Physiotherapists are lead providers of rehabilitation following anterior cruciate ligament injury in New Zealand. Rehabilitation is considered an essential component following anterior cruciate ligament injuries, but there is considerable variability regarding preand post-operative management. This study used data from the Accident Compensation Corporation (ACC) for the years 2013/14 to 2015/16 to gain insight into the physiotherapy management of anterior cruciate ligament injuries in New Zealand. Data were extracted from 647 claims from people with a completed anterior cruciate ligament reconstruction and 221 claims from people with a confirmed injury who did not undergo surgery. In the 12 months following either anterior cruciate ligament injury or surgery, 81% of claimants had fewer than 15 ACC-funded physiotherapy treatments, and 13% of claimants had no ACC-funded physiotherapy treatments. Nine percent of claimants had a previous or subsequent claim for an anterior cruciate ligament injury. Compared to best practice literature, the results indicate a significant number of people in New Zealand received fewer than the recommended number of physiotherapy treatments following anterior cruciate ligament injury. Possible reasons may include the cost of private physiotherapy services, a lack of endorsement from the respective orthopaedic surgeons, decreased patient adherence/motivation and decreased patient understanding of the importance of rehabilitation.
Physiotherapy is considered an important component of rehabilitation following anterior cruciate ligament reconstruction (ACLR). The relationship between physiotherapy treatment and patient-reported outcomes following ACLR in New Zealand (NZ) is not clear. We used repeated measures logistic regression to examine the relationship between patient-reported outcome data from the NZ ACL Registry and physiotherapy treatment data from the Accident Compensation Corporation (ACC). Outcome measures utilised were the patient acceptable symptom state (PASS) on the Knee Injury Osteoarthritis and Outcome Score (KOOS 4 ) and a normative score on the Marx Activity Rating Scale (MARS) within 24 months of ACLR. Data from 5,345 individuals were included in the final analysis, with a mean (SD) of 11.7 (10.5) (range 0-91) physiotherapy treatments received, over an average (SD) of 185 (153) (range 0-725) days, in the two years following ACLR. Physiotherapy treatment post-ACLR increased the likelihood of achieving a KOOS 4 PASS score at 6 and 12 months, but not at 24 months, following surgery. Physiotherapy did not increase the likelihood of achieving a normative MARS score in the 24 months after ACLR. Multiple factors likely contribute to people who have had an ACLR in NZ receiving a low dosage of physiotherapy treatment following surgery. Physiotherapy treatment after ACLR may increase patient acceptance of any post-surgical symptoms and functional limitations, but the effect on post-operative activity levels is less clear.
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