Physiotherapists' experiences of the management of anterior cruciate ligament injuries

Lived experiences of physical therapists treating traumatic knee injury using integrated psychological training (MOTIFS): a qualitative interview study

BACKGROUND

The novel Motor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS) training model, which began development in 2018, integrates psychological training into physical rehabilitation in knee-injured people.

OBJECTIVE

This qualitative interview study aims to understand, interpret, and describe how physical therapists perceive using the MOTIFS Model.

METHODS

One-on-one semi-structured interviews were conducted with six physical therapists familiar with the MOTIFS model and eight with experience with care-as-usual training only, analyzed using Interpretive Phenomenological Analysis.

RESULTS

Two major themes were generated in the MOTIFS group: 1) "MOTIFS increases psychological focus during rehabilitation training"; and 2) "Care-as-Usual training is mainly physical, and lacks the necessary psychological focus." Physical therapists perceived structured methods of addressing psychological factors, such as using imagery to influence patients' motivation, fear, and preparation for return to activity. Three major themes were generated in the Care-as-Usual group: 1) "Rehabilitation is mainly to restore physical function"; 2) "Rehabilitation training includes a biopsychosocial interaction"; and 3) "Psychological factors are important to address, but strategies are lacking."

CONCLUSION

Physical therapists perceive MOTIFS as a method of consciously shifting perspective toward an increased focus on psychological factors in knee-injury rehabilitation. Results indicate that a training model with integrated psychological strategies to create more holistic rehabilitation may be beneficial.

Working as a physiotherapist in a rapid response team: 'An emotional rollercoaster'

BACKGROUND AND INTRODUCTION

Rapid Response Teams (RRTs) are multidisciplinary, 'hospital at home' services which have developed over the last 10 years, aiming to improve recovery from illness more efficiently, prevent unnecessary hospital admission, and prevent early admission to residential care. However, little is known about the experience of professionals working in these roles.

PURPOSE

The aim of this study was to explore how working in an RRT is experienced and perceived by physiotherapists.

METHODS

This study used phenomenographically inspired methodology. Six participants who were working in RRTs were recruited to this study and all were working in the South of England. Data were collected via semi-structured interviews, and phenomenographic analysis was undertaken.

RESULTS

Participants working in RRTs described a range of varied, concrete lived-through experiences in addition to a more rhetorical discussion of how they conceptualized their work. Six main categories of description were generated from the analysis; each was assigned a metaphor. These included 'the detective,' 'the guru,' 'the lone ranger,' 'the team player,' 'the bricoleur,' and 'an emotional rollercoaster'; all categories were present with varied meanings. 'An emotional rollercoaster' was present within and throughout participants' descriptions of all other categories.

CONCLUSION

This study provides valuable insights into physiotherapists' experience and conceptualization of working within this discipline, which may have implications for physiotherapy practice, workforce development, new and current RR physiotherapy services, RRT health professionals, and physiotherapy education.

Beyond guidelines: A qualitative clinical stakeholder study of optimal management of anterior cruciate ligament rehabilitation

AIMS

This study gathered expert perspectives in the management of anterior cruciate ligament (ACL) rehabilitation to explore current practice, variations in care and optimal management strategies.

MATERIALS AND METHODS

This was a qualitative semi-structured interview study. The participants' experiences were considered in terms of their roles as employees, managers, clinicians and professional gatekeepers. Purposive and snowball sampling were used to recruit physiotherapists and orthopaedic surgeons. Participants were included if they had a proven record in clinical management or research involving ACL patients. Persons were excluded if they could not speak English. Interviews were conducted in person, via skype or over the phone at a time convenient to the participant. Data was analysed using a framework analysis and critical realist approach.

RESULTS

Results included 24 interviews that were conducted with 19 physiotherapists and 5 surgeons. Themes of variation in current care and optimal care were explored including subthemes of patient centred practice, evidence based medicine, resources, self-management, multidisciplinary teamwork, training and expertise were explored. Participant's perceptions of current care were that it was a location 'lottery' that significantly varied for patients across the UK.

CONCLUSIONS

Stakeholders identified that optimal management should be patient centred and incorporate adequate equipment, specific training for physiotherapists and a closely communicating multidisciplinary team. Research is needed to explore cost effective models of optimal rehabilitation that include return to sport strategies.

Is resistance training intensity adequately prescribed to meet the demands of returning to sport following anterior cruciate ligament repair? A systematic review

Objective

To identify, critique and synthesise the research findings that evaluate the use of resistance training (RT) programmes on return to sport outcome measures for people following ACL repair (ACLR).

Design and data sources

This systematic review included a comprehensive search of electronic databases (EBSCO health databases (CINAHL, MEDLINE, SPORTDiscus), Scopus and Pedro) performed in June 2020 and was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Studies were appraised using the Downs and Black checklist.

Eligibility criteria

Randomised and non-randomised controlled trials, longitudinal cohort studies and case series were considered for inclusion where an adequate description of the RT intervention was provided as a part of the study's ACLR rehabilitation protocol. Articles that did not include outcome measures related to return to sport criteria were excluded.

Results

Eleven articles met the inclusion criteria and were subjected to appraisal and data extraction. Study quality ranged from poor to excellent. RT intensity varied considerably among studies (between 5% and >80% of one repetition maximum). Only one identified study specifically investigated the effect of a low-intensity versus high-intensity RT protocol. The majority of studies reported participant outcomes that would not meet commonly used return to sport criteria.

Conclusion

There appears to be considerable variation in the intensity of RT prescribed in research for people following ACLR. Furthermore, in most of the identified studies, RT protocols promoted muscle endurance and hypertrophy without progressing to strength or power-based RT. The findings of this review provide insight into potential factors limiting returning to sport and contributing to reinjury for people following ACLR.

Chaos and confusion with confidence: Managing fear of Re-Injury after anterior cruciate ligament reconstruction

OBJECTIVES

To explore strategies enabling competitive athletes to manage re-injury fears or anxieties, facilitating return to competitive sport following anterior cruciate ligament reconstruction (ACLR).

DESIGN

Qualitative study.

SETTING

University.

PARTICIPANTS

Ten athletes with ACLR within the last 5 years who had returned to competitive sport with a minimum 7/10 Tegner Activity score.

METHODS

Semi-structured interviews, recorded, transcribed and analysed using interpretive description.

RESULTS

Three main themes. "Driving reasons to return to sport" included the athletic identity, the competitive team spirit and commitment; "Preparation of body and mind" encompassed connectedness with health professionals, coaches, the sports team and family, graded exposure and progression of physical tasks, and psychological or cognitive skills to improve mental toughness; "Risk Acceptance" entailed situational risk analysis, problem solving, and avoidance of unacceptable risk and acceptance of risk and responsibility.

CONCLUSION

Participants described intrinsic and extrinsic motivators as drivers for rehabilitation. Interactions with therapists, coaches and team members enhanced confidence, supported by both physical rehabilitation and psychological influences. Psychological strategies were essential for several participants to return to sport. Graded sports exposure, leading towards total immersion in training and competition, appears important to manage re-injury fear following ACLR.

"Not always a straight path": patients' perspectives following anterior cruciate ligament rupture and reconstruction

PURPOSE

To explore patients' perspectives following anterior cruciate ligament rupture and subsequent reconstructive surgery.

METHODS

A qualitative study design was employed, using validated questionnaires, interviews and general inductive methodology. Semi-structured interviews were conducted with five men and four women who had undergone an anterior cruciate ligament reconstruction in the past 6-36 months. Participants completed the Knee Osteoarthritis Outcome Score and the Tegner Activity Score. Descriptive statistics were used to analyze quantitative data. Interviews were recorded, transcribed and analyzed using the general inductive approach to develop key themes.

RESULTS

Participants had not returned to pre-injury knee-related activity levels (Tegner score: 7 pre-injury; 4 current). The theme of a disruptive "journey" emerged with two sub-themes of "loss of identity" and "life at the present," influenced positively and negatively by "support systems" and experience with the "care pathway." This unequivocally negative experience resulted in irrevocable changes to their lives, reflected by current lower knee-related quality of life.

CONCLUSIONS

Anterior cruciate ligament injury and rehabilitation thereof have a profound influence in the individual's identity. The results imply that a broader approach is needed within the rehabilitation process to address psychosocial factors, in addition to physical impairments and function. Implications for rehabilitation Anterior cruciate ligament rupture has a profound influence on patients' understanding of their individual identity. Support systems the patients have in place influence the patients' experience of the care pathway. Understanding psychosocial responses and implementing appropriate strategies and interventions for these may be critical for rehabilitation of these patients.