Physiotherapy treatment and rehabilitation following anterior cruciate ligament injury in New Zealand: Are we doing enough?

Abstract

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.

Patient acceptance of knee symptoms and function after anterior cruciate ligament reconstruction improves with physiotherapy treatment

“…This prior approval process represents a barrier to receiving additional physiotherapy treatments, as a decision to decline additional funding results in the patient being liable for the full cost of any further physiotherapy treatment, further compounding any financial burden on the patient. Other potential factors preventing engagement in physiotherapy following ACLR include patient-specific barriers (health literacy/understanding of the condition, cultural beliefs, socioeconomic status), provider-specific barriers (patient interactions), and healthcare system barriers (waiting times, location of services, involvement of multiple providers) (Fausett et al, 2019).…”

“…Functional rehabilitation following anterior cruciate ligament reconstruction (ACLR) is considered an effective intervention to increase the likelihood of a patient achieving their post-surgical goals (Lobb et al, 2012). In New Zealand (NZ), physiotherapists typically oversee rehabilitation following ACLR (Fausett et al, 2019). Therefore, the quantity and duration of post-operative physiotherapy treatment likely provides an accurate estimation of the dosage of rehabilitation received following ACLR in NZ.…”

Programa de rehabilitación psicológica de lesión deportiva: una intervención de tercera generación

“…Para Bahr y Maehlum (2004), este proceso se desarrolla a través de tres estadios o fases antes de regresar a competencia: aguda, rehabilitación física y vuelta a entrenamiento. Su éxito está asociado a altos niveles de adherencia al tratamiento (Bassett, 2006;Brewer et al, 2004), aunque aún no hay suficiente evidencia acerca de la relación entre adherencia y tiempo de recuperación ( Hamson-Utley et al, 2008). Para Abenza et al (2009), la adherencia es un determinante importante para lograr el retorno del deportista lesionado a competencia; afirman que, a menor adherencia, mayor peligro de lesión, y que esta tiende a disminuir en procesos largos de rehabilitación, lo mismo que en tratamientos para hacer en casa.…”