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

Introduction: Non-operative management of acute Achilles tendon rupture (ATR) with early functional rehabilitation produces functional outcomes equivalent to surgery, but its effectiveness depends critically on patient compliance with bracing, weight-bearing and physiotherapy. Psychological factors, including motivation, self-efficacy, kinesiophobia, and social support, are plausible determinants of compliance and outcome, yet have received minimal systematic attention.

Sources of data: Seven databases were searched from inception to June 2026 without language restriction. Studies of adults with ATR managed non-operatively, with any psychological assessment reporting compliance, re-rupture rate, Achilles Tendon Total Rupture Score (ATRS) or return to sport, were eligible. Six studies met the inclusion criteria (797 non-operative patients in total), and two further non-operative randomized controlled trials were used for functional benchmarking only. Data were synthesized narratively (SWiM framework).