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| 2. |
- Gustavsson, Alexander, et al.
(författare)
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A test battery for evaluating hop performance in patients with an ACL injury and patients who have undergone ACL reconstruction
- 2006
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Ingår i: Knee Surg Sports Traumatol Arthrosc. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 14:8, s. 778-88
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to develop a test battery of hop tests with high ability to discriminate (i.e. high test-retest reliability, sensitivity, specificity and accuracy) between the hop performance of the injured and the uninjured side in patients with an ACL injury and in patients who have undergone ACL reconstruction. Five hop tests were analysed: three maximum single hop tests and two hop tests while developing fatigue. Fifteen healthy subjects performed the five hop tests on three separate occasions in a test-retest design. Thirty patients, mean 11 months after an ACL injury and 35 patients, mean 6 months after ACL reconstruction were tested. ICC values ranged from 0.85 to 0.97 for the five hop tests, indicating that all the tests had high test-retest reliability. Sixty-seven percent to 100% of the healthy subjects had normal symmetry (i.e. <10% side-to-side difference) in the five hop tests. Abnormal symmetry in the five hop tests ranged from 43 to 77% for patients with an ACL injury and from 51 to 86% for patients who had undergone ACL reconstruction respectively. The three tests with the highest ability to discriminate hop performance were chosen for the test battery; they were the vertical jump, the hop for distance and the side hop. The test battery revealed a high level of sensitivity and accuracy in patients with an ACL injury (87 and 84%) and in patients who had undergone ACL reconstruction (91 and 88%), when at least one of the three tests was classified as abnormal. To summarise, the test battery consisting of both maximum single hop performances: the vertical jump and the hop for distance and hop performance while developing fatigue: the side hop, produced high test-retest reliability, sensitivity and accuracy. Further, the test battery produced higher values compared with any of the three hop tests individually revealing that only one out of ten patients had restored hop performance 11 months after an ACL injury and 6 months after ACL reconstruction. It is concluded that this test battery showed a high ability to discriminate between the hop performance of the injured and the uninjured side both in patients with an ACL injury and in patients who have undergone ACL reconstruction.
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| 3. |
- Neeter, Camille, 1968, et al.
(författare)
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Development of a strength test battery for evaluating leg muscle power after anterior cruciate ligament injury and reconstruction
- 2006
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Ingår i: Knee Surg Sports Traumatol Arthrosc. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 14:6, s. 571-80
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Tidskriftsartikel (refereegranskat)abstract
- A more sports-specific and detailed strength assessment has been advocated for patients after anterior cruciate ligament (ACL) injury and reconstruction. The purpose of this study was to develop a test battery of lower extremity strength tests with high ability to discriminate between leg power development on the injured and uninjured sides in patients after ACL injury and in patients who have undergone ACL reconstruction. Twenty-three patients were tested 6 months after ACL injury and 44 patients were tested 6 months after ACL reconstruction. Twenty-four of the 44 patients were operated on using a hamstrings graft and 20 patients were operated on using a patellar tendon graft. All the patients performed a test battery of three strength tests for each leg in a randomised order. The three strength tests were chosen to reflect quadriceps and hamstring muscular power in a knee-extension and a knee-flexion test (open kinetic chain) and lower-extremity muscular power in a leg-press test (closed kinetic chain). There was a higher sensitivity for the test battery to discriminate abnormal leg power compared with any of the three strength tests individually. Nine out of ten patients after ACL reconstruction and six out of ten of the patients after ACL injury exhibited abnormal leg power symmetry using the test battery. Thus, this test battery had high ability in terms of discriminating between the leg power performance on the injured and uninjured side, both in patients with an ACL injury and in patients who have undergone ACL reconstruction. It is concluded that a test battery consisting of a knee-extension, knee-flexion and leg-press muscle power test had high ability to determine deficits in leg power 6 months after ACL injury and reconstruction. Only a minority of the patients had restored leg muscle power. The clinical relevance is that the test battery may contribute to the decision-making process when deciding whether and when patients can safely return to strenuous physical activities after an ACL injury or reconstruction.
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| 4. |
- Nilsson-Helander, Katarina, 1957, et al.
(författare)
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The Achilles tendon Total Rupture Score (ATRS): development and validation
- 2007
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Ingår i: The American Journal of Sports Medicine. - : SAGE Publications. - 0363-5465 .- 1552-3365. ; 35:3, s. 421-426
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: There is a need for a patient-relevant instrument to evaluate outcome after treatment in patients with a total Achilles tendon rupture. PURPOSE: To develop and validate a new patient-reported instrument for measuring outcome after treatment for total Achilles tendon rupture. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 1. METHODS: Development of this instrument consisted of item generation and test construction, item reduction, validation, evaluation of structure and internal consistency, test-retest, and test for responsiveness. The final version, the Achilles tendon Total Rupture Score (ATRS), was tested for validity, structure, and internal consistency (Cronbach's alpha) on 82 patients and 52 healthy persons. A correlation analysis was performed of the ATRS with the 2 validated foot/ankle/Achilles tendon scores, the Foot and Ankle Outcome Score (FAOS) and the Swedish version of the Victorian Institute of Sports Assessment-Achilles questionnaire (VISA-A-S). Structure was evaluated with factor analysis. Test-retest reliability was evaluated on 43 patients. The ATRS responsiveness was tested on 43 patients by calculating the effect size. RESULTS: The total score for the patients ranged from 17 to 100 with a mean (median) of 77 (85) and a standard deviation (interquartile range) of 21.4 (23). A significantly (P < .0001) higher total score was found for the healthy subjects, ranging from 94 to 100 with a mean (median) of 99.8 (100) and a standard deviation (interquartile range) of 1.1 (0). The ATRS correlated significantly (P < .01) with all subscales of the FAOS (r = 0.60-0.84) and the VISA-A-S (r = 0.78). The factor analysis gave 1 factor of importance. The internal consistency was 0.96 as measured with Cronbach's alpha. The test-retest produced an intraclass correlation coefficient of 0.98. The tests for responsiveness showed an effect size between 0.87 and 2.21. CONCLUSION: The ATRS is a patient-reported instrument with high reliability, validity, and sensitivity for measuring outcome after treatment in patients with a total Achilles tendon rupture. CLINICAL RELEVANCE: The ATRS is a self-administered instrument with high clinical utility, and we suggest the score for measuring the outcome, related to symptoms and physical activity, after treatment in patients with a total Achilles tendon rupture.
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| 5. |
- Thomeé, Pia, 1955, et al.
(författare)
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A new instrument for measuring self-efficacy in patients with an anterior cruciate ligament injury
- 2006
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Ingår i: Scand J Med Sci Sports. ; 16:3, s. 181-7
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Tidskriftsartikel (refereegranskat)abstract
- It has been suggested that self-efficacy belief is of major importance for rehabilitation outcome after sports-related injuries. No instruments are, however, available to evaluate perceived self-efficacy for prognostic and outcome expectations in patients with an anterior cruciate ligament (ACL) injury. Perceived self-efficacy is defined as a judgment of one's potential ability to carry out a task, rather than a measure of whether or not one actually can or does perform the task. The purpose of this study was to develop a reliable and valid instrument for measuring perceived self-efficacy in patients with an ACL injury. A total of 210 male and female patients with an ACL injury were included in this study. The items were generated by health professionals with long clinical experience of patients with an ACL injury and by discussions with patients. After item analysis and item reduction, based on the results from 88 patients, the final 22-item version of the Knee Self-Efficacy Scale (K-SES) was evaluated in 18 patients for test-retest reliability and in 104 patients for internal consistency and validity. The K-SES was compared with the Multidimensional Health Locus of Control (MHLC), Coping Strategies Questionnaire (CSQ), SF-36 and Knee Injury and Osteoarthritis Outcome Score (KOOS) instruments. A factor analysis was also performed on the K-SES. The test-retest revealed a correlation of r(s)=0.73 between test-days and an intraclass correlation coefficient of 0.75. No significant difference between test-days was found. The internal consistency was 0.94, as calculated with Cronbach's alpha. There were low correlations between the K-SES and MHLC and the K-SES and CSQ, respectively. A strong correlation was found between the K-SES and physical functioning, as measured by the SF-36 (r(s)=0.8). All the sub-scales in the KOOS correlated moderately to strongly (r(s)=0.4-0.7) to the K-SES. The factor analysis produced two factors of importance. Factor one was related to how patients perceived their present physical performance/function, while factor two was related to how patients perceived the future physical performance/prognosis of their knee. Good reliability and good face, content, construct and convergent validity were demonstrated for this new instrument (K-SES) for measuring perceived self-efficacy in patients with an ACL injury. The K-SES is recommended for studies designed to evaluate prognostic and outcome expectations of perceived self-efficacy in patients with an ACL-insufficient knee.
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| 6. |
- Thomeé, Pia, 1955, et al.
(författare)
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A randomized, controlled study of a rehabilitation model to improve knee-function self-efficacy with ACL injury
- 2010
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Ingår i: Journal of sport rehabilitation. - 1056-6716. ; 19:2, s. 200-213
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Tidskriftsartikel (refereegranskat)abstract
- CONTEXT: The Knee Self-Efficacy Scale (K-SES) has good reliability, validity, and responsiveness for patients' perceived knee-function self-efficacy during rehabilitation after an anterior cruciate ligament (ACL) injury. Preoperative knee-function self-efficacy has also been shown to have a predictive ability in terms of outcome 1 y after ACL reconstruction. OBJECTIVE: To evaluate a new clinical rehabilitation model containing strategies to enhance knee-function self-efficacy. DESIGN: A randomized, controlled study. SETTING: Rehabilitation clinic and laboratory. PATIENTS: 40 patients with ACL injuries. INTERVENTION: All patients followed a standardized rehabilitation protocol. Patients in the experimental group were treated by 1 of 3 physiotherapists who had received specific training in a clinical rehabilitation model. These physiotherapists were also given their patients' self-efficacy scores after the initial and 4-, 6-, and 12-mo follow-ups, whereas the 5 physiotherapists treating the patients in the control group were not given their patients' self-efficacy scores. MAIN OUTCOME MEASURES: The K-SES, the Tegner Activity Scale, the Physical Activity Scale, the Knee Injury and Osteoarthritis Outcome Score, and the Multidimensional Health Locus of Control. RESULTS: Twenty-four patients (12 in each group) completed all follow-ups. Current knee-function self-efficacy, knee symptoms in sports, and knee quality of life improved significantly (P = .05) in both groups during rehabilitation. Both groups had a significantly (P = .05) lower physical activity level at 12 mo than preinjury. No significant differences were found between groups. CONCLUSION: In this study there was no evidence that the clinical rehabilitation model with strategies to enhance self-efficacy resulted in a better outcome than the rehabilitation protocol used for the control group.
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| 7. |
- Thomeé, Pia, 1955, et al.
(författare)
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Determinants of self-efficacy in the rehabilitation of patients with anterior cruciate ligament injury
- 2007
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Ingår i: J Rehabil Med. - : Medical Journals Sweden AB. - 1650-1977. ; 39:6, s. 486-92
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To explore physical and psychological measures believed to determine patients' perceived self-efficacy in the rehabilitation of patients with anterior cruciate ligament injury. DESIGN: An explorative descriptive study. PATIENTS: A total of 116 patients with an anterior cruciate ligament deficient or reconstructed knee. METHOD: At one visit; 12 months post-injury/reconstruction, patients reported their perceived self-efficacy on the Knee Self-Efficacy Scale. Thirty-nine other measures related to self-efficacy were also documented. A linear regression model was applied to identify determinants of perceived self-efficacy. RESULTS: 40% of the variance in the complete Knee Self-Efficacy Scale was explained by the Lysholm score, Knee Injury and Osteoarthritis Outcome ScoreSport/Recreation, Internal Locus of Control and Locus of Control by Chance. The variance in patients' present perceived self-efficacy was explained to 41% by the same measures. Perceived self-efficacy of future capability was explained to 38% by the variance in the Lysholm score, Knee Injury and Osteoarthritis Outcome ScoreSport/Recreation, TegnerPresent level and Internal Locus of Control. CONCLUSION: Self-reported symptoms/functions and Internal Locus of Control were the most important determinants of self-efficacy in patients with an anterior cruciate ligament injury. In order to strengthen self-efficacy, these determinants should be considered by the clinicians involved in the rehabilitation.
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| 8. |
- Thomeé, Pia, 1955, et al.
(författare)
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Self-efficacy of knee function as a pre-operative predictor of outcome 1 year after anterior cruciate ligament reconstruction
- 2008
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 16:2, s. 118-27
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Tidskriftsartikel (refereegranskat)abstract
- The knee self-efficacy scale (K-SES) has been shown to have good reliability, validity and responsiveness during rehabilitation for patients' perceived self-efficacy of knee function. Determinants of self-efficacy of knee function 1 year after ACL reconstruction have been found to be the patients' internal locus of control and knee symptoms in sports and recreation. The predictive ability of perceived self-efficacy of knee function measured by the K-SES has not been studied in terms of patient outcome after an ACL reconstruction. The purpose of this study was to explore the potential for pre-operative self-efficacy of knee function measured by the K-SES to predict patient outcome in terms of physical activity, knee symptoms and muscle function 1 year after an ACL reconstruction. Thirty-eight patients were evaluated for outcome in terms of physical activity with the Tegner activity scale and the physical activity scale (PAS), knee symptoms with the Lysholm knee scoring scale and the knee injury and osteoarthritis outcome score (KOOS) and knee function with ability tests for muscle function 1 year after ACL reconstruction. Multiple regression and logistic multiple regression analysis were used to evaluate the K-SES as a possible predictor of outcome. The patients' present perceived self-efficacy of knee function (K-SES(Present)) pre-operatively was a significant predictor (P = 0.016) of the patients returning to their intensity and frequency of physical activity (PAS) 1 year after ACL reconstruction, when adjusted for age, gender and pre-injury physical activity level (Tegner(Pre-injury)) (odds ratio = 2.1). The patients' perceived future self-efficacy of knee function (K-SES(Future)) pre-operatively was a significant predictor (P = 0.045) of their self-rated knee function in sports/recreational activities (KOOS(Sports/recreation)) at the 1-year follow-up, when adjusted for age, gender and Tegner(Pre-injury )(R (2 )=0.25). The pre-operative K-SES(Future) was also a significant predictor (P = 0.023) of the patients' knee-related quality of life (KOOS(Qol)), at the 1-year follow-up, when adjusted for age, gender and Tegner(Pre-injury) (R (2 )=0.23). The pre-operative K-SES(Future) was furthermore a significant predictor of an acceptable outcome 1 year after surgery, on the Lysholm knee scoring scale (P = 0.003, odds ratio = 1.7), as well as on KOOS(Sports/recreation) (P = 0.002, odds ratio = 1.6) and knee-related quality of life (KOOS(Qol)) (P = 0.037, odds ratio = 1.4), when adjusted for age, gender and Tegner(Pre-injury). The pre-operative K-SES(Future) was also a significant predictor (P = 0.04) of an acceptable outcome 1 year after surgery, on the one-leg hop for distance (odds ratio = 2.2), when adjusted for age, gender and Tegner(Pre-injury). In conclusion, this study indicates that patients' perceived self-efficacy of knee function pre-operatively is of predictive value for their return to acceptable levels of physical activity, symptoms and muscle function 1 year after ACL reconstruction.
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| 10. |
- Thomeé, Pia, 1955, et al.
(författare)
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Self-efficacy, symptoms and physical activity in patients with an anterior cruciate ligament injury: a prospective study
- 2007
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Ingår i: Scand J Med Sci Sports. - : Wiley. - 0905-7188. ; 17:3, s. 238-45
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Tidskriftsartikel (refereegranskat)abstract
- Self-efficacy belief may be of major importance for the outcome of rehabilitation after sports-related injuries. A new instrument, the Knee Self-Efficacy Scale (K-SES), was used to evaluate the role of perceived self-efficacy in patients with an anterior cruciate ligament (ACL) injury. The purpose of this prospective exploratory study was to describe the patients' perceived self-efficacy at various times post-injury and surgery, respectively, for responsiveness of the K-SES and to correlate the K-SES score with the patients' subjective symptoms. The purpose was also to describe the influence of gender, age and physical activity on the patients' perceived self-efficacy. Thirty recently injured patients with an ACL-deficient knee and 33 patients who had undergone ACL reconstruction reported their physical activity level and their perceived self-efficacy on four test occasions during a 1-year period. The patients' subjective knee symptoms were documented on two of the test occasions. A significant increase in the K-SES score was seen after injury as well as after surgery, during the course of rehabilitation. Pre-operatively, men's perceived self-efficacy was significantly (P=0.013) higher compared with women's self-efficacy. Patients with a high baseline (pre-injury) physical activity level (Tegner 7-10) perceived their self-efficacy as being significantly (P=0.005) higher pre-operatively compared with patients with a low baseline activity level (Tegner 3-6). "Younger" (age 17-29), recently injured patients, perceived their self-efficacy as being significantly (P=0.034) higher compared with "older" patients (age 30-54). At the 12-month test, 15 of 30 patients with an ACL-deficient knee and 15 of 33 patients who had undergone ACL reconstruction reported that they had returned or nearly returned to their baseline physical activity level. The subjective knee outcome score, as measured by the Knee Injury and Osteoarthritis Outcome Score (KOOS), improved significantly (P<0.01) during rehabilitation, apart from the KOOS subscale of "pain" (P=0.077) for patients who had undergone ACL reconstruction. There was a "low" to "strong" correlation (r(s)=0.0-0.7) between the K-SES and the five subscales in the KOOS. We conclude from the present study that K-SES has good responsiveness with significantly increased self-efficacy during the rehabilitation process for patients with an ACL-deficient knee as well as for patients who had undergone ACL reconstruction. The improvement in perceived self-efficacy could, however, only be partly explained by the improvement in subjective symptoms. Furthermore, self-efficacy differed significantly with gender, age and physical activity level early in the rehabilitation process.
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