The role of the external factors on anterior cruciate ligament rehabilitation
Darain, H. (2014) The role of the external factors on anterior cruciate ligament rehabilitation, no. 334.
Rehabilitation programme following anterior cruciate ligament (ACL) reconstruction is multifaceted and may be influenced by a variety of factors. The role of the environment for care and the levels of supervision from physiotherapists on the outcomes of ACL rehabilitation, have not received robust attention in the literature. In this thesis, two trials were carried out to investigate the role of these factors on the outcomes of ACL rehabilitation. In the first trial, a total of 76 patients [hospital-based rehabilitation group, n = 48 (age: mean ± sd: 31.5 ± 12.1 yr, height: 1.74 ± 0.06 m, body mass: 78.2 ± 10.8 kg, waiting time: 37.3 ± 33.7 months) and community-based rehabilitation group, n = 28 (age: mean ± sd: 34.5 ± 9.9 yr, height: 1.71 ± 0.07 m, body mass: 75.2 ± 12.4 kg, waiting time: 31.1 ± 26.7 months)] self-selected themselves into the hospital- and the community-based rehabilitation programmes. The patients in both the hospital- and the community-based rehabilitation programmes were assessed by selected patient-reported outcome measures (PROMs) included IKDC, KOOS, K-SES, VAS and Lysholm at four different occasions (pre-surgery and at the 6th, 12th and 24th weeks post-surgically). Significant differences at early phase of rehabilitation (up to 12th week post-surgery) on PROMs of function, favouring the outcomes of the hospital-based rehabilitation programme compared to the community-based rehabilitation programme, were observed. However, no differences between the outcomes of the latter two programmes were observed across 24 weeks rehabilitation programme following ACL reconstruction. This suggested that community-care had offered a similar environment to the hospital for achieving the outcomes of rehabilitation. In the second trial, the patients in the hospital-based rehabilitation programme (n=48) were iii further randomly allocated to the fully-supervised and the minimally-supervised rehabilitation groups [ fully-supervised rehabilitation group, n=24 (age: mean ± sd: 32.2 ± 11.1 yr, height: 1.73 ± 0.07 m, body mass: 75.8 ± 10.7 kg, waiting time: 35.8 ± 29.4 months), minimally-supervised rehabilitation group, n=24 (age: mean ± sd: 31.0 ± 13.2 yr, height: 1.75 ± 0.06 m, body mass: 80.6 ± 10.7 kg, waiting time: 28.8 ± 25.1 months)]. The patients in both the fully-supervised and the minimally-supervised rehabilitation groups were assessed on four different occasions (pre-surgery and at the 6th, 12th and 24th week post-surgery) on estimates of function (single-leg hop), physical performance (peak force, rate of force development, sensorimotor performance and electromechanical delay) and musculoskeletal performance (anterior tibio-femoral displacement) alongside the selected PROMs. Significant differences during the early phase of rehabilitation (up to 12th week post-surgery), favouring outcomes of the fully-supervised rehabilitation programme on some aspects and the outcomes of the minimally-supervised rehabilitation programme on other aspects, were observed. However, similar knee function across 24 weeks rehabilitation was observed on the selected objective measures and PROMs amongst the outcomes of the latter two rehabilitation programmes. This indicated that the outcomes of ACL rehabilitation had not influenced by the levels of supervision from the physiotherapists. In short, the environment and the levels of supervision from rehabilitation team were less likely to influence the final outcomes of ACL rehabilitation.