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Tondelli E, Feroldi A, García F, Meza F, Dingenen B. Rehabilitation and return-to-sport after anterior cruciate ligament injury and reconstruction: Exploring physical therapists' approaches in Argentina. Phys Ther Sport 2024; 67:131-140. [PMID: 38703448 DOI: 10.1016/j.ptsp.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/18/2024] [Accepted: 04/18/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES To investigate the current clinical practice regarding pre- and post-surgical rehabilitation and return to sport (RTS) criteria following anterior cruciate ligament reconstruction (ACLR). DESIGN Cross-sectional design. Online survey. SETTING Survey platform. PARTICIPANTS Argentinian physical therapists (PTs). OUTCOME MEASURES The survey consisted of a combination of 39 open- and closed-ended questions, divided across 3 sections: (1) demographic and professional information, (2) clinical practice and rehabilitation strategies, and (3) return-to-running (RTR) and RTS. RESULTS A total of 619 PTs completed the survey. Considerable variability was observed in preoperative rehabilitation, criteria used for rehabilitation progression and RTS decision-making criteria used by PTs. From the total surveyed, 336 (54.3%) carried out RTS assessment in their clinical practice. Most of PTs (53.3%) use visual estimation to assess knee range of motion. Only 20% of the PTs reported incorporating patient-reported outcome measures in their decision-making. From PTs who use strength assessment as a criterion of RTS (68.8%), 16.6% extrapolate this from jump tests and 15.3% use manual muscle testing. Less than the 50% of the PTs recommended nine months or more to allow patients to RTS. CONCLUSIONS Current rehabilitation practices of Argentinian PTs following ACLR are largely variable and not aligned with current evidence and scientific guidelines. To achieve better rehabilitation and RTS practices better knowledge dissemination and implementation are required.
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Affiliation(s)
- Eduardo Tondelli
- Sport Physiotherapy, Faculty of Medical Sciences, Pontifical Catholic University of Argentina, Buenos Aires, Argentina; Sport Physiotherapy (CPC), School of Physiotherapy, Faculty of Medical Sciences, University of Buenos Aires, Buenos Aires, Argentina.
| | - Alejo Feroldi
- Sport Physiotherapy (CPC), School of Physiotherapy, Faculty of Medical Sciences, University of Buenos Aires, Buenos Aires, Argentina; Functional Anatomy and Biomechanics, Faculty of Medical Sciences, Favaloro University, Buenos Aires, Argentina
| | - Felipe García
- Sport Physiotherapy (CPC), School of Physiotherapy, Faculty of Medical Sciences, University of Buenos Aires, Buenos Aires, Argentina; New Performance Argentina Athletic Center, Buenos Aires, Argentina
| | - Franco Meza
- Sport Physiotherapy (CPC), School of Physiotherapy, Faculty of Medical Sciences, University of Buenos Aires, Buenos Aires, Argentina; Physical Therapy and Medical Department, Club Atlético Huracán, Buenos Aires, Argentina
| | - Bart Dingenen
- Reval Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
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Sayer TA, van Melick N, Riera J, Jackson J, Bryant A, Bogie R, Cross N, Edouard P, Rambaud A. Is it time to develop specific return to running criteria for ACL rehabilitation? An international survey of physiotherapists criteria for return to running following ACL injury. Phys Ther Sport 2024; 67:19-24. [PMID: 38457997 DOI: 10.1016/j.ptsp.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE To determine return to running criteria currently used by physiotherapists following anterior cruciate ligament (ACL) injury. DESIGN Self-reported online international survey. METHODS An online survey of physiotherapists across Australia, the Netherlands and France. RESULTS A total of 476 respondants participated in the survey across Australia (n = 153), the Netherlands (n = 162), and France (n = 161). For return to running criteria following a non-operative approach, the majority of respondents chose swelling (40.55%, n = 193/476), pain (38.24%, n = 182/476), knee extensor strength (34.34%, n = 163/476), single leg squat (31.93%, n = 152/476) and knee flexor strength (29.83%, n = 142/476). After ACL reconstruction, the highest responses were also swelling (41.18%, n = 196/476), pain (37.18%, n = 177/476), knee extensor strength (37.18%, n = 177/476) and single leg squat (33.19%, n = 158/476). From the identified themes the most common cutoff variables were pain between 0 and 3/10, swelling < grade 1+ and limb symmetry on strength and hop tests >70 %. CONCLUSION Physiotherapists in Australia, France, and the Netherlands use many different return to running criteria and most of them use more than one criterion. Despite this, there was little consensus on the cut-off physiotherapists use to apply these criteria.
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Affiliation(s)
- Timothy A Sayer
- Melbourne CBD Physiotherapy and Sports Medicine Clinic, Melbourne, Victoria, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Nicky van Melick
- Sports & Orthopedics Research Center, Anna Hospital, Geldrop, the Netherlands
| | - Jerome Riera
- Centre Hopitalier Universitaire de Saint Etienne, Saint Etienne, France
| | - Jeremy Jackson
- Melbourne CBD Physiotherapy and Sports Medicine Clinic, Melbourne, Victoria, Australia
| | - Adam Bryant
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rob Bogie
- Sports & Orthopedics Research Center, Anna Hospital, Geldrop, the Netherlands
| | - Nicholas Cross
- Melbourne CBD Physiotherapy and Sports Medicine Clinic, Melbourne, Victoria, Australia
| | - Pascal Edouard
- Centre Hopitalier Universitaire de Saint Etienne, Saint Etienne, France
| | - Alexandre Rambaud
- Centre Hopitalier Universitaire de Saint Etienne, Saint Etienne, France
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Alshehri YS, Aljohani MMA, Alzahrani H, Alzhrani M, Alkhathami KM, Alshahrani A, Khaled OA. Current Rehabilitation Practices and Return to Sports Criteria After Anterior Cruciate Ligament Reconstruction: A Survey of Physical Therapists in Saudi Arabia. J Sport Rehabil 2024; 33:114-120. [PMID: 38109883 DOI: 10.1123/jsr.2023-0260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/16/2023] [Accepted: 11/11/2023] [Indexed: 12/20/2023]
Abstract
CONTEXT With the high prevalence of anterior cruciate ligament rupture among young and active individuals, rehabilitation after the injury and surgery should meet the current evidence-based recommendations to restore knee function and reduce the risk of further injury. This study aimed to investigate the current rehabilitation practices and return to sports (RTS) criteria after anterior cruciate ligament reconstruction (ACLR) among physical therapists in Saudi Arabia. DESIGN Online cross-sectional survey-based study. METHODS A total of 177 physical therapists in Saudi Arabia participated in this survey. The survey included questions about the preferred postoperative timing and frequency of rehabilitation, current views on the importance of preoperative and postoperative rehabilitation to the overall outcomes, the timeframe of RTS, and the decision-making process to RTS. RESULTS Most therapists (96.6%) believed preoperative rehabilitation was essential/important to postoperative outcomes. Two-thirds encouraged patients to start rehabilitation program within 1 to 4 days immediately post-ACLR. RTS was permitted 6 to 9 months post-ACLR by 60% of therapists if satisfied with patient progress and capacity. Factors considered before RTS included knee strength (72.9%), functional capacity (86.4%), lower limb and trunk mechanics (62.7%), and psychological readiness (42.2%). Knee strength was assessed by manual muscle testing (39%), handheld dynamometry (15.3%), and isokinetic dynamometer (13.6%). While 60% of the therapists used single-limbed hop for distance for evaluating functional capacity, only 27.1% used a hop test battery. CONCLUSIONS The surveyed physical therapists in Saudi Arabia demonstrated variations in the current rehabilitation practices and RTS criteria post-ACLR. Over half of the surveyed therapists considered preoperative rehabilitation essential to postoperative outcomes. However, the therapists should update their perspective with current evidence-based practice regarding the RTS timeframe, psychological readiness assessment for RTS, and knee strength evaluation using objective measurements.
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Affiliation(s)
- Yasir S Alshehri
- Department of Physical Therapy, College of Medical Rehabilitation Sciences, Taibah University, Madinah, Saudi Arabia
| | - Marwan M A Aljohani
- Department of Physical Therapy, College of Medical Rehabilitation Sciences, Taibah University, Madinah, Saudi Arabia
| | - Hosam Alzahrani
- Department of Physical Therapy, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Msaad Alzhrani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia
| | - Khalid M Alkhathami
- Department of Health Rehabilitation, Shaqra University, Shaqra, Saudi Arabia
| | - Adel Alshahrani
- Department of Medical Rehabilitation Sciences-Physiotherapy Program, College of Applied Medical Sciences, Najran University, Najran, Saudi Arabia
| | - Osama A Khaled
- Department of Physical Therapy, College of Medical Rehabilitation Sciences, Taibah University, Madinah, Saudi Arabia
- Basic Science Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Pulver M, Hilfiker R, Bizzini M, Mathieu N, Meyer S, Allet L. Clinical practice and barriers among Swiss physiotherapists treating patients with anterior cruciate ligament reconstruction: A survey of pre-operative rehabilitation to return to sport. Phys Ther Sport 2024; 65:38-48. [PMID: 38006798 DOI: 10.1016/j.ptsp.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/27/2023]
Abstract
OBJECTIVES To investigate current clinical practice of Swiss physiotherapists treating patients with anterior cruciate ligament reconstruction (ACLR) from pre-operative rehabilitation until return to sport (RTS). We assessed optimisation strategies in daily practice and the perceived barriers to these optimisations, and evaluated whether there was a relevant difference in clinical practice for physiotherapists with post-graduate certification in sports physiotherapy or deep clinical experience and those without such experience. DESIGN Cross-sectional survey. SETTING Online survey platform. PARTICIPANTS Swiss physiotherapists. MAIN OUTCOME MEASURES The survey comprised six sections: participant information, pre-operative rehabilitation, post-operative rehabilitation, RTS, re-injury prevention, and optimisation strategies and barriers. RESULTS A minority of physiotherapists treated ACLR patients pre-operatively. Overall, 91% included quadriceps open kinetic chain exercise in their treatment, 37% used patient-reported outcomes measures (PROMs) and 39% considered psychological criteria when making decisions about RTS. Most physiotherapists (67%) felt limited due to the time available, the number of prescriptions and the tariffication system. CONCLUSION This study highlights areas within ACLR rehabilitation practice in Switzerland that could be improve. Improvements in understanding of the barriers to implementation of best evidence in practice and a redefinition of the clinical process around ACLR rehabilitation in Switzerland are necessary.
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Affiliation(s)
- Mathieu Pulver
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland; School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, HES-SO Valais-Wallis, Sion, Switzerland.
| | | | - Mario Bizzini
- Schulthess Clinic Human Performance Lab, Zurich, Switzerland
| | - Nicolas Mathieu
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, HES-SO Valais-Wallis, Leukerbad, Switzerland
| | - Stephan Meyer
- Sport Physiotherapy, Swiss Federal Institute of Sport Magglingen SFISM, Magglingen, Switzerland
| | - Lara Allet
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, HES-SO Valais-Wallis, Sion, Switzerland; The Sense, Innovation & Research Center, Sion, Switzerland; Department of Medicine, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
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Buckthorpe M, Gokeler A, Herrington L, Hughes M, Grassi A, Wadey R, Patterson S, Compagnin A, La Rosa G, Della Villa F. Optimising the Early-Stage Rehabilitation Process Post-ACL Reconstruction. Sports Med 2024; 54:49-72. [PMID: 37787846 DOI: 10.1007/s40279-023-01934-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/04/2023]
Abstract
Outcomes following anterior cruciate ligament reconstruction (ACLR) need improving, with poor return-to-sport rates and a high risk of secondary re-injury. There is a need to improve rehabilitation strategies post-ACLR, if we can support enhanced patient outcomes. This paper discusses how to optimise the early-stage rehabilitation process post-ACLR. Early-stage rehabilitation is the vital foundation on which successful rehabilitation post-ACLR can occur. Without high-quality early-stage (and pre-operative) rehabilitation, patients often do not overcome major aspects of dysfunction, which limits knee function and the ability to transition through subsequent stages of rehabilitation optimally. We highlight six main dimensions during the early stage: (1) pain and swelling; (2) knee joint range of motion; (3) arthrogenic muscle inhibition and muscle strength; (4) movement quality/neuromuscular control during activities of daily living (5) psycho-social-cultural and environmental factors and (6) physical fitness preservation. The six do not share equal importance and the extent of time commitment devoted to each will depend on the individual patient. The paper provides recommendations on how to implement these into practice, discussing training planning and programming, and suggests specific screening to monitor work and when the athlete can progress to the next stage (e.g. mid-stage rehabilitation entry criteria).
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Affiliation(s)
- Matthew Buckthorpe
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK.
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy.
| | - Alli Gokeler
- Exercise Science and Neuroscience, Department Exercise & Health, Faculty of Science, Paderborn University, Paderborn, Germany
| | - Lee Herrington
- Centre for Human Sciences Research, University of Salford, Salford, UK
| | - Mick Hughes
- North Queensland Physiotherapy Centre, Townsville, QLD, Australia
| | - Alberto Grassi
- II Clinica Ortopedica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ross Wadey
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK
| | - Stephen Patterson
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK
| | - Alessandro Compagnin
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Giovanni La Rosa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Francesco Della Villa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
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Greig M, Langley B. Exploring the issue of 'functionality' in isokinetic dynamometry. Res Sports Med 2023:1-6. [PMID: 37727119 DOI: 10.1080/15438627.2023.2260521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/12/2023] [Indexed: 09/21/2023]
Abstract
Strength is a primary and modifiable contributor to performance, injury risk, and rehabilitative success. The gold standard measure of strength is the isokinetic dynamometer, providing the clinician with the opportunity to manipulate contraction modality, range, and speed about a joint. However, criticism has highlighted a lack of functional relevance, with arbitrary selection of speed across the full range. To better understand function, biomechanical analysis of movement can inform a bespoke isokinetic data collection protocol. In this case, we use walking gait, a function goal for daily living and clinically assessed following knee replacement surgery for example. Concentric knee flexor and extensor demand was evident at an average angular velocity of 70°·s-1, whilst eccentric knee flexor and extensor demands were evident at speeds of 192°·s-1 and 165°·s-1, respectively. The efficacy of isokinetic dynamometry can be enhanced with bespoke data collection protocols, which better reflect the functional demands of the clinical movement objective.
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Affiliation(s)
- Matt Greig
- Clinical Biomechanics Research Group, Edge Hill University, Ormskirk, UK
| | - Ben Langley
- Clinical Biomechanics Research Group, Edge Hill University, Ormskirk, UK
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Nicholls M, Ingvarsson T, Filbay S, Lohmander S, Briem K. Smoking and secondary ACL rupture are detrimental to knee health post ACL injury-a Bayesian analysis. J Exp Orthop 2023; 10:79. [PMID: 37556084 PMCID: PMC10412518 DOI: 10.1186/s40634-023-00638-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/17/2023] [Indexed: 08/10/2023] Open
Abstract
PURPOSE To identify potential prognostic factors for patient-reported outcomes in an Icelandic cohort of ACL injured subjects. METHODS All knee MRI reports written in Iceland between the years 2001 to 2011 were read to identify individuals with a possible ACL injury. These individuals were contacted and asked to complete an online questionnaire regarding their injury and current knee related health. The questionnaire collected information on years since surgery, injury circumstance, brace use, physiotherapy, ACL surgery, second ACL injury and current smoking status. In addition, the baseline status of their meniscii were assessed from the original MRI report and medical records were used to identify any subsequent, non-ACL surgery. The patient-reported Knee Osteoarthritis and Injury Outcome Score (KOOS) was used assess current knee related health. A Bayesian proportional odds model was used to assess the effect of all potential prognostic factors above as well as age and sex on KOOS outcomes. RESULTS A total of 408 subjects completed the questionnaire indicating that they did rupture their ACL. The following variables were associated with worse outcomes across all KOOS subscales: having a subsequent arthroscopy, reinjury to your ACL, and smoking. Having physiotherapy for 9 months was associated with worse KOOS pain scores than having 6 months of physiotherapy. Conversely KOOS pain score tended to be higher if you injured your knee during sports. CONCLUSION Reinjuring your ACL, smoking and having subsequent (non-ACLR) surgery predict your knee related health following an ACL injury. Strategies should be implemented to reduce the risk of secondary ACL injury, and patients should be strongly advised not to smoke.
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Affiliation(s)
- Micah Nicholls
- Faculty of Medicine, Research Centre for Movement Sciences, The University of Iceland, Sæmundargata 2, Reykjavík, 102, Iceland.
| | | | - Stephanie Filbay
- Department of Physiotherapy, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Stefan Lohmander
- Department of Clinical Sciences Lund, Orthopaedics, Lunds Universitet, Lund, Sweden
| | - Kristin Briem
- Faculty of Medicine, Research Centre for Movement Sciences, The University of Iceland, Sæmundargata 2, Reykjavík, 102, Iceland
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Dunphy E, Button K, Murray E, Hamilton FL. Beyond guidelines: A qualitative clinical stakeholder study of optimal management of anterior cruciate ligament rehabilitation. Musculoskeletal Care 2023; 21:117-129. [PMID: 35852464 DOI: 10.1002/msc.1673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Emma Dunphy
- Research Department of Primary Care and Population Health, eHealth Unit, London, UK
| | | | - Elizabeth Murray
- Research Department of Primary Care and Population Health, eHealth Unit, London, UK
| | - Fiona L Hamilton
- Research Department of Primary Care and Population Health, eHealth Unit, London, UK
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