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Bodkin SG. Time to Reflect on Return to Sport Timing Following ACL Reconstruction. Sports Med 2024; 54:1749-1754. [PMID: 38554249 DOI: 10.1007/s40279-024-02017-0] [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: 03/08/2024] [Indexed: 04/01/2024]
Abstract
The time of return to sport following anterior cruciate ligament (ACL) reconstruction is a commonly discussed topic within clinical settings and the sports medicine literature. Emerging science has demonstrated protective effects of delaying the time of sport clearance on athlete reinjury. Though a single time cutoff is unlikely to be applicable for all athletes, large inconsistencies in the time of return to sport clearance are present in both the literature and within prescribed clinical protocols. A multitude of patient factors, such as perceived function, objective function, confidence, post-operative goals, among others, are vital for how athletes are progressed and released for sport participation. This Current Opinion article is constructed to discuss the time to return to sport after ACL reconstruction-factors that may influence timing decisions, how time is assessed within the scientific literature-and to promote discussion on this common topic within the sports medicine and athletic communities. The aim of the article is not to establish defined clinical time cutoffs for this population.
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Affiliation(s)
- Stephan G Bodkin
- Department of Physical Therapy and Athletic Training, University of Utah, 290 S 1850 E, HPER-W 113, Salt Lake City, UT, 84115, USA.
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2
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Manoharan A, Fithian A, Xie V, Hartman K, Schairer W, Khan N. Return to Sports After Anterior Cruciate Ligament Reconstruction. Perm J 2024; 28:102-108. [PMID: 38659351 PMCID: PMC11232915 DOI: 10.7812/tpp/23.132] [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] [Indexed: 04/26/2024]
Abstract
Anterior cruciate ligament (ACL) tears are one of the most common orthopedic injuries among athletes. Although a small proportion of patients with isolated tears can return to sports after completing a nonsurgical rehabilitation program, ACL reconstruction is frequently recommended for young athletes, especially those with concomitant knee injuries or symptomatic knee instability. Alongside emerging evidence for the effect of prehabilitation, the current standard of care for postoperative ACL physical therapy includes pain control, range of motion, quadriceps strengthening, weight bearing, postoperative bracing, and dynamic limb stabilization and control. The early rehabilitation period includes non-weight-bearing exercises and passive range of motion, which is followed by a longer period of gradual strengthening focused on regaining preinjury strength, proprioception, and control with progressively more demanding dynamic movements. The total rehabilitation period is expected to take around 9 months, during which the patient should be evaluated at frequent intervals by a licensed physical therapist in addition to a daily home exercise program. Prior to discharge from the rehabilitation program, patients should be evaluated by both the surgeon and physical therapist. Patients are encouraged to return to sports once they meet a set of perceptual, subjective, objective, neuromuscular, functional, sport-specific drills, and load management testing criteria.
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Affiliation(s)
- Aditya Manoharan
- Department of Orthopedic Surgery, Southern California Permanente Medical Group, El Cajon, CA, USA
| | - Andrew Fithian
- Department of Orthopedic Surgery, Southern California Permanente Medical Group, El Cajon, CA, USA
| | - Virginia Xie
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, USA
| | - Kurt Hartman
- Department of Physical Medicine & Rehabilitation/Physical Therapy, Southern California Permanente Medical Group, San Marcos, CA, USA
| | - William Schairer
- Department of Orthopedic Surgery, Southern California Permanente Medical Group, El Cajon, CA, USA
| | - Najeeb Khan
- Department of Orthopedic Surgery, Southern California Permanente Medical Group, San Diego, CA, USA
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3
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Moussa MK, Lefèvre N, Valentin E, Khalaf Z, Meyer A, Grimaud O, Bohu Y, Gerometta A, Khiami F, Hardy A. Association of Patient-Surgeon and Patient-Physical Therapist Relationships With Return to Sports After ACL Reconstruction: The Untested Dimension in Outcome Assessments. Orthop J Sports Med 2024; 12:23259671241254749. [PMID: 38881855 PMCID: PMC11179478 DOI: 10.1177/23259671241254749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/06/2023] [Indexed: 06/18/2024] Open
Abstract
Background The Quality of Patient-Surgeon Relationship (QPASREL) is an 11-item questionnaire developed and validated to assess the relationship between practitioners and patients on recovery and return to work after surgery. Purpose To evaluate the association of patient-surgeon relationship (PSR) and patient-physical therapist relationship (PPR), as measured by QPASREL, with a patient's return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR). Study Design Case-control study; Level of evidence, 3. Methods This study targeted patients who underwent primary ACLR at a specialized sports surgery referral center between January and May 2021. Patients who had revision surgery, multiligamentous knee injury, and sedentary status were excluded from the study. Patients were grouped based on ability to RTS at the preinjury level 1 year postoperatively (RTS group and no-RTS group). The primary outcome was rate of RTS at 1 year postoperatively, and the primary dependent variables were the quality of PSR and PPR as measured by QPASREL scores at 6-month intervals. Secondary outcomes were the correlation and discriminative capacity of the QPASREL compared with the Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) scores (collected at 6-month intervals). Results The study included 243 patients. Patients in the RTS group exhibited a higher mean PPR QPASREL score (36.6 ± 5.1) compared with no-RTS patients (34.8 ± 5.2; P = .01) as well as a higher mean PSR score (35.7 ± 5.1) compared with no-RTS patients (33.8 ± 5.9; P = .01). Multivariate analysis showed that every 5-point increase in the QPASREL scores for PPR and PSR resulted in a 39% (odds ratio [OR] = 1.39; P = 0.014) and 35% (OR = 1.35, P = 0.021) increased odds of RTS, respectively. A weak yet positive correlation was found between QPASREL and ACL-RSI. The predictive capacity of the QPASREL (area under the curve [AUC] = 0.60 for PPR and 0.61 for PSR), although significant, was less powerful compared with that of the ACL-RSI (AUC = 0.73). Conclusion The quality of the PPR and PSR, as measured by QPASREL scores, demonstrated a significant association with RTS rates at 1 year after ACLR. A weak yet positive correlation was found between QPASREL and ACL-RSI.
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Affiliation(s)
- Mohamad K Moussa
- Clinique du Sport, Paris, France
- Groupe Hospitalier Sélestat - Obernai, Sélestat, France
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Tan EK, Ahmad Hanif KA, Mohamed Saaid F, Yeak RDK, Abdul Kahar J, Mahmud A, Nasir NM. Cost-Outcome Descriptive Study for Mobile App (UPSCALER) in the Rehabilitation of Anterior Cruciate Ligament (ACL) Injuries After Reconstructive Surgery. Cureus 2024; 16:e59886. [PMID: 38854226 PMCID: PMC11160346 DOI: 10.7759/cureus.59886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/11/2024] Open
Abstract
Anterior cruciate ligament (ACL) injuries are a significant concern in athletes, often leading to long-term complications and reduced quality of life. Despite advancements in surgical techniques, outcomes following ACL reconstruction remain suboptimal, largely due to poor adherence to postoperative rehabilitation. This study introduces a novel postoperative rehabilitation approach utilizing a smartphone application, UPSCALER, developed by the Universiti Putra Malaysia Sports Injury and Arthroscopic Surgery Center of Excellence. The application delivers a validated accelerated rehabilitation protocol through instructional videos tailored to each patient's recovery phase. Results from the study demonstrate promising outcomes, including improvements in Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales post-rehabilitation, potentially attributed to increased adherence facilitated by the application's accessibility. Furthermore, the study explores the cost-effectiveness of this approach compared to conventional methods. In conclusion, smartphone application-guided rehabilitation shows promise in improving ACL reconstruction outcomes, warranting further research to validate its effectiveness and long-term impact on patient recovery and healthcare costs.
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Affiliation(s)
- Eng Kee Tan
- Department of Orthopedics and Traumatology, Universiti Putra Malaysia, Serdang, MYS
| | | | | | - Raymond D K Yeak
- Department of Orthopedics and Traumatology, Universiti Putra Malaysia, Serdang, MYS
| | - Johan Abdul Kahar
- Department of Orthopedics and Traumatology, Universiti Putra Malaysia, Serdang, MYS
| | - Aidalina Mahmud
- Department of Community Health, Universiti Putra Malaysia, Serdang, MYS
| | - Nizlan M Nasir
- Department of Orthopedics and Traumatology, Universiti Putra Malaysia, Serdang, MYS
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Frouin A, Desfontaines N, Lacourpaille L, Nordez A, Le Sant G. Preoperative Rehabilitation Enhances Mental and Physical Well-Being in Anterior Cruciate Ligament-Injured Individuals: A Mixed Methods Study. J Sport Rehabil 2024; 33:289-296. [PMID: 38580299 DOI: 10.1123/jsr.2023-0312] [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: 09/18/2023] [Revised: 02/14/2024] [Accepted: 02/27/2024] [Indexed: 04/07/2024]
Abstract
CONTEXT Rehabilitation after an anterior cruciate ligament injury is recommended to be started soon after the injury. When surgery is required, research supports the delivery of physiotherapy before anterior cruciate ligament reconstruction (prehabilitation) to optimize recovery and positive outcomes. Individuals attending prehabilitation have never been questioned regarding their adherence to prehabilitation, perception of utility in meeting needs, upcoming events, or anticipated recovery goals. DESIGN Mixed methods cross-sectional study: Methods: 25 individuals before anterior cruciate ligament reconstruction (43% of eligible individuals from 12 clinics during the delivery period) were surveyed on their mindset and recovery expectancies. Semistructured interviews conducted in 9 of 25 participants assessed their lived experience of prehabilitation. RESULTS Participants reported that preventing a reinjury (96% of responses) and feeling confident during daily activities about their knee (92%) were the higher rating expectations at this stage of their treatment course. Three themes were developed from the interviews and analyses. (1) Participants reported that prehabilitation was a period full of challenges with memories of the injury and uncertainties. (2) They viewed prehabilitation as a step to move forward by finding support and self-motivating. (3) They believed that prehabilitation would have positive impacts on the treatment outcomes. Participants were confident that prehabilitation would accelerate the recovery of muscle volume (88%) and strength (84%). CONCLUSION Participants had positive experiences of prehabilitation, aligning with the findings on functional outcomes in the existing literature on prehabilitation.
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Affiliation(s)
- Antoine Frouin
- Nantes Université, Movement-Interactions-Performance, MIP, UR 4334, Nantes, France
- Institut Sport Atlantique, ISA Clinic, Saint-Herblain, France
| | | | - Lilian Lacourpaille
- Nantes Université, Movement-Interactions-Performance, MIP, UR 4334, Nantes, France
| | - Antoine Nordez
- Nantes Université, Movement-Interactions-Performance, MIP, UR 4334, Nantes, France
- Institut Universitaire de France, IUF, Paris, France
| | - Guillaume Le Sant
- Nantes Université, Movement-Interactions-Performance, MIP, UR 4334, Nantes, France
- School of Physiotherapy, IFM3R, St-Sebastien/Loire, France
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Yu F, Xiao LE, Wang T, Hu Y, Xiao J. Nurse-Assisted Rehabilitation Protocols Following Anterior Cruciate Ligament Reconstruction. Orthop Nurs 2024; 43:163-178. [PMID: 38861747 DOI: 10.1097/nor.0000000000001030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
Despite significant advancements in surgical instruments and operation skills, short- and long-term outcomes following anterior cruciate ligament reconstruction (ACLR) remain unsatisfactory, as many patients fail to return to their pre-injury level of sports. Inadequate ACL rehabilitation is the primary cause of poor outcomes. Nurses have become a crucial element in the rehabilitation process. Although there is no consensus regarding the optimal post-operative rehabilitation protocols, restoring muscle strength and neuromuscular control are consistently the primary goals. This literature review presents nurse-assisted rehabilitation protocols aiming at improving muscle strength and neuromuscular control. The review discusses postoperative rehabilitation, including home-based and supervised rehabilitation, open and closed kinetic chain exercises, eccentric and concentric training, blood flow restriction training, and plyometric training. Each training protocol has its benefits and drawbacks, and should be used cautiously in specific stages of rehabilitation. Neuromuscular training, such as neuromuscular electrical stimulation, neuromuscular control exercises, and vibration therapy, is considered crucial in rehabilitation.
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Affiliation(s)
- Fang Yu
- Fang Yu, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Li-En Xiao, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Tao Wang, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Yong Hu, PhD, Department of Joint Surgery, the Fifth Affiliated Hospital of Southern Medical University, GuangZhou City, GuangDong Province, China
- Jun Xiao, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
| | - Li-En Xiao
- Fang Yu, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Li-En Xiao, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Tao Wang, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Yong Hu, PhD, Department of Joint Surgery, the Fifth Affiliated Hospital of Southern Medical University, GuangZhou City, GuangDong Province, China
- Jun Xiao, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
| | - Tao Wang
- Fang Yu, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Li-En Xiao, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Tao Wang, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Yong Hu, PhD, Department of Joint Surgery, the Fifth Affiliated Hospital of Southern Medical University, GuangZhou City, GuangDong Province, China
- Jun Xiao, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
| | - Yong Hu
- Fang Yu, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Li-En Xiao, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Tao Wang, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Yong Hu, PhD, Department of Joint Surgery, the Fifth Affiliated Hospital of Southern Medical University, GuangZhou City, GuangDong Province, China
- Jun Xiao, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
| | - Jun Xiao
- Fang Yu, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Li-En Xiao, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Tao Wang, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Yong Hu, PhD, Department of Joint Surgery, the Fifth Affiliated Hospital of Southern Medical University, GuangZhou City, GuangDong Province, China
- Jun Xiao, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
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Dauty M, Le Mercier E, Menu P, Grondin J, Hirardot T, Daley P, Fouasson-Chailloux A. Prolonged Physiotherapy after Anterior Cruciate Ligament Reconstruction Does Not Improve Muscular Strength and Function. J Clin Med 2024; 13:2519. [PMID: 38731047 PMCID: PMC11084926 DOI: 10.3390/jcm13092519] [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: 01/29/2024] [Revised: 04/03/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Background: After the rupture of the anterior cruciate ligament (ACL), surgery is proposed in the case of knee instability or for athletes who want to return to a pivotal and/or contact sport. The current trend is to extend physiotherapy sessions until a patient's return to sport. We aimed to assess the interest in prolonging the physiotherapy sessions up to 4 postoperative months to restore muscle knee strength and function. Methods: From a historical cohort, 470 patients (24.3 ± 8.7 years) were included; 312 (66%) were males. They all had undergone a primary ACL reconstruction with a hamstring procedure. The number of physiotherapy sessions was established at 4 postoperative months. The main study parameters to assess the benefit of prolonged physiotherapy were the isokinetic limb symmetry index (LSI) for the quadriceps and the hamstrings as well as the Lysholm score. Results: At 4 postoperative months, 148 patients (31.4%) still had physiotherapy sessions. This group had performed 49 ± 14 physiotherapy sessions at the time of evaluation compared to 33 ± 9 sessions performed by the group that stopped physiotherapy at 3 months post-ACL reconstruction. The isokinetic knee LSI and the Lysholm score were not different between the two groups. Continued physiotherapy sessions were associated with female gender, previous high sport level, meniscal repair, lateral tenodesis and outpatient rehabilitation at the beginning of the rehabilitation management, while knee pain complications were not associated. Conclusions: No significant correlation was found between the number of physiotherapy sessions and the knee strength LSI or the Lysholm score. Prolonging patient physiotherapy sessions after 3 months post-ACL reconstruction seems ineffective in improving knee strength recovery and function.
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Affiliation(s)
- Marc Dauty
- Physical Medicine and Rehabilitation, Sport Medicine Center, University Hospital of Nantes, CHU Nantes, 44093 Nantes, France; (M.D.); (E.L.M.); (P.M.); (T.H.)
- Institut Régional de Médecine du Sport des Pays de Loire (IRMS), 44093 Nantes, France;
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, 44042 Nantes, France
| | - Emmanuel Le Mercier
- Physical Medicine and Rehabilitation, Sport Medicine Center, University Hospital of Nantes, CHU Nantes, 44093 Nantes, France; (M.D.); (E.L.M.); (P.M.); (T.H.)
| | - Pierre Menu
- Physical Medicine and Rehabilitation, Sport Medicine Center, University Hospital of Nantes, CHU Nantes, 44093 Nantes, France; (M.D.); (E.L.M.); (P.M.); (T.H.)
- Institut Régional de Médecine du Sport des Pays de Loire (IRMS), 44093 Nantes, France;
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, 44042 Nantes, France
| | - Jérôme Grondin
- Physical Medicine and Rehabilitation, Sport Medicine Center, University Hospital of Nantes, CHU Nantes, 44093 Nantes, France; (M.D.); (E.L.M.); (P.M.); (T.H.)
- Institut Régional de Médecine du Sport des Pays de Loire (IRMS), 44093 Nantes, France;
| | - Thomas Hirardot
- Physical Medicine and Rehabilitation, Sport Medicine Center, University Hospital of Nantes, CHU Nantes, 44093 Nantes, France; (M.D.); (E.L.M.); (P.M.); (T.H.)
- Institut Régional de Médecine du Sport des Pays de Loire (IRMS), 44093 Nantes, France;
| | - Pauline Daley
- Institut Régional de Médecine du Sport des Pays de Loire (IRMS), 44093 Nantes, France;
| | - Alban Fouasson-Chailloux
- Physical Medicine and Rehabilitation, Sport Medicine Center, University Hospital of Nantes, CHU Nantes, 44093 Nantes, France; (M.D.); (E.L.M.); (P.M.); (T.H.)
- Institut Régional de Médecine du Sport des Pays de Loire (IRMS), 44093 Nantes, France;
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, 44042 Nantes, France
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Truong LK, Mosewich AD, Miciak M, Losciale JM, Li LC, Whittaker JL. Social support and therapeutic relationships intertwine to influence exercise behavior in people with sport-related knee injuries. Physiother Theory Pract 2024:1-14. [PMID: 38374585 DOI: 10.1080/09593985.2024.2315520] [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: 08/22/2023] [Accepted: 01/03/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE Explore how social support influences exercise therapy participation and adherence before and after enrolling in an education and exercise therapy intervention (Stop OsteoARthritis, SOAR). METHODS Study design: Interpretative description. We sampled participants with sport-related knee injuries from the SOAR randomized controlled trial. SOAR is a virtual, physiotherapist-guided, education and exercise therapy-based knee health program that targets individuals at risk of early osteoarthritis. One-on-one semi-structured interviews were completed, and an inductive approach was guided by Braun & Clarke's reflexive thematic analysis. RESULTS Fifteen participants (67% female, median age 26 [19-35] years) were interviewed. Three themes were generated that encapsulated participants' social support experiences that fostered exercise participation: 1) Treat me as a whole person represented the value of social support that went beyond participants' physical needs, 2) Work with me highlighted the working partnership between the clinician and the participant, and 3) Journey with me indicated a need for on-going support is necessary for the long-term management of participants' knee health. A theme of the therapeutic relationship was evident across the findings. CONCLUSIONS Insight was gained into how and why perceived support may be linked to exercise behavior, with the therapeutic relationship being potentially linked to perceived support. Social support strategies embedded within an education and exercise therapy program may boost exercise adherence after sport-related knee injuries.
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Affiliation(s)
- Linda K Truong
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Amber D Mosewich
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada
| | - Maxi Miciak
- College of Health Sciences, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Justin M Losciale
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Linda C Li
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
- College of Health Sciences, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
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Ambros-Antemate JF, Beristain-Colorado MDP, Vargas-Treviño M, Gutiérrez-Gutiérrez J, Hernández-Cruz PA, Gallegos-Velasco IB, Moreno-Rodríguez A. Improving Adherence to Physical Therapy in the Development of Serious Games: Conceptual Framework Design Study. JMIR Form Res 2023; 7:e39838. [PMID: 37948110 PMCID: PMC10674146 DOI: 10.2196/39838] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 04/25/2023] [Accepted: 10/14/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Insufficient levels of treatment adherence can have adverse effects on the outcomes of physical rehabilitation. To address this issue, alternative approaches to traditional therapies, such as serious games, have been designed to enhance adherence. Nevertheless, there remain gaps in the development of serious games concerning the effective implementation of motivation, engagement, and the enhancement of treatment adherence. OBJECTIVE This study aims to design a conceptual framework for the development of serious games that incorporate essential adherence factors to enhance patient compliance with physical rehabilitation programs. METHODS We formulated a conceptual framework using iterative techniques inspired by a conceptual framework analysis. Initially, we conducted a comprehensive literature review, concentrating on the critical adherence factors in physical rehabilitation. Subsequently, we identified, categorized, integrated, and synthesized the concepts derived from the literature review to construct the conceptual framework. RESULTS The framework resembles a road map, comprising 3 distinct phases. In the initial phase, the patient's characteristics are identified through an initial exploration. The second phase involves the development of a serious game, with a focus on enhancing treatment adherence by integrating the key adherence factors identified. The third phase revolves around the evaluation of the serious game. These phases are underpinned by 2 overarching themes, namely, a user-centered design and the GameFlow model. CONCLUSIONS The conceptual framework offers a detailed, step-by-step guide for creating serious games that incorporate essential adherence factors, thereby contributing to improved adherence in the physical rehabilitation process. To establish its validity, further evaluations of this framework across various physical rehabilitation programs and user groups are necessary.
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Affiliation(s)
| | | | - Marciano Vargas-Treviño
- Facultad de Sistemas Biológicos e Innovación Tecnológica, Universidad Autónoma "Benito Juárez" de Oaxaca, Oaxaca de Juárez, Mexico
| | - Jaime Gutiérrez-Gutiérrez
- Facultad de Sistemas Biológicos e Innovación Tecnológica, Universidad Autónoma "Benito Juárez" de Oaxaca, Oaxaca de Juárez, Mexico
| | - Pedro Antonio Hernández-Cruz
- Laboratorio de genómica y proteómica, Centro de investigación Universidad Nacional Autónoma de México-Universidad Autónoma "Benito Juárez" de Oaxaca, Facultad de Medicina y Cirugía, Universidad Autónoma "Benito Juárez" de Oaxaca, Oaxaca de Juárez, Mexico
| | - Itandehui Belem Gallegos-Velasco
- Laboratorio de genómica y proteómica, Centro de investigación Universidad Nacional Autónoma de México-Universidad Autónoma "Benito Juárez" de Oaxaca, Facultad de Medicina y Cirugía, Universidad Autónoma "Benito Juárez" de Oaxaca, Oaxaca de Juárez, Mexico
| | - Adriana Moreno-Rodríguez
- Facultad de Ciencias Químicas, Universidad Autónoma "Benito Juárez" de Oaxaca, Oaxaca de Juárez, Mexico
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10
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McNeill K, Marmura H, Werstine M, Alcock G, Birmingham T, Willits K, Getgood A, LeBel ME, Litchfield R, Bryant D, Giffin JR. The Effect of Staged Versus Usual Care Physiotherapy on Knee Function Following Anterior Cruciate Ligament Reconstruction. J Sport Rehabil 2023; 32:884-893. [PMID: 37699588 DOI: 10.1123/jsr.2022-0343] [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: 09/19/2022] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 09/14/2023]
Abstract
CONTEXT The long duration and high cost of anterior cruciate ligament reconstruction (ACLR) rehabilitation can pose barriers to completing rehabilitation, the latter stages of which progress to demanding sport-specific exercises critical for a safe return to sport. A staged approach shifting in-person physiotherapy sessions to later months of recovery may ensure patients undergo the sport-specific portion of ACLR rehabilitation. Design/Objective: To compare postoperative outcomes of knee function in patients participating in a staged ACLR physiotherapy program to patients participating in usual care physiotherapy through a randomized controlled trial. METHODS One hundred sixty-two patients were randomized to participate in staged (n = 80) or usual care physiotherapy (n = 82) following ACLR and assessed preoperatively and postoperatively at 2 weeks, 6 weeks, 3 months, and 6 months. The staged group completed the ACLR rehabilitation protocol at home for the first 3 months, followed by usual care in-person sessions. The usual care group completed in-person sessions for their entire rehabilitation. Outcome measures included the Lower Extremity Functional Scale, International Knee Documentation Committee Questionnaire, pain, range of motion, strength, and hop testing. RESULTS There were no statistically significant between-group differences in measures of knee function at 6 months postoperative. Patients in the usual care group reported significantly higher International Knee Documentation Committee scores at 3 months postoperative (mean difference = 5.8; 95% confidence interval, 1.3 to 10.4; P = .01). CONCLUSION A staged approach to ACLR rehabilitation does not appear to impede knee function at 6 months postoperative but may result in worse patient reported outcomes at early follow-ups.
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Affiliation(s)
- Kestrel McNeill
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON,Canada
| | - Hana Marmura
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON,Canada
- Fowler Kennedy Sport Medicine Clinic, Western University, London, ON,Canada
- Bone and Joint Institute, Western University, London, ON,Canada
| | - Melanie Werstine
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON,Canada
- Fowler Kennedy Sport Medicine Clinic, Western University, London, ON,Canada
| | - Greg Alcock
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON,Canada
- Fowler Kennedy Sport Medicine Clinic, Western University, London, ON,Canada
| | - Trevor Birmingham
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON,Canada
- Fowler Kennedy Sport Medicine Clinic, Western University, London, ON,Canada
- Bone and Joint Institute, Western University, London, ON,Canada
- Wolf Orthopedic Biomechanics Lab, Western University, London, ON,Canada
| | - Kevin Willits
- Fowler Kennedy Sport Medicine Clinic, Western University, London, ON,Canada
- Division of Orthopedics, Department of Surgery, The Schulich School of Medicine and Dentistry, Western University, London, ON,Canada
| | - Alan Getgood
- Fowler Kennedy Sport Medicine Clinic, Western University, London, ON,Canada
- Division of Orthopedics, Department of Surgery, The Schulich School of Medicine and Dentistry, Western University, London, ON,Canada
| | - Marie-Eve LeBel
- Fowler Kennedy Sport Medicine Clinic, Western University, London, ON,Canada
- Division of Orthopedics, Department of Surgery, The Schulich School of Medicine and Dentistry, Western University, London, ON,Canada
| | - Robert Litchfield
- Fowler Kennedy Sport Medicine Clinic, Western University, London, ON,Canada
- Division of Orthopedics, Department of Surgery, The Schulich School of Medicine and Dentistry, Western University, London, ON,Canada
| | - Dianne Bryant
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON,Canada
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON,Canada
- Fowler Kennedy Sport Medicine Clinic, Western University, London, ON,Canada
- Division of Orthopedics, Department of Surgery, The Schulich School of Medicine and Dentistry, Western University, London, ON,Canada
| | - J Robert Giffin
- Fowler Kennedy Sport Medicine Clinic, Western University, London, ON,Canada
- Wolf Orthopedic Biomechanics Lab, Western University, London, ON,Canada
- Division of Orthopedics, Department of Surgery, The Schulich School of Medicine and Dentistry, Western University, London, ON,Canada
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11
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Alzakri AA, Alsultan OA, Alhuqbani MN, Aldosari ZA, Alghadir OM, Aldosari OA, Alshehri BF, Alsaleh KA. Barriers and facilitators to physiotherapy among adult orthopedic patients at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia: A cross-sectional study. Saudi Med J 2023; 44:679-686. [PMID: 37463715 PMCID: PMC10370374 DOI: 10.15537/smj.2023.44.7.20230276] [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: 04/23/2023] [Accepted: 06/21/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVES To identify barriers and facilitators to physiotherapy adherence in adult patients who attended an orthopaedic clinic and underwent physical therapy at King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia. METHODS This cross-sectional study was performed at KKUH between September 2022 and January 2023. After conducting a literature review, a survey questionnaire was created, and a pilot study was conducted to evaluate its validity and clarity. Patients were approached in the waiting areas of the outpatient clinics and provided with a consent form to participate in the study. RESULTS Ongoing pain, travel distance, and lack of transportation were common barriers while being given a choice in rehabilitation activities, regular assessments of progress and function, and regular goal setting with the physician were common facilitators. Living in rural areas and the belief that rehabilitation is important were associated with both higher barrier and facilitator scores. CONCLUSION A patient-centred approach to physical therapy, effective pain management, and regular evaluation of functional progress can increase adherence to physiotherapy. These findings have implications for physiotherapy providers, policymakers, and patients in promoting adherence to treatment for improved functional outcomes, reduced pain, and increased patient satisfaction.
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Affiliation(s)
- Abdulmajeed A. Alzakri
- From the Department of Orthopedics (Alzakri, Alsultan, Alhuqbani, Aldosari, Alghadir, Aldosari, Alshehri Alsaleh), College of Medicine, King Saud University; from the Department of Orthopedics (Alsultan, Alsaleh), King Saud University Medical City, King Saud University; and from the Department of Spine Surgery (Alzakri), King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Omar A. Alsultan
- From the Department of Orthopedics (Alzakri, Alsultan, Alhuqbani, Aldosari, Alghadir, Aldosari, Alshehri Alsaleh), College of Medicine, King Saud University; from the Department of Orthopedics (Alsultan, Alsaleh), King Saud University Medical City, King Saud University; and from the Department of Spine Surgery (Alzakri), King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Mohammed N. Alhuqbani
- From the Department of Orthopedics (Alzakri, Alsultan, Alhuqbani, Aldosari, Alghadir, Aldosari, Alshehri Alsaleh), College of Medicine, King Saud University; from the Department of Orthopedics (Alsultan, Alsaleh), King Saud University Medical City, King Saud University; and from the Department of Spine Surgery (Alzakri), King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Zyad A. Aldosari
- From the Department of Orthopedics (Alzakri, Alsultan, Alhuqbani, Aldosari, Alghadir, Aldosari, Alshehri Alsaleh), College of Medicine, King Saud University; from the Department of Orthopedics (Alsultan, Alsaleh), King Saud University Medical City, King Saud University; and from the Department of Spine Surgery (Alzakri), King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Omar M. Alghadir
- From the Department of Orthopedics (Alzakri, Alsultan, Alhuqbani, Aldosari, Alghadir, Aldosari, Alshehri Alsaleh), College of Medicine, King Saud University; from the Department of Orthopedics (Alsultan, Alsaleh), King Saud University Medical City, King Saud University; and from the Department of Spine Surgery (Alzakri), King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Omar A. Aldosari
- From the Department of Orthopedics (Alzakri, Alsultan, Alhuqbani, Aldosari, Alghadir, Aldosari, Alshehri Alsaleh), College of Medicine, King Saud University; from the Department of Orthopedics (Alsultan, Alsaleh), King Saud University Medical City, King Saud University; and from the Department of Spine Surgery (Alzakri), King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Badr F. Alshehri
- From the Department of Orthopedics (Alzakri, Alsultan, Alhuqbani, Aldosari, Alghadir, Aldosari, Alshehri Alsaleh), College of Medicine, King Saud University; from the Department of Orthopedics (Alsultan, Alsaleh), King Saud University Medical City, King Saud University; and from the Department of Spine Surgery (Alzakri), King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Khalid A. Alsaleh
- From the Department of Orthopedics (Alzakri, Alsultan, Alhuqbani, Aldosari, Alghadir, Aldosari, Alshehri Alsaleh), College of Medicine, King Saud University; from the Department of Orthopedics (Alsultan, Alsaleh), King Saud University Medical City, King Saud University; and from the Department of Spine Surgery (Alzakri), King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia.
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12
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Henning M, Henning R, Dummett J. Improving the quality of rehabilitation following anterior cruciate ligament reconstruction surgery, in an outpatient physiotherapy department. BMJ Open Qual 2023; 12:e002300. [PMID: 37524514 PMCID: PMC10391794 DOI: 10.1136/bmjoq-2023-002300] [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: 02/01/2023] [Accepted: 07/25/2023] [Indexed: 08/02/2023] Open
Abstract
Anterior cruciate ligament reconstruction (ACLR) is a type of orthopaedic knee surgery and physiotherapy rehabilitation is undertaken for several months postoperatively, often with the aim of returning the patient to sport. Variations in postoperative protocols to guide rehabilitation exist between National Health Service (NHS) Trusts. Although there is no single guideline to guide clinicians, strong evidence does support several clinical measures to be included post-ACLR, to improve outcomes and reduce the need for revision surgery. This project aimed to align our NHS Trust's ACLR physiotherapy care with best-evidence.A literature review was completed to establish key quality standards for ACLR rehabilitation. A retrospective notes audit was then undertaken to quantify the baseline quality of care, measured against these standards. Quality improvement methods were used to improve the quality of care and postoperative rehabilitation processes for ACLR patients. A new evidence-based, postoperative rehabilitation protocol was created, a core group of clinicians was formed to see ACLR patients and a rehabilitation class, solely for ACLR patients was also implemented.The key process measure for the project was patients engaging in 'criteria-driven progressions of rehabilitation'. This 'criteria-driven progressions' rate increased from 0% at baseline to 100% during the project period. Overall, non-attendance rates maintained at a similar level from 5.4% at baseline to a final rate of 4.8%. There was also an increase in mean 'return to sport' times, from 6 to 9.9 months, which is in line with best-evidence recommendations.The previous rehabilitation provided in our trust was not aligned with current evidence. This quality improvement project has led to improvements in patient care and lessons from the project will allow other trusts to learn from the changes made, to improve their own care pathways.
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Affiliation(s)
- Michael Henning
- Orthopaedic Interface, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | - Rose Henning
- Physiotherapy Outpatients, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | - Joe Dummett
- Physiotherapy Outpatients, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
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13
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Kotsifaki R, Korakakis V, King E, Barbosa O, Maree D, Pantouveris M, Bjerregaard A, Luomajoki J, Wilhelmsen J, Whiteley R. Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction. Br J Sports Med 2023; 57:500-514. [PMID: 36731908 DOI: 10.1136/bjsports-2022-106158] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 02/04/2023]
Abstract
This guideline was developed to inform clinical practice on rehabilitation after anterior cruciate ligament reconstruction (ACLR) and was performed in accordance with the Appraisal of Guidelines for REsearch & Evaluation II (AGREE II) instrument and used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. A Guideline Development Group systematically searched and reviewed evidence using randomised clinical trials and systematic reviews to evaluate the effectiveness of rehabilitation interventions and guide clinicians and patients on the content of the optimal rehabilitation protocol after ACLR.The guideline targets patients during rehabilitation after ACLR and investigates the effectiveness of the available interventions to the physiotherapist, alone or in combination (eg, exercise, modalities, objective progression criteria). Exercise interventions should be considered the mainstay of ACLR rehabilitation. However, there is little evidence on the dose-response relationship between volume and/or intensity of exercise and outcomes. Physical therapy modalities can be helpful as an adjunct in the early phase of rehabilitation when pain, swelling and limitations in range of motion are present. Adding modalities in the early phase may allow earlier pain-free commencement of exercise rehabilitation. Return to running and return to training/activity are key milestones for rehabilitation after ACLR. However, there is no evidence on which progression or discharge criteria should be used.While there is a very low level of certainty for most components of rehabilitation, most of the recommendations provided in this guideline were agreed to by expert clinicians. This guideline also highlights several new elements of ACLR management not reported previously.
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Affiliation(s)
- Roula Kotsifaki
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Vasileios Korakakis
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Enda King
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Olivia Barbosa
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Dustin Maree
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Michail Pantouveris
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Andreas Bjerregaard
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Julius Luomajoki
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Jan Wilhelmsen
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Rodney Whiteley
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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14
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Riffitts M, Cook H, McClincy M, Bell K. Evaluation of a Smart Knee Brace for Range of Motion and Velocity Monitoring during Rehabilitation Exercises and an Exergame. SENSORS (BASEL, SWITZERLAND) 2022; 22:9965. [PMID: 36560329 PMCID: PMC9781044 DOI: 10.3390/s22249965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
Anterior cruciate ligament (ACL) injuries often require a lengthy duration of rehabilitation for patients to return to their prior level of function. Adherence to rehabilitation during this prolonged period can be subpar due to the treatment duration and poor adherence to home exercises. This work evaluates whether a smart instrumented knee brace system is capable of monitoring knee range of motion and velocity during a series of common knee rehabilitation exercises and an exergame. A total of 15 healthy participants completed a series of common knee rehabilitation exercises and played an exergame while wearing a smart instrumented knee brace. The range of motion (ROM) and velocity of the knee recorded by the knee brace was compared to a reference optoelectronic system. The results show good agreement between the knee brace system and the reference system for all exercises performed. Participants were able to quickly learn how to play the exergame and scored well within the game. The system investigated in this study has the potential to allow rehabilitation to occur outside of the clinic with the use of remote monitoring, and improve adherence and outcomes through the use of an exergame.
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Affiliation(s)
- Michelle Riffitts
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15206, USA
| | - Harold Cook
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15206, USA
| | - Michael McClincy
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15206, USA
| | - Kevin Bell
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15206, USA
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15
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Differences in the course of rehabilitation and outcomes for publicly insured pediatric patients after anterior cruciate ligament reconstruction. Phys Ther Sport 2022; 58:52-57. [PMID: 36174372 DOI: 10.1016/j.ptsp.2022.09.002] [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: 06/10/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Examine the effect of insurance type on physical therapy (PT) utilization and outcomes within pediatric and adolescent patients after anterior cruciate ligament reconstruction. DESIGN Multicenter retrospective cohort study. METHODS PT visits and functional hop test performance were extracted into a shared database. The average number of PT visits per week was assessed overall and by time period. Independent samples t-test examined the effect of insurance on PT utilization and the effect of insurance status on the odds of passing single-legged hop tests was assessed using multivariable logistic regression. RESULTS A total of 281 patients (15.7 ± 1.9, 42% female) were included in this analysis. Of these, 128 (45%) had public insurance. Publicly insured patients experienced a longer delay from surgery to hop test (8.3vs7.7 months, p = 0.009), attended overall fewer PT visits per week (0.92vs1.04, p = 0.005), with most of the decreased frequency occurring between weeks 7-24. Insurance status had a significant effect on the odds of passing the single leg hop test (2.72; 95%CI, 1.27-5.81). CONCLUSION Publicly insured patients average a lower number of weekly PT visits, experienced a longer delay from surgery to hop testing and were 2.7 times less likely to pass the single leg hop for distance test.
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16
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Walker A, Hing W, Gough S, Lorimer A. 'Such a massive part of rehab is between the ears'; barriers to and facilitators of anterior cruciate ligament reconstruction rehabilitation: a qualitative focus group analysis. BMC Sports Sci Med Rehabil 2022; 14:106. [PMID: 35701850 PMCID: PMC9199234 DOI: 10.1186/s13102-022-00499-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 05/30/2022] [Indexed: 12/05/2022]
Abstract
Background Current evidence demonstrates that few patients complete anterior cruciate ligament reconstruction rehabilitation according to evidence-based guidelines. It is important to investigate the viewpoints of our patients to identify patient-reported barriers and facilitators of anterior cruciate ligament reconstruction rehabilitation. Qualitative analysis can provide insight into potential methods for improving the delivery of rehabilitation services. Methods In this qualitative study, utilising a social constructionism orientation, viewed through the social phenomenological lens, three focus groups were conducted with individuals 1–20 years post anterior cruciate ligament reconstruction (n = 20, 9 males, 11 females, mean 6.5 years post-surgery, 19–51 years old). Utilising a semi-structured interview guide, participants were asked about their experiences during anterior cruciate ligament reconstruction rehabilitation. Focus groups were recorded, transcribed, and coded using an inductive semantic thematic analysis methodology. Results Five organising themes were identified (consisting of 19 sub-themes) to provide a framework to present the data: psychological, physiological, rehabilitation service, rehabilitation characteristics, and interaction with others. Each theme details aspects of rehabilitation, such as exercise delivery, informational support, frequency, and duration of care, kinesiophobia, weight management and interactions with teams and coaches, which present barriers or facilitators for patients to adhere to and participate in rehabilitation. Example quotes are provided for each theme to provide context and the patient’s voice. Conclusions This qualitative investigation identified key aspects of a patient's rehabilitation in which they encounter a variety of barriers and facilitators of ACL reconstruction rehabilitation. These aspects, such as the rehabilitation characteristics, service delivery, psychological and physiological factors, and interactions with others, were consistently identified by this cohort as factors which affected their rehabilitation. The themes may provide targets for clinicians to improve rehabilitation and deliver patient-centred care. However, the themes must be evaluated in future trials to assess whether interventions to remove barriers or enhance facilitators improves subsequent outcomes such as return to sport and re-injury rates. Supplementary Information The online version contains supplementary material available at 10.1186/s13102-022-00499-x.
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Affiliation(s)
- Adam Walker
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, 4226, Australia. .,Bond Institute of Health and Sport, Promethean Way, Robina, QLD, 4226, Australia.
| | - Wayne Hing
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, 4226, Australia
| | - Suzanne Gough
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, 4226, Australia
| | - Anna Lorimer
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, 4226, Australia
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17
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Brzeszczyński F, Turnbull K, McLelland C, MacDonald D, Lawson G, Hamilton D. Functional outcomes and return to sport following anterior cruciate ligament reconstruction in recreational athletes: A systematic review. Knee 2022; 36:103-113. [PMID: 35576781 DOI: 10.1016/j.knee.2022.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/16/2022] [Accepted: 04/18/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Outcomes of anterior cruciate ligament reconstruction (ACLR) are well reported in athletic populations, however surprisingly little information is available for the recreational athletes that make up the majority of cases. The aim was therefore to assess post-operative outcome and return-to-sport in recreational athletes following ACLR. METHODS A systematic search was conducted in Ovid MEDLINE, CINAHL, AMED and the grey literature according to PRISMA guidelines. Studies involving a clear definition of recreational athletes who underwent ACLR and recorded postoperative outcomes were included. Publication quality was assessed using Newcastle-Ottawa Scale. RESULTS 107 studies were identified, 19 full-text records reviewed and 13 included, reflecting 1342 patients with an average age of 31.7 (SD 9.8) years. Mean follow-up was 43.6 (SD 42.8) months. Activity change post-surgery was reported in 92% (12/13) papers. Outcomes were assessed with the Tegner score in seven studies, four of which reported pre-injury scores, which worsened from 5.4 to 4.3 at final follow-up (76.5 months). 54% (7/13) studies reported return to pre-injury level of sport. In these, 59% (n = 327/555) achieved pre-injury level at a mean follow-up of 33.7 months (SD 38.6). The return-to-sports rate increased with length of follow-up. Methodological quality was moderate. CONCLUSION Substantial variation in the timeframes and outcomes assessed restricts pooled analysis of change in function. Based on seven studies, 59% of recreational athletes return to pre-injury level of sport following ACLR. The link between return rate and post-operative review timeframe suggests that longer follow-up may be required to capture return-to-sport rates in this population.
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Affiliation(s)
| | - Kirsten Turnbull
- School of Health and Social Care, Edinburgh Napier University, UK
| | - Colin McLelland
- School of Health and Social Care, Edinburgh Napier University, UK
| | - Donnie MacDonald
- School of Health and Social Care, Edinburgh Napier University, UK
| | - Graham Lawson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - David Hamilton
- School of Health and Social Care, Edinburgh Napier University, UK.
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18
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de Queiroz JHM, Murakawa YAB, de Castro SS, Almeida GPL, de Oliveira RR. Biopsychosocial Model Domains in Clinical Practice Guidelines for Return to Sport After ACL Injury: Systematic Review Using the AGREE II Checklist. Sports Health 2022; 15:165-175. [PMID: 35581734 PMCID: PMC9951001 DOI: 10.1177/19417381221094582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
CONTEXT The current status of return-to-sport (RTS) criteria can be understood from the International Classification of Functioning, Disability, and Health (ICF), which emphasizes an individual-centered approach and inclusion of all domains of human functioning, and ensures the multifactorial and biopsychosocial nature of decision-making. OBJECTIVE To analyze the inclusion of biopsychosocial model domains in clinical practice guidelines (CPGs) for RTS after anterior cruciate ligament (ACL) injury, as well as the quality of these CPGs. STUDY DESIGN Systematic review of CPGs. LEVEL OF EVIDENCE Level 1. SEARCH STRATEGY Two independent reviewers developed the search strategy, and a third reviewer corrected and compiled the developed strategies used. DATA SOURCES Ovid/Medline, Embase, and PEDro without restriction dates. STUDY SELECTION CPGs for RTS after ACL injury at any age or sport level, and published in English. DATA EXTRACTION Two independent reviewers codified the RTS criteria recommended in the CPGs according to the ICF domains, and the Appraisal of Guidelines for Research and Evaluation II (AGREE II Checklist) was used for critical appraisal. RESULTS A total of 715 records were identified, and 7 CPGs were included. Frequency distribution of the biopsychosocial model domains was as follows: body functions (37.77%), activity and participation (20.00%), body structure (13.33%), environmental factors (11.11%), and personal factors (8.88%). In the AGREE II Checklist, the lowest mean domain scores were for rigor of development (37.86 ± 36.35) and applicability (49.29 ± 22.30), and 71.42% were of low or moderate quality. CONCLUSION The CPGs cannot address the biopsychosocial model domains satisfactorily and some do not address all the ICF conceptual model components, emphasizing body functions and activity and participation domains. Therefore, the functioning model advocated by the World Health Organization has not yet been adequately incorporated into the recommendations for RTS after ACL injury. Moreover, most CPGs are of limited quality.
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Affiliation(s)
- Jeffeson Hildo Medeiros de Queiroz
- Tendon Research Group, Master Program
in Physical Therapy and Functioning Physical Therapy Department, Federal University
of Ceará, Fortaleza, CE, Brazil
| | - Yanka Aparecida Bandeira Murakawa
- Tendon Research Group, Master Program
in Physical Therapy and Functioning Physical Therapy Department, Federal University
of Ceará, Fortaleza, CE, Brazil
| | - Shamyr Sulyvan de Castro
- Master Program in Physical Therapy and
Functioning, Public Health Post Graduate Program, Physical Therapy Department,
Federal University of Ceará, Fortaleza, CE, Brazil
| | - Gabriel Peixoto Leão Almeida
- Knee and Sports Research Group, Master
Program in Physical Therapy and Functioning, Physical Therapy Department, Federal
University of Ceará, Fortaleza, CE, Brazil
| | - Rodrigo Ribeiro de Oliveira
- Tendon Research Group, Master Program
in Physical Therapy and Functioning Physical Therapy Department, Federal University
of Ceará, Fortaleza, CE, Brazil,Rodrigo Ribeiro de
Oliveira, PhD, Tendon Research Group, Physical Therapy Department, Federal
University of Ceará, Alexandre Baraúna 949, Physical Therapy Department, Rodolfo
Teófilo, Fortaleza, Ceará, Brazil ()
(Twitter: @ROliveira_fisio)
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19
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Effectiveness of a supervised rehabilitation compared with a home-based rehabilitation following anterior cruciate ligament reconstruction: A systematic review and meta-analysis. Phys Ther Sport 2022; 55:296-304. [DOI: 10.1016/j.ptsp.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 05/21/2022] [Accepted: 05/22/2022] [Indexed: 11/18/2022]
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20
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Yung KK, Ardern CL, Serpiello FR, Robertson S. A Framework for Clinicians to Improve the Decision-Making Process in Return to Sport. SPORTS MEDICINE - OPEN 2022; 8:52. [PMID: 35416633 PMCID: PMC9008084 DOI: 10.1186/s40798-022-00440-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 03/23/2022] [Indexed: 12/14/2022]
Abstract
Return-to-sport (RTS) decisions are critical to clinical sports medicine and are often characterised by uncertainties, such as re-injury risk, time pressure induced by competition schedule and social stress from coaches, families and supporters. RTS decisions have implications not only for the health and performance of an athlete, but also the sports organisation. RTS decision-making is a complex process, which relies on evaluating multiple biopsychosocial factors, and is influenced by contextual factors. In this narrative review, we outline how RTS decision-making of clinicians could be evaluated from a decision analysis perspective. To begin with, the RTS decision could be explained as a sequence of steps, with a decision basis as the core component. We first elucidate the methodological considerations in gathering information from RTS tests. Second, we identify how decision-making frameworks have evolved and adapt decision-making theories to the RTS context. Third, we discuss the preferences and perspectives of the athlete, performance coach and manager. We conclude by proposing a framework for clinicians to improve the quality of RTS decisions and make recommendations for daily practice and research.
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Affiliation(s)
- Kate K Yung
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
| | - Clare L Ardern
- Musculoskeletal and Sports Injury Epidemiology Centre, Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden.,Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia.,Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Fabio R Serpiello
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Sam Robertson
- Institute for Health and Sport, Victoria University, Melbourne, Australia
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21
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Morris JL, McEwen P, Letson HL, Dobson GP. Anterior Cruciate Ligament Reconstruction Surgery: Creating a Permissive Healing Phenotype in Military Personnel and Civilians for Faster Recovery. Mil Med 2022; 187:1310-1317. [PMID: 35389483 PMCID: PMC9617292 DOI: 10.1093/milmed/usac093] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/28/2022] [Accepted: 05/20/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Anterior cruciate ligament (ACL) rupture in military personnel and civilians can be a devastating injury. A service member is 10 times more likely to suffer an ACL injury than their civilian counterparts, and despite successful surgical stabilization, 4%-35% will develop arthrofibrosis, over 50% will not return to full active duty, and up to 50% will develop post-traumatic osteoarthritis (PTOA) within 15 years. Equally concerning, woman are 2 to 8 times more likely to experience ACL injuries than men, which represents a major knowledge gap. Materials and Methods A comprehensive literature search was performed in December 2021 using structured search terms related to prevalence, risk factors, disease progression, and treatment of ACL injury and reconstruction. The literature search was conducted independently by two researchers using PubMed, Cochrane, and Embase databases, with inclusion of articles with military, civilian, and sex relevance, and exclusion of most papers with a publication date greater than 10 years. The resources used for the review reflect the most current data, knowledge, and recommendations associated with research and clinical findings from reliable international sources. Results Currently, there is no effective system-based drug therapy that creates a “permissive environment” to reduce synovial and cartilage stress after ACL injury and reconstruction and prevent secondary complications. We argue that progress in this area has been hampered by researchers and clinicians failing to recognize that (1) an ACL injury is a system’s failure that affects the whole joint, (2) the early molecular events define and perpetuate different injury phenotypes, (3) male and female responses may be different and have a molecular basis, (4) the female phenotype continues to be under-represented in basic and clinical research, and (5) the variable outcomes may be perpetuated by the trauma of surgery itself. The early molecular events after ACL injury are characterized by an overexpression of joint inflammation, immune dysfunction, and trauma-induced synovial stress. We are developing an upstream adenosine, lidocaine, and magnesium therapy to blunt these early molecular events and expedite healing with less arthrofibrosis and early PTOA complications. Conclusions ACL injuries continue to be a major concern among military personnel and civilians and represent a significant loss in command readiness and quality of life. The lack of predictability in outcomes after ACL repair or reconstruction underscores the need for new joint protection therapies. The male–female disparity requires urgent investigation.
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Affiliation(s)
- Jodie L Morris
- Heart and Trauma Research Laboratory, College of Medicine and Dentistry, James Cook University, Townsville 4811, Australia
| | - Peter McEwen
- The Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, QLD 4812, Australia
| | - Hayley L Letson
- Heart and Trauma Research Laboratory, College of Medicine and Dentistry, James Cook University, Townsville 4811, Australia
| | - Geoffrey P Dobson
- Heart and Trauma Research Laboratory, College of Medicine and Dentistry, James Cook University, Townsville 4811, Australia
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22
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Qu X, Li K, Nam S. Effects of Mobile-Based Rehabilitation in Adolescent Football Players with Recurrent Lateral Ankle Sprains during the COVID-19 Pandemic. Healthcare (Basel) 2022; 10:healthcare10030412. [PMID: 35326890 PMCID: PMC8950648 DOI: 10.3390/healthcare10030412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 11/25/2022] Open
Abstract
Football is a sport involving dynamic movements, and ankle sprains are common sports injuries experienced by football players. Ankle sprains exhibit a high recurrence rate, and rehabilitation training is effective; however, expert-supervised rehabilitation (SVR) at training centers is difficult due to the recent COVID-19 pandemic. This study investigated the effects of mobile-based rehabilitation (MBR) performed at home by high school football players. Sixty players (SVR: 30 and MBR: 30) with recurrent ankle sprains were analyzed. The rehabilitation program consisted of strength and balance training, and the training intensity was gradually increased from week 1 to week 8. The SVR group underwent training at the center with experts, and the BMR group were provided with programs and feedback using mobile devices. Ankle muscle strength was evaluated by measuring isometric eversion, inversion, plantarflexion, and dorsiflexion contraction using a hand-held dynamometer, and dynamic balance was assessed using the Y-balance test (YBT; anterior, posteromedial, and posterolateral); the Foot and Ankle Outcome Score (FAOS) was used for the subjective evaluation. Measurements were conducted at weeks 1, 4, and 8. The patients visited the clinic within 1 week after the injury, and the first test was conducted after consent to participate in the research. Patients underwent the second test at an average of 3.2 weeks after the first test, and the last test at an average of 4.4 weeks after the second test. Although only the SVR group exhibited improvement in strength (eversion and dorsiflexion), YBT and subjective satisfaction at week 4, these measurements improved in both the SVR and MBR groups at week 8. Therefore, mobile–based rehabilitation could be a suitable alternative for high school athletes with ankle sprains who cannot undergo supervised rehabilitation.
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Affiliation(s)
- Xiaobo Qu
- College of Physical Education, Pingdingshan University, Pingdingshan 467000, China;
| | - Kai Li
- Department of Physical Education, Jeonbuk National University, Jeonju 54896, Korea;
| | - Sangcheul Nam
- College of Physical Education, Pingdingshan University, Pingdingshan 467000, China;
- Correspondence: ; Tel.: +86-199-375-11345; Fax: +86-375-265-7598
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23
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Fausett WA, Reid DA, Larmer PJ. Current perspectives of New Zealand physiotherapists on rehabilitation and return to sport following anterior cruciate ligament reconstruction: A survey. Phys Ther Sport 2021; 53:166-172. [PMID: 34711502 DOI: 10.1016/j.ptsp.2021.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the clinical beliefs and practices of New Zealand physiotherapists regarding pre- and post-surgical rehabilitation and return to sport (RTS) criteria following anterior cruciate ligament reconstruction (ACLR). DESIGN Online cross-sectional survey. METHODS A survey was adapted from a previously published survey and disseminated to New Zealand physiotherapists who were considered more likely to be involved in post-ACLR rehabilitation. RESULTS The number of completed surveys was 318. Most physiotherapists (85%) preferred to first consult patients within 14 days of ACLR. In the first six weeks following ACLR, 89% of physiotherapists see patients at least once per week. Between 3- and 6-months post-ACLR, 76% of physiotherapists see patients at least once a fortnight. Pre-operative rehabilitation and post-operative rehabilitation exceeding six months are considered essential or important to patient outcomes by over 95% of physiotherapists. While 63% of physiotherapists support RTS 9-12 months after ACLR, 11% permit RTS within 6-9 months of surgery. Common RTS considerations include functional capacity, movement quality during functional tasks, time from ACLR, and knee strength. CONCLUSION The survey revealed variability in the beliefs and practices of NZ physiotherapists regarding post-ACLR rehabilitation, and these beliefs and practices are at times inconsistent with best practice recommendations.
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Affiliation(s)
- Wayne A Fausett
- Faculty of Health and Environmental Sciences, Auckland University of Technology, New Zealand.
| | - Duncan A Reid
- School of Clinical Sciences, Auckland University of Technology, New Zealand
| | - Peter J Larmer
- School of Clinical Sciences, Auckland University of Technology, New Zealand
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24
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Diemer F, Zebisch J, Saueressig T. [Consequences of anterior cruciate ligament rupture: a systematic umbrella review]. SPORTVERLETZUNG-SPORTSCHADEN 2021; 36:18-37. [PMID: 34544171 DOI: 10.1055/a-1474-8986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The treatment of an anterior cruciate ligament rupture is still controversial. In particular, this applies to the question of conservative versus surgical treatment. The answer to this question is often based on consequential damage such as the development of posttraumatic osteoarthritis, secondary damage to the meniscus or cartilage, and participation in sports. If there are significant differences in these parameters between the individual treatment options, the results will be of great importance for the development of evidence-based treatment pathways. Therefore, the aim of this work was to evaluate the development of knee osteoarthritis after rupture of the anterior cruciate ligament and the corresponding treatment (conservative or surgical). MATERIAL AND METHODS To answer the above question, a systematic literature search was conducted in Medline via Pubmed, the Cochrane Library and in CINAHL. Only systematic reviews with a minimum follow-up period of 10 years were included. The search was conducted in January 2020 and updated in January 2021. Investigated cohorts included patients with a rupture of the anterior cruciate ligament who had undergone either conservative or surgical treatment. Osteoarthritis was diagnosed either radiologically (recognized scores) or clinically (pain and impaired function). Appropriate reviews were qualitatively evaluated using the AMSTAR-2 questionnaire. RESULTS The literature research initially identified n = 42 reviews from which 14 reviews were included. After full-text review and qualitative evaluation, only n = 2 systematic reviews remained for evaluation. The results of both papers show imprecise data with a high variability. However, it can be assumed with high probability that the development of osteoarthritis of the knee is increased after a rupture of the anterior cruciate ligament. There is no evidence that the incidence of joint degeneration may be reduced by reconstruction of the anterior cruciate ligament, nor is there a difference when comparing conservative and surgical treatment directly. CONCLUSION Patients with an anterior cruciate ligament rupture are likely to be at a greater risk of developing progressive joint degeneration. A protective effect of cruciate ligament surgery has not been found in the evaluated studies. A general argument in favour of cruciate ligament surgery aiming to achieve a protective effect on hyaline articular cartilage seems obsolete based on the results and should therefore not be used in patient education in the future.
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Affiliation(s)
- Frank Diemer
- DIGOTOR GbR, Brackenheim, Germany.,Physio Meets Science GmbH, Leimen, Germany
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25
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McClincy M, Seabol LG, Riffitts M, Ruh E, Novak NE, Wasilko R, Hamm ME, Bell KM. Perspectives on the Gamification of an Interactive Health Technology for Postoperative Rehabilitation of Pediatric Anterior Cruciate Ligament Reconstruction: User-Centered Design Approach. JMIR Serious Games 2021; 9:e27195. [PMID: 34448715 PMCID: PMC8433934 DOI: 10.2196/27195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/29/2021] [Accepted: 05/24/2021] [Indexed: 11/26/2022] Open
Abstract
Background Pediatric and adolescent athletes are a large demographic undergoing anterior cruciate ligament reconstruction (ACL-R). Postoperative rehabilitation is critical, requiring patients to complete home exercise programs (HEPs). To address obstacles to HEP adherence, we developed an interactive health technology, interACTION (iA), to monitor knee-specific rehabilitation. iA is a web-based platform that incorporates wearable motion sensors and a mobile app that provides feedback and allows remote monitoring. The Wheel of Sukr is a gamification mechanism that includes numerous behavioral elements. Objective This study aims to use a user-centered design process to incorporate behavioral change strategies derived from self-management theory into iA using the Wheel of Sukr, with the aim of influencing patient behavior. Methods In total, 10 athletes aged 10-18 years with a history of ACL-R were included in this study. Patients were between 4 weeks and 1 year post–ACL-R. Participants underwent a 60-minute triphasic interview. Phase 1 focused on elements of gaming that led to high participation and information regarding surgery and recovery. In phase 2, participants were asked to think aloud and rank cards representing the components of the Wheel of Sukr in order of interest. In phase 3, the patients reviewed the current version of iA. Interviews were recorded, transcribed, and checked for accuracy. Qualitative content analysis segmented the data and tagged meaningful codes until descriptive redundancy was achieved; next, 2 coders independently coded the data set. These elements were categorized according to the Wheel of Sukr framework. The mean age of participants was 12.8 (SD 1.32) years, and 70% (7/10) were female. Most participants (7/10, 70%) reported attending sessions twice weekly. All patients were prescribed home exercises. Self-reported HEP compliance was 75%-100% in 40% (4/10), 50%-75% in 40% (4/10), and 25%-50% of prescribed exercises in 20% (2/10) of the participants. Results The participants responded positively to an app that could track home exercises. Desirable features included exercise demonstrations, motivational components, and convenience. The participants listed sports specificity, competition, notifications, reminders, rewards, and social aspects of gameplay as features to incorporate. In the Wheel of Sukr card sort exercise, motivation was ranked first; self-management, second; and growth, esteem, and fun tied for the third position. The recommended gameplay components closely followed the themes from the Wheel of Sukr card sort activity. Conclusions The participants believe iA is a helpful addition to recovery and want the app to include exercise movement tracking and encouragement. Despite the small number of participants, thematic saturation was reached, suggesting the sample was sufficient to obtain a representative range of perspectives. Future work will implement motivation; self-management; and growth, confidence, and fun in the iA user experience. Young athlete ACL-R patients will complete typical clinical scenarios using increasingly developed prototypes of the gamified iA in a controlled setting.
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Affiliation(s)
- Michael McClincy
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Liliana G Seabol
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Michelle Riffitts
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ethan Ruh
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Natalie E Novak
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Rachel Wasilko
- Center for Research on Healthcare Data, University of Pittsburgh, Pittsburgh, PA, United States
| | - Megan E Hamm
- Center for Research on Healthcare Data, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kevin M Bell
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, United States
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26
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Dunphy E, Button K, Hamilton F, Williams J, Spasic I, Murray E. Feasibility randomised controlled trial comparing TRAK-ACL digital rehabilitation intervention plus treatment as usual versus treatment as usual for patients following anterior cruciate ligament reconstruction. BMJ Open Sport Exerc Med 2021; 7:e001002. [PMID: 34035951 PMCID: PMC8103946 DOI: 10.1136/bmjsem-2020-001002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 01/24/2023] Open
Abstract
Objectives To evaluate the feasibility of trialling taxonomy for the rehabilitation of knee conditions—ACL (TRAK-ACL), a digital health intervention that provides health information, personalised exercise plans and remote clinical support combined with treatment as usual (TAU), for people following ACL reconstruction. Methods The study design was a two-arm parallel randomised controlled trial (RCT). Eligible participants were English-speaking adults who had undergone ACL reconstruction within the last 12 weeks, had access to the internet and could provide informed consent. Recruitment took place at three sites in the UK. TRAK-ACL intervention was an interactive website informed by behaviour change technique combined with TAU. The comparator was TAU. Outcomes were: recruitment and retention; completeness of outcome measures at follow-up; fidelity of intervention delivery and engagement with the intervention. Individuals were randomised using a computer-generated random number sequence. Blinded assessors allocated groups and collected outcome measures. Results Fifty-nine people were assessed for eligibility at two of the participating sites, and 51 were randomised; 26 were allocated to TRAK-ACL and 25 to TAU. Follow-up data were collected on 44 and 40 participants at 3 and 6 months, respectively. All outcome measures were completed fully at 6 months except the Client Service Receipt Inventory. Two patients in each arm did not receive the treatment they were randomised to. Engagement with TRAK-ACL intervention was a median of 5 logins (IQR 3–13 logins), over 18 weeks (SD 12.2 weeks). Conclusion TRAK-ACL would be suitable for evaluation of effectiveness in a fully powered RCT.
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Affiliation(s)
- Emma Dunphy
- Research Department of Primary Care and Population Health, University College London, London, UK.,Physiotherapy Department, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Kate Button
- School of Healthcare Sciences, Cardiff University, Cardiff, UK.,Physiotherapy Department, Cardiff and Vale University Local Health Board, Cardiff, UK
| | - Fiona Hamilton
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Jodie Williams
- Physiotherapy Department, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Irena Spasic
- School of Computer Science and Informatics, Cardiff University, Cardiff, UK
| | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK
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27
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Piussi R, Krupic F, Senorski C, Svantesson E, Sundemo D, Johnson U, Hamrin Senorski E. Psychological impairments after ACL injury - Do we know what we are addressing? Experiences from sports physical therapists. Scand J Med Sci Sports 2021; 31:1508-1517. [PMID: 33772890 DOI: 10.1111/sms.13959] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/15/2021] [Accepted: 03/22/2021] [Indexed: 11/29/2022]
Abstract
Psychological impairments can follow an anterior cruciate ligament (ACL) injury and can impact the rehabilitation process. Our aim was to investigate experiences of sports physical therapists (PTs) in addressing psychological impairments in patients after ACL injury. We conducted four focus group interviews with fourteen sports PTs. The PTs' experiences of working with psychological impairments after ACL injury were summarized in four main categories: (1) "Calling for a guiding light", where PTs stated that the most common method of acquiring knowledge on addressing psychological impairments was through discussions with colleagues, and, at the same time, PTs expressed an insufficient knowledge of how to address psychological impairments; (2) "Meeting the burden of psychological impairments" where PTs stated that psychological impairments are greater than physical; (3) "Trying to balance physical and psychological aspects" where patient education and assessments were reported to be important in order to understand psychological impairments during rehabilitation; and (4) "Goal setting: a helpful challenge" where sports PTs expressed a need for specific knowledge of the rehabilitation of psychological impairments following ACL injury. To help provide the current best practice, we encourage researchers to develop psychologically centered interventions for rehabilitation after an ACL injury, and PTs to stay up-to-date with the literature published on the subject, including to implement eventual interventions.
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Affiliation(s)
- Ramana Piussi
- Sportrehab, Sports Medicine Clinic, Gothenburg, Sweden.,Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden
| | - Ferid Krupic
- Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carl Senorski
- Sportrehab, Sports Medicine Clinic, Gothenburg, Sweden
| | - Eleonor Svantesson
- Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - David Sundemo
- Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Urban Johnson
- Centre of Research on Welfare Health and Sport (CVHI), Halmstad University, Halmstad, Sweden
| | - Eric Hamrin Senorski
- Sportrehab, Sports Medicine Clinic, Gothenburg, Sweden.,Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden.,Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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28
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Patterson BE, Barton CJ, Culvenor AG, Cooper RL, Crossley KM. Exercise-therapy and education for individuals one year after anterior cruciate ligament reconstruction: a pilot randomised controlled trial. BMC Musculoskelet Disord 2021; 22:64. [PMID: 33430844 PMCID: PMC7802328 DOI: 10.1186/s12891-020-03919-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/26/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Guided rehabilitation beyond 6-months is rare following anterior cruciate ligament reconstruction (ACLR), despite high prevalence of unacceptable symptoms and quality of life (QoL). Our primary aim was to determine the feasibility of a randomised controlled trial (RCT) evaluating a physiotherapist-guided intervention for individuals 1-year post-ACLR with persistent symptoms. Our secondary aim was to determine if a worthwhile treatment effect could be observed for the lower-limb focussed intervention (compared to the trunk-focussed intervention), for improvement in knee-related QoL, symptoms, and function. DESIGN Participant- and assessor-blinded, pilot feasibility RCT. METHODS Participant eligibility criteria: i) 12-15 months post-ACLR; ii) < 87.5/100 on the Knee injury and Osteoarthritis Outcome Score (KOOS) QoL subscale; and either a one-leg rise test < 22 repetitions, single-hop < 90% limb symmetry; or Anterior Knee Pain Scale < 87/100. Participants were randomised to lower-limb or trunk-focussed focussed exercise and education. Both interventions involved 8 face-to-face physiotherapy sessions over 16-weeks. Feasibility was assessed by eligibility rate (> 1 in 3 screened), recruitment rate (> 4 participants/month), retention (< 20% drop-out), physiotherapy attendance and unsupervised exercise adherence (> 80%). Between-group differences for knee-related QoL (KOOS-QoL, ACL-QoL), symptoms (KOOS-Pain, KOOS-Symptoms), and function (KOOS-Sport, functional performance tests) were used to verify that the worthwhile effect (greater than the minimal detectable change for each measure) was contained within the 95% confidence interval. RESULTS 47% of those screened were eligible, and 27 participants (3 participants/month; 48% men, 34±12 years) were randomised. Two did not commence treatment, and two were lost to follow-up (16% drop-out). Physiotherapy attendance was > 80% for both groups but reported adherence to unsupervised exercise was low (< 55%). Both interventions had potentially worthwhile effects for KOOS-QoL and ACL-QoL, while the lower-limb focussed intervention had potentially greater effects for KOOS-Sport, KOOS-Pain, and functional performance. CONCLUSIONS A larger-scale RCT is warranted. All feasibility criteria were met, or reasonable recommendations could be made to achieve the criteria in future trials. Strategies to increase recruitment rate and exercise adherence are required. The potential worthwhile effects for knee-related QoL, symptoms, and function indicates a fully-powered RCT may detect a clinically meaningful effect. TRIAL REGISTRATION Prospectively registered ( ACTRN12616000564459 ).
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Affiliation(s)
- Brooke E. Patterson
- La Trobe Sport & Exercise Medicine Research Centre, School of Allied Health, Humans Services and Sport, La Trobe University, Bundoora, 3086 Australia
| | - Christian J. Barton
- La Trobe Sport & Exercise Medicine Research Centre, School of Allied Health, Humans Services and Sport, La Trobe University, Bundoora, 3086 Australia
| | - Adam G. Culvenor
- La Trobe Sport & Exercise Medicine Research Centre, School of Allied Health, Humans Services and Sport, La Trobe University, Bundoora, 3086 Australia
| | - Randall L. Cooper
- La Trobe Sport & Exercise Medicine Research Centre, School of Allied Health, Humans Services and Sport, La Trobe University, Bundoora, 3086 Australia
| | - Kay M. Crossley
- La Trobe Sport & Exercise Medicine Research Centre, School of Allied Health, Humans Services and Sport, La Trobe University, Bundoora, 3086 Australia
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29
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Walker A, Hing W, Lorimer A, Rathbone E. Rehabilitation characteristics and patient barriers to and facilitators of ACL reconstruction rehabilitation: A cross-sectional survey. Phys Ther Sport 2021; 48:169-176. [PMID: 33486409 DOI: 10.1016/j.ptsp.2021.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To investigate patient-reported rehabilitation characteristics and barriers to and facilitators of ACL reconstruction rehabilitation. DESIGN Survey-based study. SETTING Online survey platform. PARTICIPANTS Adults 1-20 years post ACL reconstruction (n = 304). MAIN OUTCOME MEASURES 1) rehabilitation characteristics, 2) barriers to and facilitators of rehabilitation. RESULTS Fear of re-injury (43.8%) was the highest rating barrier to rehabilitation adherence, while a good relationship with your rehabilitation provider was regarded as the most important factor (83.6%) in facilitating rehabilitation. Rehabilitation frequency reduced across the duration of rehabilitation from most commonly 1 x week (38.2%) in the first three months to once every month (26%) from 6 to 9 months. Almost all participants (95.7%) consulted a rehabilitation provider for the first six months. Only 43.4% of respondents returned to their previous level of sport. The exploratory analysis identified that low barriers to rehabilitation and a longer duration of supervised rehabilitation are associated with a faster return to sport, greater likelihood of return to previous level of sport and fewer reported ongoing problems with the knee. CONCLUSIONS This cross-sectional survey provides insight into the patient's experience of rehabilitation practices and a patient's perspective on the key barriers to and facilitators of ACL rehabilitation adherence and participation.
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Affiliation(s)
- Adam Walker
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast 4226, Australia.
| | - Wayne Hing
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast 4226, Australia
| | - Anna Lorimer
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast 4226, Australia
| | - Evelyne Rathbone
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast 4226, Australia
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