Alarming underutilisation of rehabilitation in athletes with anterior cruciate ligament reconstruction: four ways to change the game

Grindem, Hege; Arundale, Amelia; Ardern, Clare L

doi:10.1136/bjsports-2017-098746

Cited by 34 publications

(25 citation statements)

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“…The probability of a patient completing rehabilitation to discharge was significantly associated with a longer duration of physiotherapy, an increased number of attended sessions, and the CONTROL model of care ( Table 6 ). There is currently no ideal duration or dose of physiotherapy identified in the literature 9,13,16,21 . In this study, 'completion' of physiotherapy indicated that the treating physiotherapist discharged the patient from the service.…”

Section: Logistic Regressionsmentioning

confidence: 99%

“…Variation in rehabilitation exists with respect to setting, progression, duration and return to functional activities and sport 8,15,16 The literature suggests ACLR rehabilitation should address several factors including range of motion (ROM), muscle function (neuromuscular control, strength, endurance, power), performance and psychological factors 8,19,23,25 . Additionally, there is good evidence that rehabilitation should be progressive in nature and based on the achievement of objective outcomes and a battery of 2 tests used to determine readiness for discharge and return to sport 5,8,16,19,23 . Suggested tests include strength measurement of several muscle groups, hop tests and movement quality assessment.…”

Section: Introductionmentioning

confidence: 99%

“…The optimal length of supervised rehabilitation post ACLR is currently unclear due to a lack of high-quality studies 9,19 . Literature suggests many ACLR patients receive insufficient rehabilitation due to early discharge from services or inadequate content of rehabilitation 16 . The level of individual physiotherapists' experience and knowledge regarding evidence-based recommendations varies, and when considering the public healthcare setting, rehabilitation services are provided with finite resources.…”

Section: Introductionmentioning

confidence: 99%

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Evolution of Service Metrics and Utilisation of Evidence-Based Outcome Measures in Anterior Cruciate Ligament Reconstruction Rehabilitation: An Observational Review of Two Cohorts in a Public Hospital Physiotherapy Department

Tuckerman

Potts

Ebrahimi³

et al. 2020

Preprint

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Objective: Determine in patients undergoing supervised rehabilitation post ACL reconstruction in a public hospital, whether a new model of care incorporating a phase-based program, compared to standard care, increased physiotherapist utilisation of outcome measures, improved service metrics such as attendance and rehabilitation completion rates, as well as increased self-reported knee function and activity levels. Methods: Patients attending outpatient physiotherapy after ACL reconstruction at a metropolitan public hospital (N = 132) were included in retrospective chart review to assess utilisation of outcomes such as quadriceps and hamstrings strength assessment, patient attendance and rehabilitation completion. Phone followup (minimum one year) was conducted to retrieve patient-reported measures of knee function (IKDC) and activity (Tegner Activity Scale). Patients were categorised by rehabilitation model of care (contemporary - time based [N = 93] vs new - phase based [N = 39]) and logistic regression used to assess the influence of patient factors and model of care on outcomes. Results: Patients included for analysis were aged 25 years at surgery (IQR 20.3 - 30.8), with 42.4% of non-Australia country of origin. Compliance was equivalent between models of care and completion rates (formally discharged by therapist) were low (30-38%). The probability of a patient receiving strength assessment was significantly associated with model of care, sex, BMI and the number of sessions attended. The probability of a patient being recorded as discharged from the program was significantly associated with the model of care, as well as the duration and number of sessions. Conclusion: The transition to a new model of care incorporating a phase-based rehabilitation program increased physiotherapist utilisation of certain evidence-based outcome measures, increased total duration of rehabilitation and increased the total number of sessions attended. Despite this, rehabilitation completion rates remained low, and no change was demonstrated with respect to self-reported knee function and activity levels.

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Section: Logistic Regressionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evolution of Service Metrics and Utilisation of Evidence-Based Outcome Measures in Anterior Cruciate Ligament Reconstruction Rehabilitation: An Observational Review of Two Cohorts in a Public Hospital Physiotherapy Department

Tuckerman

Potts

Ebrahimi³

et al. 2020

Preprint

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“…While the surgeon is responsible for the surgery, the physiotherapist should lead the decision-making in rehabilitation (van Melick et al, 2016). Good communication between the surgeon and physiotherapist is essential following ACL injury (Grindem et al, 2018) to overcome any potential disconnect between providers (von Aesch, Perry, & Sole, 2016).…”

Section: Duration and Quantity Of Physiotherapy Treatmentmentioning

confidence: 99%

“…Physical rehabilitation lasting up to 12 months is recommended after ACLR to restore function and stability to the knee (Adams et al, 2012;Zadro & Pappas, 2018), and to optimise post-surgical outcomes (Grindem, Granan, et al, 2015). Recent evidence suggests people may not be completing sufficient post-ACLR rehabilitation before returning to pre-injury activities Grindem, Arundale, & Ardern, 2018). Irrespective of how an ACL injury is managed, a significant percentage of people do not return to pre-injury activity levels (Ardern, Taylor, Feller, & Webster, 2014;Øiestad, Holm, & Risberg, 2018;Webster & Feller, 2018), or they suffer a subsequent ACL injury (Crawford, Waterman, & Lubowitz, 2013;Lai, Ardern, Feller, & Webster, 2017;Wright, Magnussen, Dunn, & Spindler, 2011).…”

Section: Introductionmentioning

confidence: 99%

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2019

NZJP

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An exploration of UK student physiotherapists' goal setting practices within anterior cruciate ligament rehabilitation

Alexanders

Chesterton

Brooks

et al. 2020

Musculoskeletal Care

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Background Anterior cruciate ligament (ACL) injuries are a common and complex injury coupled with a lengthy rehabilitation. Goal setting is said to be an effective psychological tool within ACL rehabilitation due to its simplicity and is commonly used amongst sport and health professionals. To date, literature surrounding goal setting practices has only focused on qualified therapists. Purpose The central aim of this study was to explore UK student physiotherapists' perceptions towards goal setting practices used in ACL rehabilitation and whether they feel prepared for practice. Method Semi‐structured interviews involving 11 participants from one UK university was conducted using an inductive approach. Data analysis included thematic analysis with triangulation and a comprehensive five‐stage analysis process to enhance confirmability and credibility, whilst respecting ethical considerations. Results/Discussion Participants reported some understanding of goal setting and the importance of involving the patient during this process. However, participants negatively experienced goal setting practices as being mainly therapist/protocol led. The training participants received on goal setting was minimal, but further training was welcomed by all participants. The findings were consistent with previous UK and international research surrounding inadequate education and training across sport and health professionals when applying goal setting practice within ACL rehabilitation. Conclusion These findings suggest that, initially, a review of the psychological content of sport and health professional courses is warranted to clearly identify potential knowledge gaps. There is also an opportunity whereby a global specialist interest group could be designed to share psychological practices and globally connect like‐minded sport and health professionals together.

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Alarming underutilisation of rehabilitation in athletes with anterior cruciate ligament reconstruction: four ways to change the game

Cited by 34 publications

References 10 publications

Evolution of Service Metrics and Utilisation of Evidence-Based Outcome Measures in Anterior Cruciate Ligament Reconstruction Rehabilitation: An Observational Review of Two Cohorts in a Public Hospital Physiotherapy Department

Evolution of Service Metrics and Utilisation of Evidence-Based Outcome Measures in Anterior Cruciate Ligament Reconstruction Rehabilitation: An Observational Review of Two Cohorts in a Public Hospital Physiotherapy Department

Untitled

An exploration of UK student physiotherapists' goal setting practices within anterior cruciate ligament rehabilitation

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