| 1. |
- Ardern, Clare, 1985-, et al.
(författare)
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Psychological Aspects of Anterior Cruciate Ligament Injuries
- 2016
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Ingår i: Operative techniques in sports medicine. - : W B SAUNDERS CO-ELSEVIER INC. - 1060-1872 .- 1557-9794. ; 24:1, s. 77-83
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Tidskriftsartikel (refereegranskat)abstract
- Impairment-based evaluation has, until recently, been the mainstay of orthopaedic research in anterior cruciate ligament (ACL) reconstruction. However, participation-based outcomes, in particular returning to sport, have lately garnered increased research attention. This is important because returning to sport is typically a main concern of injured athletes. Recent metaanalyses have demonstrated that the return to sport rate after ACL reconstruction is disappointingly low, and that a range of contextual factors including age, sex, sport participation level, and psychological factors may affect the return to sport rate. Moderate to large effect sizes have been demonstrated for greater psychological readiness to return to sport, and lower fear of reinjury favoring returning to the preinjury level sport after ACL reconstruction. Understanding the relationship between psychological factors and returning to sport is essential in light of the fact that most athletes recover good physical function after surgery, and many athletes with good knee function do not return to sport. Psychological factors are potentially modifiable with appropriate intervention, yet these factors are not systematically addressed in routine postoperative rehabilitation. This review summarizes the recent evidence for the relationship between psychological factors and ACL injury, including recovery from injury and returning to sport. Oper Tech Sports Med 24:77-83 Crown Copyright (C) 2015 Published by Elsevier Inc. All rights reserved.
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| 2. |
- Ardern, Clare, 1985-, et al.
(författare)
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What is the evidence to support a psychological component to rehabilitation programs after anterior cruciate ligament reconstruction?
- 2016
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Ingår i: Current Orthopaedic Practice. - : Wolters Kluwer. - 1940-7041. ; 27:3, s. 263-268
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Forskningsöversikt (refereegranskat)abstract
- One of the main indications for anterior cruciate ligament reconstruction is the athlete’s desire to return to his or her preinjury level of sports. Postoperative rehabilitation has a strong focus on recovery of the physical capabilities necessary to manage a return to sports. On average, athletes achieve good physical function after surgery, based on standard impairment-based and activity-based measures. Yet the return to sports rate is disappointingly low; only two in every three return to their preinjury level sport and only half of the athletes return to competitive sports after surgery. There are a range of factors, many of them nonmodifiable (e.g. age, sex, and preinjury level of competition), that affect returning to a specific sport. However, recent research has identified psychological factors as key influences on returning to sports after anterior cruciate ligament reconstruction. This is particularly important for clinicians given that these factors may be modifiable with appropriate intervention. However, they are not systematically discussed during standard postoperative rehabilitation. In this review, we examine the evidence for the effect of psychological factors on return to sport outcomes after anterior cruciate ligament reconstruction and provide a rationale for the inclusion of interventions that specifically and systematically affect these factors during postoperative rehabilitation.
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| 3. |
- Kvist, Joanna, 1967-, et al.
(författare)
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Natural corollaries and recovery after acute ACL injury : The NACOX cohort study protocol
- 2018
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 8:6
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Anterior cruciate ligament (ACL) injury can result in joint instability, decreased functional performance, reduced physical activity and quality of life and an increased risk for post-traumatic osteoarthritis. Despite the development of new treatment techniques and extensive research, the complex and multifaceted nature of ACL injury and its consequences are yet to be fully understood. The overall aim of the NACOX study is to evaluate the natural corollaries and recovery after an ACL injury. Methods and analysis The NACOX study is a multicentre prospective prognostic cohort study of patients with acute ACL injury. At seven sites in Sweden, we will include patients aged 15-40 years, within 6 weeks after primary ACL injury. Patients will complete questionnaires at multiple occasions over the 3 years following injury or the 3 years following ACL reconstruction (for participants who have surgical treatment). In addition, a subgroup of 130 patients will be followed with clinical examinations, several imaging modalities and biological samples. Data analyses will be specific to each aim. Ethics and dissemination This study has been approved by the regional Ethical committee in Linköping, Sweden (Dnr 2016/44-31 and 2017/221-32). We plan to present the results at national and international conferences and in peer-reviewed scientific journals. Participants will receive a short summary of the results following completion of the study. Trial registration number NCT02931084.
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| 4. |
- Tigerstrand Grevnerts, Hanna, 1981-
(författare)
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Treatment Decision after Anterior Cruciate Ligament Injury, and Evaluation of Measurement Properties of a Patient Reported Outcome Measure
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: After an ACL injury, treatment aims to restore knee function. Evaluation of treatment progress is important, and adequate measurement methods are necessary. The International Knee Documentation Committee- Subjective Knee Form (IKDC-SKF) is a common patient-reported outcome measure (PROM) used after ACL injury. It evaluates symptoms, function and physical activity. The IKDC-SKF had not been translated to Swedish language for use in Swedish clinical and research settings. The measurement properties of the IKDC-SKF had been tested, but no assessment of methodological quality of the studies investigating it, nor compiling of results, was published.Sooner or later after an ACL injury, a treatment decision must be made. Treatment options are either ACL reconstruction (ACLR) plus rehabilitation, or rehabilitation alone. There are guidelines stating that a decision for ACLR should be made if the patient has high activity demands and/or knee instability. It is unclear which factors orthopaedic surgeons and physiotherapists prioritise when recommending ACLR. It is also unclear when the decision for treatment is taken, on what grounds, and how treatment decision correlates to patients reported symptoms and function.Aims: The overall aim of this thesis was to evaluate the measurement properties of a patient-reported measure for evaluation of function after ACL injury and treatment, and to overview the treatment decision process after an ACL injury.Methods: A systematic review was conducted to assess the measurement properties of the IKDC-SKF. The IKDC-SKF was translated from English to Swedish, and the Swedish version was tested for reliability, validity, responsiveness and interpretability.A survey study was conducted, where 98 orthopaedic surgeons and 391 physiotherapists rated 21 predefined factors based on importance to the decision for ACLR. Orthopadic surgeons and physiotherapists rated how important they considered their own, their counterparts’ and patient’s wishes for treatment decision making.In a prospective cohort study, patients with an ACL injury were followed from within 6 weeks up to 12 months after injury. Data regarding treatment chosen, when and why, 11were described and compared to patient-reported pre-injury activity level, instability and function.Results: The English and Swedish version of the IKDC-SKF had good measurement properties and interpretability.Swedish orthopaedic surgeons and physiotherapists considered young age, high activity demands, knee-demanding occupation, and knee instability despite adequate rehabilitation indications to recommend ACLR.An early decision for ACLR was primarily based on high activity demands. A later decision was mainly due to instability and high activity demands. A decision taken later than five months after injury was based mainly on instability.A decision for non-operative treatment taken and maintained during the first 12 months after injury was mainly due to sufficient function or no instability problems, and patients were older than other groups.Conclusions: The patient-reported outcome measurement IKDC-SKF was suitable for evaluation and assessment in patients with ACL injury.ACLR as treatment after an ACL injury was recommended for young patients and/or those with high activity demands (i.e. knee demanding occupation and/or instability despite adequate rehabilitation).An early decision for ACLR was more often based on high activity demands, while later decisions were more often based upon perceived instability. Non-operative treatment decisions were often based upon lack of instability problems or sufficient knee function.Self-reported instability and function during the first three months after ACL injury were no different in patients who chose ACLR treatment or who chose non-operative treatment.
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