informatics website. Declarations of interests of the authors are not routinely published, however competing interests of all those involved in the topic update or development are listed below. Competing interests include:

• Personal financial interests
• Personal family interest
• Personal non-financial interest
• Non-personal financial gain or benefit

Although particular attention is given to interests that could result in financial gains or losses for the individual, competing interests may also arise from academic competition or for political, personal, religious, and reputational reasons. An individual is not obliged to seek out knowledge of work done for, or on behalf of, the healthcare industry within the departments for which they are responsible if they would not normally expect to be informed.

Who should declare competing interests?

Any individual (or organization) involved in developing, reviewing, or commenting on clinical content, particularly the recommendations should declare competing interests. This includes the authoring team members, expert advisers, external reviewers of draft topics, individuals providing feedback on published topics, and Editorial Steering Group members. Declarations of interest are completed annually for authoring team and editorial steering group members, and are completed at the start of the topic update and development process for external stakeholders.

Competing interests declared for this topic:

None.