Applying ethical standards to guide shared decision-making with youth athletes

Ardern, Clare L; Grindem, Hege; Ekås, Guri Ranum; Seil, Romain; McNamee, Mike

doi:10.1136/bjsports-2018-099183

Cited by 9 publications

(12 citation statements)

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“…Our findings can be used to inform clinicians and support them in shared decision making. 4 This case series may be a useful reference for expected outcomes among children with ACL injuries after progressing through our treatment algorithm and can be used to inform patients and their caretakers. However, in this study, we closely followed the patients to be able to change our treatment approach if active rehabilitation did not provide adequate knee function.…”

Section: Clinical Relevancementioning

confidence: 99%

Coping With Anterior Cruciate Ligament Injury From Childhood to Maturation: A Prospective Case Series of 44 Patients With Mean 8 Years’ Follow-up

et al. 2018

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Background: There is no consensus regarding the best treatment approach for skeletally immature children with anterior cruciate ligament (ACL) injuries. High-quality studies with long-term follow-up are lacking, and evidence to support decision-making is limited. Purpose: To evaluate functional and patient-reported outcome, surgical history and complications in young adults who sustained an ACL injury before the age of 13 years and were treated with active rehabilitation and the option of delayed ACL reconstruction if needed. Study design: Prospective case seriesMethods: Forty-six children younger than 13 years of age with a total, intrasubstance ACL injury were included. None of these patients had additional injuries that warranted early surgery. At final followup at mean 8 years after time of injury, 44 patients remained in the study. The same test battery was conducted at baseline, 1 and 2 years and at final follow-up at approximately 18 years of age. The test battery included functional tests (hop tests and isokinetic muscle strength tests of quadriceps and hamstrings), patient-reported outcome measures (including the Knee and Osteoarthritis Outcome Score KOOS and the International Knee Documentation Committee Subjective Knee form IKDC) and clinical examination. Medical records were reviewed to assess surgical history and complications. Results: At mean 8 years follow-up, 24 patients (55 %) had undergone ACL reconstruction, and 16 patients (36 %) had undergone meniscal surgery. Quadriceps muscle strength symmetry was above 90 % for 30 patients (68 %). Mean leg symmetry indexes for hop and strength tests were consistently above 90 %, except for the single hop and hamstrings muscle strength for ACL-reconstructed patients. Mean IKDC scores were 86.3 ± 13.7 for the ACL-reconstructed patients and 90.6 ± 11.8 for the non-reconstructed patients. Forty patients (91 %) remained active in sports, but 29 patients (66 %) reduced their activity level to non-pivoting sports.Conclusion: Active rehabilitation may have a role in treatment of ACL injured children. Approximately 50 % of children may cope well even through to adulthood without a surgical intervention. The other half may develop instability which warrants ACL reconstruction and one third may require meniscal surgery.

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Section: Clinical Relevancementioning

confidence: 99%

Coping With Anterior Cruciate Ligament Injury From Childhood to Maturation: A Prospective Case Series of 44 Patients With Mean 8 Years’ Follow-up

et al. 2018

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“…In sports medicine, efforts should be made to consider long-term outcome, especially for young athletes. Cost-effectiveness and risk assessment must be considered, and an assessment of the appropriateness of the stakeholders to make the decision, as well as the appropriateness of the decision itself6,10 .…”

mentioning

confidence: 99%

Treatment Decision after Anterior Cruciate Ligament Injury, and Evaluation of Measurement Properties of a Patient Reported Outcome Measure

Grevnerts

2019

Linköping University Medical Dissertations

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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 joint 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. Orthopaedic surgeons and physiotherapists rated how important they considered their own and each other's assesments 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,

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“…The physiotherapist may be uniquely skilled in overseeing the process of ensuring that the patient becomes accustomed, adjusted or acclimated to future impactful life situations [1,2]. By necessity, the patient recovery focus should evolve from comparatively shorter term, relatively quicker basic activity of daily living achievement to the successful achievement of longer term rehabituation goals.…”

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confidence: 99%

“…This indeed is a lofty, and perhaps unrealistic goal. However, it also represents a large portion of the benefits that physiotherapists with contributions from other professionals such as nutritionists, strength coaches, athletic trainers, nurses, sports psychologists and others are uniquely trained to provide [1,2]. If these rehabilitative needs are not provided by this inter-professional team, the stage may be set for the patient to experience a future of additional injuries, further surgery and/or rehabilitation, unfulfilled expectations and a suddenly steeper downward spiral toward greater impairments, functional limitations, disabilities and a reduced health-related quality of life.…”

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confidence: 99%

“…To achieve effective post-surgical and rehabilitation outcomes at 2 (early), 5 (intermediate) and more than 10 years (long-term) post-intervention warrants a better understanding of the potential influence of all others who interact with the patient and the activities that the patient engages in over these extended time periods [1,2]. Although the physiotherapist may no longer be regularly treating the patient at this time, they should continue to interact with them at least from a consultatory or advisory perspective.…”

mentioning

confidence: 99%

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