Current perspectives of Australian therapists on rehabilitation and return to sport after anterior cruciate ligament reconstruction: A survey

Ebert, Jay R.; Webster, Kate E.; Edwards, Peter; Joss, Brendan; D’Alessandro, Peter; Janes, Gregory C.; Annear, Peter

doi:10.1016/j.ptsp.2018.12.004

Cited by 41 publications

(51 citation statements)

References 37 publications

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“…Recent literature has emphasised the importance of evaluating post-operative progression against objective and time based criterion; a return to sport decision based on time alone is considered insu cient [8,46]. A recent survey of Australian orthopaedic surgeons and physiotherapists found that when asked about return to sport time, a large proportion of both professions (77% surgeons, 78% physio) do not permit a return earlier than 9-months after ACLR [47,48]. Returning to sport sooner than 9-months has also been suggested to increase the risk of reinjury [46] with some arguing the return should be no earlier than 12-months [49].…”

Section: Clinical and Research Implicationsmentioning

confidence: 99%

The effectiveness of preoperative rehabilitation programmes on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction: a systematic review.

Carter

Littlewood

Webster

et al. 2020

Preprint

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Background To explore the effectiveness of preoperative rehabilitation programmes (PreHab) on postoperative physical and psychological outcomes following anterior cruciate ligament reconstruction (ACLR). Method A systematic search was conducted from inception to November 2019. Randomised controlled trials (RCTs) published in English were included. Risk of bias was assessed using Version 2 of the Cochrane risk-of-bias tool, and the Grading of Recommendations Assessment system was used to evaluate the quality of evidence. Results The search identified 739 potentially eligible studies, three met the inclusion criteria. All included RCTs scored ‘high’ risk of bias. PreHab in all three RCTs was an exercise programme, each varied in content (strength, control, balance and perturbation training), frequency (10 to 24 sessions) and length (3.1- to 6-weeks). Statistically significant differences (p<0.05) were reported for quadriceps strength (one RCT) and single leg hop scores (two RCTs) in favour of PreHab three months after ACLR. One RCT reported no statistically significant between-group difference for pain and function. No RCT evaluated post-operative psychological outcomes. Conclusion Low-quality evidence suggests that PreHab that includes muscular strength, balance and perturbation training offers a small benefit to quadriceps strength and single leg hop scores three months after ACLR. There is no consensus on the optimum PreHab programme content, frequency and length; this requires future consideration including the development of PreHab programmes that consider psychosocial factors and the measurement of relevant post-operative outcomes such as psychological readiness. PROSPERO trial registration number CRD42020162754

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Section: Clinical and Research Implicationsmentioning

confidence: 99%

The effectiveness of preoperative rehabilitation programmes on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction: a systematic review.

Carter

Littlewood

Webster

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Our results have highlighted a potential under-utilisation of physiotherapy treatment following ACL injury and surgery, and prior to ACLR in New Zealand. Physiotherapists consider pre-operative rehabilitation to have an important influence on post-operative outcomes (Ebert, Webster, Edwards, Joss, D'Alessandro, et al, 2018). A structured physiotherapy-led pre-ACLR rehabilitation programme of up to 27 sessions has been shown to be effective and safe, and to improve outcomes two years after ACLR (Alshewaier, Yeowell, & Fatoye, 2017;Eitzen et al, 2010;Eitzen et al, 2009;Failla et al, 2016;Logerstedt et al, 2013).…”

Section: Duration and Quantity Of Physiotherapy Treatmentmentioning

confidence: 99%

“…While many factors potentially influence outcomes after ACL injury and surgery, rehabilitation remains an important variable (Ebert, Webster, Edwards, Joss, D'Allesandro, et al, 2018) and is almost universally recommended (Adams et al, 2012;Ebert, Webster, Edwards, Joss, D'Alessandro, et al, 2018;Lobb, Tumilty, & Claydon, 2012;van Melick et al, 2016). Over 80% of Australian physiotherapists believe six to 12 treatments are required in the first six weeks after ACL surgery (Ebert, Webster, Edwards, Joss, D'Alessandro, et al, 2018), with a physiotherapist review recommended every two weeks (Filbay & Grindem, 2019). Therefore, rehabilitation lasting from nine to 12 months would equate to between 21 and 35 physiotherapy visits within 12 months following ACL surgery.…”

Section: Duration and Quantity Of Physiotherapy Treatmentmentioning

confidence: 99%

“…The cost of private physiotherapy services may influence physiotherapy utilisation (Ebert, Webster, Edwards, Joss, D'Alessandro, et al, 2018). ACL rehabilitation in New Zealand is commonly supplied by private physiotherapy providers, who may charge a co-payment of up to $50 per treatment.…”

Section: Duration and Quantity Of Physiotherapy Treatmentmentioning

confidence: 99%

“…Although the number of ACC-funded physiotherapy treatments under a claim may provide an indication of the amount of rehabilitation the individual received, it cannot be assumed this accurately reflects their total rehabilitation. Other potential sources of rehabilitation include orthopaedic surgeons or other allied health professionals (Ebert, Webster, Edwards, Joss, D'Alessandro, et al, 2018), ACC-funded rehabilitation under VRS, non-clinically led rehabilitation (e.g. fitness trainer or gym instructor), privately funded physiotherapy or self-directed rehabilitation.…”

Section: Duration and Quantity Of Physiotherapy Treatmentmentioning

confidence: 99%

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2019

NZJP

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Functional progression milestones following anterior cruciate ligament reconstruction are more appropriate than time-based criteria: a survey among the ESSKA

Vascellari

Gokeler

Grassi

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose The aim of this study was to report current rehabilitation recommendations after ACL reconstruction in ESSKA community, with a particular focus on the specific criteria utilized to guide activity progression Methods A web-based survey was developed to investigate preferences between time-based and functional ACL reconstruction rehabilitation progression milestones of ESSKA community. Results Eight hundred and twenty completed questionnaires were received. Responders were from 86 different countries worldwide, 63% of them from European countries. Functional criteria were considered more appropriate to decide if a patient can start specific activities/exercises by 67% of the responders. Good core and lower extremity neuromuscular control were the most often used functional criteria for decision-making regarding readiness for sport-specific rehabilitation (66%), sportspecific drills without (65%) and with contact (66%). Strength assessed with an isokinetic dynamometer was considered by about half of the responders a determinant to initiate sport-specific drills without (51%-isokinetic strength, LSI > 80%) and with contact (58%-isokinetic strength, LSI > 85-90%). To determine readiness for sport-specific drills, hop tests were used by 40% of respondents for drills without contact and 48% of respondents for drills with contact. ConclusionThe results of this survey involving mainly orthopaedic surgeons indicate that functional measures are considered more appropriate than milestones based on time from surgery to guide progression through the postoperative rehabilitation process after ACLR. The main clinical relevance of this study is that updated information on collective agreement could be useful for clinicians and physiotherapists to delineate their postoperative treatments after ACLR. These results should be interpreted with caution, as this sample represents only a small portion of ESSKA community involved in knee surgery and treating patients following ACLR. Level of evidence III.

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Current perspectives of Australian therapists on rehabilitation and return to sport after anterior cruciate ligament reconstruction: A survey

Cited by 41 publications

References 37 publications

The effectiveness of preoperative rehabilitation programmes on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction: a systematic review.

The effectiveness of preoperative rehabilitation programmes on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction: a systematic review.

Untitled

Functional progression milestones following anterior cruciate ligament reconstruction are more appropriate than time-based criteria: a survey among the ESSKA

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