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Marmura H, Bryant D, Getgood A, Webster F. 'It's just my knee': a qualitative study investigating the process of reframing and young athletes' perceived quality of life between anterior cruciate ligament injury and surgery. BMJ Open 2024; 14:e076799. [PMID: 38724051 PMCID: PMC11086484 DOI: 10.1136/bmjopen-2023-076799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 04/24/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES To understand the factors influencing young athletes' perceptions of quality of life (QOL) following an anterior cruciate ligament (ACL) rupture, prior to reconstructive surgery. DESIGN Qualitative descriptive study using semi-structured interviews and thematic analysis of data. SETTING Tertiary sports medicine clinic with patients recruited from the practices of three specialist orthopaedic surgeons. PARTICIPANTS Twenty athletes aged 14-25 provided consent to participate in the study and completed interviews prior to their ACL reconstruction surgery. Participants were eligible to participate if they were scheduled to undergo ACL reconstruction, were 25 years of age or younger, identified as athletes (participated in any level of organised sport), could communicate in English and agreed to be audio recorded. Participants were not eligible if they had experienced a multiligament injury or fracture. RESULTS Young athletes shared common factors that made up their QOL; social connections and support, sport, health, and independence. However, participants' perceptions of their current QOL were quite variable (13-95/100 on a Visual Analogue Scale). Participants who were able to reframe their injury experience by shifting focus to the positive or unaffected aspects of their lives tended to have more favourable perceptions of their QOL than participants who shifted focus to the losses associated with injury. CONCLUSIONS Young athletes who have experienced an ACL injury define their QOL based on social support, sport, health and independence. Individual processes of adaptation and cognitive reframing in response to an ACL injury may exert a greater influence on postinjury QOL than the physical ramifications of the injury itself. Understanding individual perceptions may help target potential interventions or supports to enhance athletes' adaptation to injury.
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Affiliation(s)
- Hana Marmura
- Faculty of Health Sciences, Western University, London, ON, Canada
- Fowler Kennedy Sport Medicine Clinic, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
- Lawson Research, London Health Sciences Centre, London, ON, Canada
| | - Dianne Bryant
- Faculty of Health Sciences, Western University, London, ON, Canada
- Fowler Kennedy Sport Medicine Clinic, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
- Lawson Research, London Health Sciences Centre, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Alan Getgood
- Faculty of Health Sciences, Western University, London, ON, Canada
- Fowler Kennedy Sport Medicine Clinic, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
- Lawson Research, London Health Sciences Centre, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Fiona Webster
- Faculty of Health Sciences, Western University, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
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Welling W. Return to sports after an ACL reconstruction in 2024 - A glass half full? A narrative review. Phys Ther Sport 2024; 67:141-148. [PMID: 38749349 DOI: 10.1016/j.ptsp.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 06/10/2024]
Abstract
A successful return to sports (RTS) after an anterior cruciate ligament reconstruction (ACLR) is multifactorial, and therefore difficult and challenging. Unfortunately, low percentages of patients RTS, and for those who succeed, one-fifth of patients will sustain a second ACL injury. Over the past years, test batteries were developed to assess whether patients can RTS with a low risk for a second ACL injury risk. Low rates of patients who meet RTS criteria were found, coupled with the insufficiency of current RTS test batteries in predicting second ACL injuries suggesting poor sensitivity. The result of an RTS test is likely to reflect the content of a rehabilitation program, raising critical questions regarding what we are offering patients within the rehabilitation programme. Are we preparing our patients well enough for the high demands of complex situations within pivoting team sports? This narrative review offers insights from key lessons of the last 15 years on 1) RTS testing, 2) the content of rehabilitation, and 3) the RTS continuum, all from a "helicopter perspective".
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Affiliation(s)
- Wouter Welling
- Pro-F Fysiotherapie, Kotkampweg 65, 7531 AS, Enschede, the Netherlands; University of Groningen, University Medical Center Groningen, Center for Human Movement Science, A. Deusinglaan 1, 9713 AV, Groningen, the Netherlands.
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Losciale JM, Truong LK, Zhang K, Silvester-Lee T, Miciak M, Pajkic A, Le CY, Xie H, Hoens AM, Mosewich AD, Hunt MA, Li LC, Roos EM, Whittaker JL. Assessing the efficacy of the Stop OsteoARthritis (SOAR) program: A randomized delayed-controlled trial in persons at increased risk of early onset post-traumatic knee osteoarthritis. Osteoarthritis Cartilage 2024:S1063-4584(24)01151-8. [PMID: 38615974 DOI: 10.1016/j.joca.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE Assess the efficacy of an 8-week virtual, physiotherapist (PT)-guided knee health program (Stop OsteoARthritis (SOAR)) to improve knee extensor strength in individuals at risk of post-traumatic knee osteoarthritis (PTOA). METHOD In this superiority, randomized delayed-control trial, persons aged 16-35 years, 1-4 years after a self-reported knee joint injury were randomly assigned (1:1) to receive the SOAR program immediately (experimental group) or after a 9-week delay (control group). SOAR includes 1) one-time Knee Camp (virtual PT-guided group education, knee assessment, 1:1 exercise and physical activity (PA) goal-setting); 2) Weekly personalized home-based exercise and PA program with tracking; 3) Weekly 1:1 PT counseling (virtual). The primary outcome was a change in isokinetic knee extensor strength (baseline to 9-weeks). Additional outcomes included change in self-reported knee-related quality-of-life (QOL), self-efficacy, self-management and kinesiophobia, and PA (accelerometer) at 9 and 18-weeks. Linear regression models estimated the effect of the 8-week intervention at the primary endpoint (9-week). RESULTS 49 of 54 randomized participants completed the study (91%). Participants were a mean ± standard deviation age of 27 ± 5.0 years, and 2.4 ± 0.9 years post-injury. No mean between group differences for the primary (0.05; 95% confidence interval (CI): -0.10, 0.19) or other outcomes were seen at 9 weeks except for greater improvements in perceived self-management (Partner in Health Scale; 11.3/96, 95%CI: 5.5, 17.1) and kinesiophobia (Tampa Scale of Kinesiophobia; -4.4/33, 95%CI: -7.0, -1.8). CONCLUSION For active persons with elevated risk of PTOA, an 8-week SOAR program did not change knee-related strength, QOL, self-efficacy, or PA, on average, but may benefit the ability to self-manage knee health and kinesiophobia.
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Affiliation(s)
- Justin M Losciale
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Linda K Truong
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Kexin Zhang
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | | | - Maxi Miciak
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Andrea Pajkic
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Christina Y Le
- Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Alberta, Canada
| | - Hui Xie
- Arthritis Research Canada, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Alison M Hoens
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Amber D Mosewich
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Michael A Hunt
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Linda C Li
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Ewa M Roos
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada.
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Kaplánová A. Psychological readiness of football players for the match and its connection with self-esteem and competitive anxiety. Heliyon 2024; 10:e27608. [PMID: 38496851 PMCID: PMC10944273 DOI: 10.1016/j.heliyon.2024.e27608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/02/2024] [Accepted: 03/04/2024] [Indexed: 03/19/2024] Open
Abstract
For athletes, failure in a match is psychologically difficult. Since the movement abilities of athletes are often comparable, it is assumed that one of the key elements of victory is also their psychological readiness. Many experts recommend rigorously examining all factors affecting the performance of football players, especially in matches. The aim of our study is to determine whether a football player's coping with adversity, coachability, motivation to succeed, goal setting, peaking under pressure, or fear of failure are significantly predicted by their self-esteem or a specific aspect of competitive anxiety, which can be crucial for the direction of psychological preparation in collective sports. The research sample consisted of 107 male football players in the age range of 18-29 years registered with the Slovak Football Association, who actively participated in the team's matches. Football players filled out a booklet of psychological tests, including the Athletic Coping Skills Inventory, the Sport Anxiety Scale, and the Rosenberg Self-Esteem Scale. The results of the regression analysis showed that the self-esteem of football players is a significant predictor of achievement motivation and their ability to listen to the coach's instructions. Along with the somatic component of anxiety, it also predicts goal-setting. Cognitive anxiety of football players, characterized by negative thoughts, turned out to be a significant predictor of coping with adversity during a football match and their peaking under pressure, and together with concentration disruption, it also predicts the ability of football players to free themselves from worries about what the audience thinks about their sporting performance in the match.
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Affiliation(s)
- Adriana Kaplánová
- Faculty of Physical Education and Sport, Comenius University in Bratislava, Slovakia
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5
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Ekenros L, Fridén C, von Rosen P. Experiences of rehabilitation in young elite athletes: an interview study. BMJ Open Sport Exerc Med 2023; 9:e001716. [PMID: 37937307 PMCID: PMC10626772 DOI: 10.1136/bmjsem-2023-001716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 11/09/2023] Open
Abstract
Even though injuries are common in elite youth sports, rehabilitation experiences are limited explored in young athletes. This study explored rehabilitation experiences in athletes with a previous injury studying at sports high schools. Twenty-six (14/12 females/males) young elite athletes (age 15-19 years) from 11 individual/team sports were interviewed in focus groups about the rehabilitation experiences following a sports injury. Data were analysed using content analysis. The results led to four main categories identified: 'High-quality rehabilitation', 'Lack of communication between healthcare and coach', 'Various consequences of injury' and 'No clear path to accessing rehabilitation'. The athletes valued that the healthcare providers had high expertise, were clear and signalled secureness and confidence. It was also important to receive help with rehabilitation as rapidly as possible. The athletes perceived that they felt responsible for providing information regarding rehabilitation progression between healthcare providers and their coach. It was also challenging not to be able to participate in training and competition while injured - causing a sense of frustration and fear of falling behind their peer athletes in terms of development and performance. The athletes described that no well-defined medical teams at the sports high schools were available- instead medical help was offered in several other ways. Based on our findings, the collaboration and communication between the healthcare providers and coaches need to be improved, addressing the rehabilitation content, progress and access to rehabilitation. Through these actions, the rehabilitation process will be more adjusted to the needs of young elite athletes.
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Affiliation(s)
- Linda Ekenros
- Department of Neurobiology, Care Sciences, and Society (NVS), Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Fridén
- Department of Neurobiology, Care Sciences, and Society (NVS), Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- School of Health, Care and Social Welfare, Physiotherapy, Mälardalen University, Mälardalen, Västerås, Sweden
| | - Philip von Rosen
- Department of Neurobiology, Care Sciences, and Society (NVS), Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
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Holm PM, Simonÿ C, Brydegaard NK, Høgsgaard D, Thorborg K, Møller M, Whittaker JL, Roos EM, Skou ST. An early care void: The injury experience and perceptions of treatment among knee-injured individuals and healthcare professionals - A qualitative interview study. Phys Ther Sport 2023; 64:32-40. [PMID: 37696196 DOI: 10.1016/j.ptsp.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVES To better comprehend the initial injury experience and care requirements of knee-injured individuals, as well as healthcare professionals' interactions with early care. DESIGN Qualitative interviews. SETTING Public healthcare in Denmark. PARTICIPANTS Ten individuals (6 women) with major knee injuries (6 anterior cruciate ligament (ACL) and meniscal tears, 2 isolated ACL tears, 1 isolated meniscal tear, 1 patella dislocation), aged 16-33 years (median 19 years), 1-26 months post-injury (median 3 months). Thirteen HCPs (5 physiotherapists, 5 orthopedic surgeons, 3 general practitioners). MAIN OUTCOME MEASURE Semi-structured individual and focus group interviews, transcribed verbatim and with latent thematic analysis. RESULTS The three main themes were: 1) Emotional struggles in solitude - knee-injured individuals dealing with emotions alone due to limited HCP resources for emotional support. 2) Blurry beginning - knee-injured individuals finding initial care frustrating, a sentiment shared by HCPs. 3) A journey with no map - knee-injured individuals holding varied outcome expectations, while HCPs hesitate to discuss long-term knee health. CONCLUSION Early care for knee-injured individuals is filled with worries and unmet emotional and information support needs. HCPs need more support and training to deliver timely and appropriate care.
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Affiliation(s)
- Pætur M Holm
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - Charlotte Simonÿ
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Nadia K Brydegaard
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark
| | - Ditte Høgsgaard
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Kristian Thorborg
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark; Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Merete Møller
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Oslo Sports Trauma Research Centre, Norwegian School of Sport Sciences, Oslo, Norway
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Ewa M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Li L, Li Y, Mei Z. A Low Degree of Physical Exercise Adherence in College Students: Analyzing the Impact of Interpersonal Skills on Exercise Adherence in College Students. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01747-7. [PMID: 37682424 DOI: 10.1007/s40615-023-01747-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/25/2023] [Accepted: 08/02/2023] [Indexed: 09/09/2023]
Abstract
Physical exercise adherence (PEA) is multifaceted and significantly influenced by elements such as physical prowess, personality traits, psychosocial traits, and demographics. At present, there are problems such as the low degree of PEA in college students. Studies have shown that exercise adherence (EA) can be improved by adjusting psychological factors. Social abilities are one of the important manifestations of mental health, so this study aims to explore the intrinsic influence mechanism of social abilities on college students' PEA. Shanghai Sports University consistently ranks first among Chinese institutions that specialize in sports in the list of the best Chinese institutions. Therefore, this study decided to survey Shanghai University students. Valid data were collected from 1278 students from 6 universities in Shanghai using a questionnaire survey method. The ordinary least square (OLS) regression analysis technique was utilized in the study. The study has shown that (1) boys have stronger social abilities than girls; (2) the exercise attitude and exercise persistence of junior students are better than those of freshmen and sophomores; (3) social abilities, emotion regulation strategies, exercise needs satisfaction, exercise attitude, and EA were significantly positively associated with each other. Emotion regulation strategies and exercise attitude had a negative predictive effect on PEA, and exercise needs satisfaction and social abilities had a significant predictive effect on exercise adherence. (4) Exercise needs satisfaction and exercise attitude were used as mediating variables to regulate the influence of college students' social abilities on EA.
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Affiliation(s)
- Lingshu Li
- Department of Physical Education, Shanghai International Studies University, Shanghai, China.
| | - Yan Li
- Huzhou No. 5 Middle School Education Group, Huzhou, China
| | - Zi Mei
- School of Education, Shanghai International Studies University, Shanghai, China
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Arhos EK, Pohlig RT, Di Stasi S, Risberg MA, Snyder-Mackler L, Silbernagel KG. Clinically Relevant Subgroups Among Athletes Who Have Ruptured Their Anterior Cruciate Ligaments: A Delaware-Oslo Cohort Study. Arthritis Care Res (Hoboken) 2023; 75:1914-1924. [PMID: 36645015 PMCID: PMC10349896 DOI: 10.1002/acr.25089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 12/12/2022] [Accepted: 01/12/2023] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To identify subgroups of individuals with anterior cruciate ligament (ACL) injuries based on patient characteristics, self-reported outcomes, and functional performance at baseline, and to associate subgroups with long-term outcomes after ACL rupture. METHODS A total of 293 participants (45.7% male, mean ± SD age 26.2 ± 9.4 years, days from injury 58 ± 35) were enrolled after effusion, pain, and range of motion impairments were resolved and quadriceps strength was at least 70% of the uninvolved limb. Mixture modeling was used to uncover latent subgroups without a prior group classification using probabilistic assignment. Variables include demographics, functional testing, and self-reported outcome measures. Radiographic evidence of osteoarthritis (OA; i.e., Kellgren/Lawrence grade of ≥1) in the involved knee at 5 years after injury was the primary outcome of interest. Chi-square tests assessed differences in the presence of radiographic OA in the involved knee between subgroups at 5 years after ACL rupture. Secondary outcomes of interest included radiographic OA in the uninvolved knee, return to preinjury sport by 2 years, operative status, and clinical OA (classified using Luyten et al criteria) at 5 years. RESULTS Four distinct subgroups exist after ACL rupture (younger good self-report, younger poor self-report, older poor self-report, older good self-report) with 30%, 31%, 47%, and 53%, respectively, having involved knee OA. The percentage of radiographic OA was not significantly different between the groups (P = 0.059). CONCLUSION The prevalence of OA in all subgroups is highly concerning. These results suggest there are unique subgroupings of individuals that may guide treatment after ACL rupture and reconstruction by providing support for developing a patient-centered approach.
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Affiliation(s)
| | | | | | - May Arna Risberg
- Oslo University Hospital and Norwegian School of Sport Sciences, Oslo, Norway
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Truong LK, Mosewich AD, Miciak M, Pajkic A, Silvester-Lee T, Li LC, Whittaker JL. "I feel I'm leading the charge." Experiences of a virtual physiotherapist-guided knee health program for persons at-risk of osteoarthritis after a sport-related knee injury. OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 5:100333. [PMID: 36685259 PMCID: PMC9850175 DOI: 10.1016/j.ocarto.2022.100333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/25/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Objective Describe participants' perspectives about the feasibility of a virtual, physiotherapist-guided knee health program for people at risk of post-traumatic osteoarthritis after a sport-related knee injury. Design Qualitative description study nested within a quasi-experimental study evaluating the feasibility of the Stop OsteoARthritis (SOAR) with persons with sport-related knee injuries. SOAR includes: 1) one-time Knee Camp (group education, 1:1 exercise/activity goal-setting); 2) weekly home-based exercise/activity program with tracking, and; 3) weekly 1:1 physiotherapy-guided action-planning. Upon program completion, semi-structured 1:1 interviews were conducted with participants identified by convenience and maximum variation sampling (age, gender, program satisfaction). Open-ended questions elicited participants' experiences with the program. Content analysis was conducted. Results 12 women and 4 men [median (min-max) age; 30 (19-46) years] were interviewed. Four categories depicted participants' experiences: 1) 'SOAR satisfies an unmet need' portrayed the perceived relevance and need for a program that promotes knowledge about knee health and self-efficacy for independent exercise behaviour, 2) 'Regaining control of knee health' described how SOAR empowered participants and fostered a sense of 'leading the charge' to their own knee health, 3) 'Social support encourages exercise participation' highlighted that weekly physiotherapy interactions provided accountability for achieving exercise goals, and that relating to other participants was inspirational, 4) 'Program refinements and barriers' suggested enhancements to meet the needs of future participants. Conclusions Participants report the SOAR program to be acceptable, relevant, and empowering. Improved knowledge about one's knee health, self-efficacy, autonomy, and social support may encourage exercise adherence and self-management of future knee OA risk.
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Affiliation(s)
- Linda K. Truong
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada,Arthritis Research Canada, Vancouver, Canada
| | - Amber D. Mosewich
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada
| | - Maxi Miciak
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Andrea Pajkic
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | | | - Linda C. Li
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada,Arthritis Research Canada, Vancouver, Canada
| | - Jackie L. Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada,Arthritis Research Canada, Vancouver, Canada,Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada,Corresponding author.Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada. #223, 212 Friedman Building 2177 Wesbrook Mall, Vancouver, British Columbia, Canada, V6T 1Z3.
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10
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Whittaker JL, Culvenor AG, Juhl CB, Berg B, Bricca A, Filbay SR, Holm P, Macri E, Urhausen AP, Ardern CL, Bruder AM, Bullock GS, Ezzat AM, Girdwood M, Haberfield M, Hughes M, Ingelsrud LH, Khan KM, Le CY, Losciale JM, Lundberg M, Miciak M, Øiestad BE, Patterson B, Räisänen AM, Skou ST, Thorlund JB, Toomey C, Truong LK, Meer BLV, West TJ, Young JJ, Lohmander LS, Emery C, Risberg MA, van Middelkoop M, Roos EM, Crossley KM. OPTIKNEE 2022: consensus recommendations to optimise knee health after traumatic knee injury to prevent osteoarthritis. Br J Sports Med 2022; 56:1393-1405. [DOI: 10.1136/bjsports-2022-106299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2022] [Indexed: 11/16/2022]
Abstract
The goal of the OPTIKNEE consensus is to improve knee and overall health, to prevent osteoarthritis (OA) after a traumatic knee injury. The consensus followed a seven-step hybrid process. Expert groups conducted 7 systematic reviews to synthesise the current evidence and inform recommendations on the burden of knee injuries; risk factors for post-traumatic knee OA; rehabilitation to prevent post-traumatic knee OA; and patient-reported outcomes, muscle function and functional performance tests to monitor people at risk of post-traumatic knee OA. Draft consensus definitions, and clinical and research recommendations were generated, iteratively refined, and discussed at 6, tri-weekly, 2-hour videoconferencing meetings. After each meeting, items were finalised before the expert group (n=36) rated the level of appropriateness for each using a 9-point Likert scale, and recorded dissenting viewpoints through an anonymous online survey. Seven definitions, and 8 clinical recommendations (who to target, what to target and when, rehabilitation approach and interventions, what outcomes to monitor and how) and 6 research recommendations (research priorities, study design considerations, what outcomes to monitor and how) were voted on. All definitions and recommendations were rated appropriate (median appropriateness scores of 7–9) except for two subcomponents of one clinical recommendation, which were rated uncertain (median appropriateness score of 4.5–5.5). Varying levels of evidence supported each recommendation. Clinicians, patients, researchers and other stakeholders may use the definitions and recommendations to advocate for, guide, develop, test and implement person-centred evidence-based rehabilitation programmes following traumatic knee injury, and facilitate data synthesis to reduce the burden of knee post-traumatic knee OA.
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11
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Gokeler A, Grassi A, Hoogeslag R, van Houten A, Bolling C, Buckthorpe M, Norte G, Benjaminse A, Heuvelmans P, Di Paolo S, Tak I, Villa FD. Return to sports after ACL injury 5 years from now: 10 things we must do. J Exp Orthop 2022; 9:73. [PMID: 35907095 PMCID: PMC9339063 DOI: 10.1186/s40634-022-00514-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/19/2022] [Indexed: 11/11/2022] Open
Abstract
Background The outcome after ACL reconstruction (ACLR) is in general disappointing with unacceptable number of athletes that do not return to pre-injury level of sports, high re-injury rates, early development of osteoarthritis and shorter careers. Athletes after ACLR have high expectation to return to sports which is in contrast with the current outcomes. The aim of this manuscript is to present an overview of factors that are needed to be incorporated and to personalize the rehabilitation process for an athlete who has undergone an ACLR. Level of evidence 4.
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Affiliation(s)
- Alli Gokeler
- Centre for Orthopaedic Surgery and Sports Medicine OCON, Hengelo, The Netherlands. .,Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam Collaboration On Health and Safety in Sports, Amsterdam UMC, Amsterdam, Netherlands. .,Department Exercise and Health, Faculty of Science, Exercise Science and Neuroscience, Paderborn University, Paderborn, Germany.
| | | | - Roy Hoogeslag
- Centre for Orthopaedic Surgery and Sports Medicine OCON, Hengelo, The Netherlands
| | - Albert van Houten
- Centre for Orthopaedic Surgery and Sports Medicine OCON, Hengelo, The Netherlands
| | - Caroline Bolling
- Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam Collaboration On Health and Safety in Sports, Amsterdam UMC, Amsterdam, Netherlands
| | - Matthew Buckthorpe
- Allied Health and Performance Science, St Mary's University, Twickenham, London, England
| | - Grant Norte
- Exercise Science Program, School of Exercise and Rehabilitation Sciences, University of Toledo, Toledo, USA
| | - Anne Benjaminse
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,School of Sport Studies, Hanze University Groningen, Groningen, the Netherlands
| | - Pieter Heuvelmans
- Department Exercise and Health, Faculty of Science, Exercise Science and Neuroscience, Paderborn University, Paderborn, Germany
| | - Stefano Di Paolo
- Dipartimento Di Scienze Biomediche E Neuromotorie DIBINEM, Università Di Bologna, Bologna, BO, Italy
| | - Igor Tak
- Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam Collaboration On Health and Safety in Sports, Amsterdam UMC, Amsterdam, Netherlands.,Sports Physical, Therapy Clinic Fysiotherapie Utrecht Oost, Utrecht, The Netherlands
| | - Francesco Della Villa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Center of Excellence, Bologna, Italy
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12
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Whittaker JL, Truong LK, Losciale JM, Silvester-Lee T, Miciak M, Pajkic A, Le CY, Hoens AM, Mosewich A, Hunt MA, Li LC, Roos EM. Efficacy of the SOAR knee health program: protocol for a two-arm stepped-wedge randomized delayed-controlled trial. BMC Musculoskelet Disord 2022; 23:85. [PMID: 35078446 PMCID: PMC8790851 DOI: 10.1186/s12891-022-05019-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/11/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Knee trauma permanently elevates one's risk for knee osteoarthritis. Despite this, people at-risk of post-traumatic knee osteoarthritis rarely seek or receive care, and accessible and efficacious interventions to promote knee health after injury are lacking. Exercise can ameliorate some mechanisms and independent risk factors for osteoarthritis and, education and action-planning improve adherence to exercise and promote healthy behaviours. METHODS To assess the efficacy of a virtually-delivered, physiotherapist-guided exercise-based program (SOAR) to improve knee health in persons discharged from care after an activity-related knee injury, 70 people (16-35 years of age, 12-48 months post-injury) in Vancouver Canada will be recruited for a two-arm step-wedged assessor-blinded delayed-control randomized trial. Participants will be randomly allocated to receive the intervention immediately or after a 10-week delay. The program consists of 1) one-time Knee Camp (group education, 1:1 individualized exercise and activity goal-setting); 2) weekly individualized home-based exercise and activity program with tracking, and; 3) weekly 1:1 physiotherapy-guided action-planning with optional group exercise class. Outcomes will be measured at baseline, 9- (primary endpoint), and 18-weeks. The primary outcome is 9-week change in knee extension strength (normalized peak concentric torque; isokinetic dynamometer). Secondary outcomes include 9-week change in moderate-to-vigorous physical activity (accelerometer) and self-reported knee-related quality-of-life (Knee injury and OA Outcome Score subscale) and self-efficacy (Knee Self Efficacy Scale). Exploratory outcomes include 18-week change in primary and secondary outcomes, and 9- and 18- week change in other components of knee extensor and flexor muscle function, hop function, and self-reported symptoms, function, physical activity, social support, perceived self-care and kinesiophobia. Secondary study objectives will assess the feasibility of a future hybrid effectiveness-implementation trial protocol, determine the optimal intervention length, and explore stakeholder experiences. DISCUSSION This study will assess the efficacy of a novel, virtually-delivered, physiotherapist-guided exercise-based program to optimize knee health in persons at increased risk of osteoarthritis due to a past knee injury. Findings will provide valuable information to inform the management of osteoarthritis risk after knee trauma and the conduct of a future effectiveness-implementation trial. TRIAL REGISTRATION Clinicaltrials.gov reference: NTC04956393. Registered August 5, 2021, https://clinicaltrials.gov/ct2/show/NCT04956393?term=SOAR&cond=osteoarthritis&cntry=CA&city=Vancouver&draw=2&rank=1.
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Affiliation(s)
- Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
- Arthritis Research Canada, Vancouver, Canada.
| | - Linda K Truong
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Justin M Losciale
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | | | - Maxi Miciak
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Andrea Pajkic
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Canada
| | - Christina Y Le
- Arthritis Research Canada, Vancouver, Canada
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Alison M Hoens
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Amber Mosewich
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Canada
| | - Michael A Hunt
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Linda C Li
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Ewa M Roos
- Department of Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
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13
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Heijne A, Silbernagel KG, Lundberg M. "I don't opt out of things because I think I will get a sore knee, but I don't expose myself to stupid risks either": patients' experiences of a second ACL injury-an interview study. Knee Surg Sports Traumatol Arthrosc 2022; 30:2244-2250. [PMID: 34661692 PMCID: PMC9206613 DOI: 10.1007/s00167-021-06762-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 09/27/2021] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this qualitative study was to describe women's experiences with anterior cruciate ligament reconstruction (ACLR) and a subsequent ACL rupture, and to identify potential facilitators and barriers for coping with rehabilitation after the second injury. METHODS Eight women between 17 and 36 years (mean 26, SD 6.5) who had experienced ACLR, followed by another ACL rupture, participated in the study. Semi-structured interviews were conducted, and data were analyzed using qualitative content analysis. RESULTS One overarching theme, "Rehabilitation after a second ACL injury-A lifelong adaptive coping process", emerged from analyses. Undergoing a second rehabilitation is described as a process of adaptation, beginning with the first injury and still ongoing, more than 5 years later. Participants applied different coping strategies to adapt to these life-altering injuries, but the common denominator was of major life adjustments with no return to previous activity levels. Initially, after the reinjury, it was about coping with the catastrophe of the dreaded second injury. Over time, they accepted their "new" life and reset their recovery/rehabilitation goal not just as "return to sport" but rather as a "personal life goal". CONCLUSION Undergoing a second ACL injury is a long process that challenges the patient's coping skills. Given these results, rehabilitation programs need to be more person centred according to the patients-adjusted life goals.
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Affiliation(s)
- Annette Heijne
- grid.4714.60000 0004 1937 0626Department of Neurobiology, Care Sciences and Sociology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Grävare Silbernagel
- grid.33489.350000 0001 0454 4791Department of Physical Therapy, University of Delaware, Newark, DE USA
| | - Mari Lundberg
- Department of Health Promoting Science, Sophiahemmet University, Box 5605, 11486, Stockholm, Sweden.
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14
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Snyder-Mackler L, Queen RM. ACL special issue, editors. J Orthop Res 2022; 40:7-9. [PMID: 34811792 DOI: 10.1002/jor.25220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Lynn Snyder-Mackler
- Physical Therapy & Biomedical Engineering University of Delaware, Newark, Delaware, USA
| | - Robin M Queen
- Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA
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15
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Whittaker JL, Runhaar J, Bierma-Zeinstra S, Roos EM. A lifespan approach to osteoarthritis prevention. Osteoarthritis Cartilage 2021; 29:1638-1653. [PMID: 34560260 DOI: 10.1016/j.joca.2021.06.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/27/2021] [Accepted: 06/18/2021] [Indexed: 02/02/2023]
Abstract
Prevention is an attractive solution for the staggering and increasingly unmanageable burden of osteoarthritis. Despite this, the field of osteoarthritis prevention is relatively immature. To date, most of what is known about preventing osteoarthritis and risk factors for osteoarthritis is relative to the disease (underlying biology and pathophysiology) of osteoarthritis, with few studies considering risk factors for osteoarthritis illness, the force driving the personal, financial and societal burden. In this narrative review we will discuss what is known about osteoarthritis prevention, propose actionable prevention strategies related to obesity and joint injury which have emerged as important modifiable risk factors, identify where evidence is lacking, and give insight into what might be possible in terms of prevention by focussing on a lifespan approach to the illness of osteoarthritis, as opposed to a structural disease of the elderly. By targeting a non-specialist audience including scientists, clinicians, students, industry employees and others that are interested in osteoarthritis but who do not necessarily focus on osteoarthritis, the goal is to generate discourse and motivate inquiry which propel the field of osteoarthritis prevention into the mainstream.
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Affiliation(s)
- J L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Arthritis Research Canada, Canada.
| | - J Runhaar
- Erasmus MC University Medical Center Rotterdam, Department of General Practice, Rotterdam, the Netherlands.
| | - S Bierma-Zeinstra
- Erasmus MC University Medical Center Rotterdam, Department of General Practice, Rotterdam, the Netherlands; Erasmus MC University Medical Center Rotterdam, Department of General Practice, and Department of Orthopaedics, Rotterdam, the Netherlands.
| | - E M Roos
- Department of Sports Science and Clinical Biomechanics, Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Denmark.
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