Background
Home exercise regimes are a well-utilised rehabilitation intervention for many conditions; however, adherence to prescribed programmes remains low. Digital interventions are recommended as an adjunct to face-to-face interventions by the National Health Service in the UK and may offer increased exercise adherence, however the evidence for this is conflicting.
Method
A systematic review was undertaken using MEDLINE and CINAHL databases using the PRISMA guidelines. Randomised controlled trials in any clinical population evaluating the adherence to prescribed home exercise interventions with and without additional digital interventions were included. Publication quality was assessed using the Cochrane Risk of Bias tool.
Results
The search strategy returned a total of 1336 articles, of which 10 randomised controlled trials containing data for 1117 participants were eligible for inclusion. 565 participants were randomised to receive the interventions, and 552 to the control. Seven of the ten trials reported a significant difference in adherence between the control and intervention groups favouring an additional digital intervention. Three trials reported equivalent findings. These three reported longer-term outcomes, suggesting an interaction between adherence and duration of intervention. There was substantial heterogeneity in outcome assessment metrics used across the trials prohibiting formal meta-analysis. This included studies were of low to moderate quality in terms of risk of bias.
Conclusion
The addition of a digital interventions to prescribed home exercise programmes can likely increase exercise adherence in the short term, with longer term effects less certain.
Introduction
Outcomes of anterior cruciate ligament reconstruction (ACLR) are well reported in athletic populations, however surprisingly little information is available for outcomes in 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.
Method
A systematic search was conducted in Ovid MEDLINE, CINAHL, AMED and the grey literature according to the 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). Mean follow-up was 43.6-months (SD 42.8). Functional activity change was reported in 92% (12/13) papers. Functional outcome was assessed with the Tegner activity score in seven studies, with 43% (3/7) reporting a post-operative improvement. The Lyshom score was used in five, of which, 60% (3/5) showed post-operative improvement, 20% (1/5) showed no difference and 20% (1/5) showed a decrease. 69% (9/13) studies reported return-to-sport, with a mean rate of 55% (S.D. 19.2) at a mean follow-up of 32-months (SD. 34.8). Reported return-to-sports rate increased with length of follow-up.
Conclusions
Approximately only 50% of recreational athletes increase activity level and return-to-sport following ACLR. There is wide variation in return-to-sports timeframes reported, and the link between return-rate and post-operative timeframe suggests that longer follow-up periods may be required to accurately capture return-to-sport rates in recreational athletes.
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