Patient and Parent Perceptions of Rehabilitation Factors That Influence Outcomes After Anterior Cruciate Ligament Reconstruction and Clearance to Return to Sport in Adolescents and Young Adults

Abstract

Background Wide variation in outcomes after anterior cruciate ligament reconstruction (ACLR) exists among adolescents and young adults. However, little evidence is available regarding key rehabilitation factors that may be driving these differences. Objective To explore patient and parent perceptions of key rehabilitation drivers related to outcomes after ACLR. Methods In this qualitative study, which used an interpretive phenomenological methodology, semi-structured interviews were conducted with patients who had returned to sport after ACLR and with their parents. The interviews asked about respondents' experience with physical therapy and how it related to their outcomes after ACLR. The interviews were recorded, transcribed, and coded. Themes were then identified using open and axial coding processes. Results There were 3 primary themes that patients and parents perceived as key factors influencing their rehabilitation outcomes after ACLR: (1) patient attributes (ie, motivation, confidence, accountability, access to resources, and social support), (2) physical therapist-patient relationship qualities (physical therapist as guide, motivator, booster of confidence, fosterer of perseverance, and coordinator of care), and (3) elements of the system (ie, availability and utilization of therapy visits, clinic environment, and coordination among care providers). Conclusion Patient and parent perspectives of key drivers that influence ACLR rehabilitation outcomes include patient, therapist, and system factors. Developing specific strategies to target these factors may enhance patient and parent perceptions of the experience. The awareness gained from these results provides a foundation for future studies examining how these factors affect outcomes and how to improve rehabilitation after ACLR. Level of Evidence Therapy, level 3. J Orthop Sports Phys Ther 2019;49(8):576–583. Epub 13 Feb 2019. doi:10.2519/jospt.2019.8608

The Influence, Barriers to and Facilitators of Anterior Cruciate Ligament Rehabilitation Adherence and Participation: a Scoping Review

“…Fifteen original studies were included in the analysis. Eight studies used a qualitative methodology [15,20,[80][81][82][83][84][85], four mixed methods [30,[77][78][79], one pilot RCT [61], one case series [71] and one prospective cohort study [86]. Fifty-five raw themes were categorised into three overall themes (environmental, personal and Methodological quality refers to the outcome or presence of the quality appraisal undertaken by the review not the authors of this study.…”

“…Of the 20 included original studies regarding supervised rehabilitation frequency, eight studies were retrospective [15,20,30,61,71,[77][78][79][80][81][82][83][84][85][86] Other factors 0 3 [30,70,87] Bold text highlights the two main categories in design, seven randomised controlled trials (RCT), three prospective, one cross-sectional and one case report ( Table 3). The mean age was 27.6 (21.4-35.5).…”

“…Furthermore, it appears warranted to consider the contextual and personal factors of rehabilitation programs that may act as barriers to or facilitators of rehabilitation. Increased awareness and understanding of these factors may offer new insights and opportunities to improve long-term ACL reconstruction outcomes and enhance clinicians' ability to provide patient-centred care [15].…”

Developing a psychological support intervention to help injured athletes get Back in the Game

“…Young athletes toiling in rehabilitation get bored and lose motivation during the long rehabilitation period. [29, 54] They feel frustrated when rehabilitation does not focus on sports performance,[14, 15] and concerned about their body’s ability to cope with the demands of their sport. [56] Anxiety about the consequences of sustaining the knee injury again often besets athletes as they work towards returning to sport.…”

Comparison of efficacy and safety of different fixation devices for anterior cruciate ligament reconstruction

“…[6–8] The incidence of ACL injury in Sweden is about 7000 cases per year and nearly 200,000 ACL injuries per year in the United States. [9–11] With the increase in sports injuries and traffic accidents, we can predict that the incidence of ACL injuries is gradually increasing. ACL injury can lead to limited function, osteoarthritis after knee trauma, secondary damage to meniscus and cartilage, and impaired quality of life.…”