Compliance in post-operative rehabilitation is a key factor for return to sport after revision anterior cruciate ligament reconstruction

Villa, F.; Andriolo, Luca; Ricci, Margherita; Filardo, Giuseppe; Gamberini, Jacopo; Caminati, Daniele; Villa, S.; Zaffagnini, Stefano

doi:10.1007/s00167-019-05649-2

Cited by 39 publications

(26 citation statements)

References 35 publications

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“…11 Positive associations between adherence to ACLR programs and clinical outcomes have been documented in several studies. 6,14,21 This is consistent with the results of this current study that found the higher the patients’ perception for the importance of home program/self-practice, the better the outcome after hip arthroscopy for FAIS.…”

Section: Discussionsupporting

confidence: 91%

Midterm Outcomes and Satisfaction After Hip Arthroscopy Are Associated With Postoperative Rehabilitation Factors

Amar

Martin

Tudor

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Arthroscopic hip-preservation surgery is commonly performed to address nonarthritic sources of hip pain in young, active individuals. However, there is little evidence to support postoperative rehabilitation protocols, including the most appropriate frequency and length of individual formal physical therapy sessions. There is also a lack of information to look at patients’ perceived value of their home program/self-practice in relation to outcomes. Purpose: To investigate postoperative rehabilitation factors after hip arthroscopy related to formal physical therapy and home program/self-practice and their correlation with patient outcomes and satisfaction. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 125 patients who underwent hip arthroscopy for femoroacetabular impingement syndrome and a labral tear (75 men) were included. The mean age was 34.6 ± 14.4 years, and the mean follow-up time was 4.9 ± 1.6 years. Hip Outcome Score–Activities of Daily Living subscale (HOS-ADL) scores, overall satisfaction scores, and factors related to supervised physical therapy and home program/self-practice were collected. Correlations between continuous variables and differences in the length of individual formal physical therapy and patients’ rating of the importance of their home program/self-practice between those who would and those who would not undergo surgery again were assessed. Results: The frequency and length of individual formal physical therapy sessions were significantly correlated with postoperative HOS-ADL scores ( r = 0.22, P = .014; and r = 0.24, P = .007, respectively) and level of satisfaction ( r = 0.24, P = .007; and r = 0.21, P = .02, respectively). The length of individual formal physical therapy sessions was significantly greater in those who noted they would undergo surgery again (35.3 vs 26.3; P = .033). A significant correlation was identified between the rating of the importance of their home program/self-practice and postoperative HOS-ADL scores ( r = 0.29; P = .001) and their level of satisfaction ( r = 0.23; P = .009). There was a significant difference in the rating of the importance of their home program/self-practice between those who would undergo surgery again and those who would not (8.9 vs 7.8; P = .007). Conclusion: Surgeons and physical therapists should emphasize the value of home program/self-practice when it comes to outcomes and may want to encourage their patients to participate in more frequent, longer, formal physical therapy sessions.

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Section: Discussionsupporting

confidence: 91%

Midterm Outcomes and Satisfaction After Hip Arthroscopy Are Associated With Postoperative Rehabilitation Factors

Amar

Martin

Tudor

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…There is consensus in contemporary sports medicine literature that the optimal rehabilitation protocol progresses through phases defined by functional goals. 2,8,11,16,18,40,41 The above-noted findings indicate that patients are receiving the majority of their PT in the early postoperative period after ACLR, when the primary goals of rehabilitation include increasing range of motion, decreasing knee effusion, and quadriceps activation exercises. 2,17,30,39 Based on typical rehabilitation guidelines, and data from previous studies 2,12,41 detailing rehabilitation after ACLR, this distribution of PT visits suggests that later-stage therapy goals (sports-specific training) may not be sufficiently addressed.…”

Section: Discussionmentioning

confidence: 97%

Temporal Utilization of Physical Therapy Visits After Anterior Cruciate Ligament Reconstruction

Burroughs

Kahan

Moore

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Physical therapy (PT) rehabilitation is critical to successful outcomes after anterior cruciate ligament reconstruction (ACLR). Later-stage rehabilitation, including sport-specific exercises, is increasingly recognized for restoring high-level knee function. However, supervised PT visits have historically been concentrated during the early stages of recovery after ACLR. Purpose/Hypothesis: To assess the number and temporal utilization of PT visits after ACLR in a national cohort. We hypothesized that PT visits would be concentrated early in the postoperative period. Study Design: Descriptive epidemiological study. Methods: The Humana PearlDiver database was searched to identify patients who underwent ACLR between 2007 and 2017. Patients with additional structures treated were excluded. The mean ± SD, median and interquartile range (IQR), and range of number of PT visits for each patient were determined for the 52 weeks after ACLR. PT visits over time were also assessed in relation to patient age and sex. Results: In total, 11,518 patients who underwent ACLR met the inclusion criteria; the mean age was 32.62 ± 13.70 years, and 42.7% were female patients. Of this study cohort, 10,381 (90.4%) had documented PT postoperatively; the range of PT visits was 0 to 121. On average, patients had 16.90 ± 10.60 PT visits (median [IQR], 16 [9-22]) after ACLR. Patients completed a mean of 52% of their PT visits in the first 6 weeks, 75% in the first 10 weeks, and 90% in the first 16 weeks after surgery. Patients aged 10 to 19 years had the highest number of PT visits (mean ± SD, 19.67 ± 12.09; median [IQR], 18 [12-25]), significantly greater than other age groups ( P < .001). Conclusion: PT after ACLR is concentrated in the early postoperative period. Physicians, therapists, and patients may consider adjusting the limited access to PT to optimize patient recovery. Clinical Relevance: As supervised PT visits may be limited, the appropriate temporal utilization of supervised PT visits must be maximized. Strategies to ensure sessions for later neuromuscular and activity-specific rehabilitation are needed.

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“…A more external focus also creates an understanding of the applicability of the movement, shifting motivation from extrinsic (outcome-oriented) to intrinsic (inherent satisfaction), which is important for adherence [ 23 ]. Adherence may then also influence physical outcomes by virtue of having performed the exercises [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

Motor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS) after traumatic knee injury: study protocol for an adaptive randomized controlled trial

Cederström

Granér

Nilsson

et al. 2021

Trials

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Background Treatment following traumatic knee injury includes neuromuscular training, with or without surgical reconstruction. The aim of rehabilitation is to restore muscle function and address psychological factors to allow a return to activity. Attention is often on rehabilitation of knee function, but deficiencies often persist. Specific interventions addressing psychological factors are sparing with varying degrees of success. We have developed a novel training program, MOTor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS), which integrates simultaneous psychological training into physical rehabilitation exercises. The MOTIFS model individualizes rehabilitation to increase central nervous system involvement by creating realistic and relevant mental images based on past experiences. We hypothesize that a 12-week MOTIFS training intervention will improve psychological readiness to return to activity and muscle function to a greater extent than current neuromuscular training (Care-as-Usual). Methods This pragmatic 1:1 single assessor-blinded adaptive cumulative cluster-randomized controlled trial will include 106 knee-injured people with a goal of returning to physical activity. Participants are randomized to either the MOTIFS or Care-as-Usual condition. Primary outcomes are the ACL Return to Sport after Injury Scale and change in injured leg hop performance in a side hop task from baseline to 12 weeks. Secondary outcomes include patient-reported outcomes and assessment of muscle function using a hop test battery and Postural Orientation Errors at 12-week follow-up. At 12-month follow-up, patient-reported outcomes are assessed. A sub-group (7-10 in each group) will be interviewed to gain insight into experiences of rehabilitation. Discussion Strengths of this trial include that it is a randomized and pragmatic trial examining commonly under-studied aspects of rehabilitation following a knee injury. The model uses the patient as a reference, creating simultaneous psychological and physical training exercises with easily adopted principles for clinical practice. Limitations include that blinding is limited due to study design, and shifting the clinical paradigm to a more holistic model is a challenge. If successful, the MOTIFS model has implications for a clinically useful, individualized, and patient-relevant method of improving rehabilitation outcomes by integrating psychological training into physical training. Trial registration ClinicalTrials.gov NCT03473821. Registered March 22, 2018, with ethical approval that has been granted (Dnr 2016/413, Dnr 2018/927). Trial status Trial Status: Protocol Version is 2020, Dec 10 – Version 1

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Compliance in post-operative rehabilitation is a key factor for return to sport after revision anterior cruciate ligament reconstruction

Cited by 39 publications

References 35 publications

Midterm Outcomes and Satisfaction After Hip Arthroscopy Are Associated With Postoperative Rehabilitation Factors

Midterm Outcomes and Satisfaction After Hip Arthroscopy Are Associated With Postoperative Rehabilitation Factors

Temporal Utilization of Physical Therapy Visits After Anterior Cruciate Ligament Reconstruction

Motor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS) after traumatic knee injury: study protocol for an adaptive randomized controlled trial

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