Anterior cruciate ligament (ACL) rupture occurs most commonly in young and active individuals and can have negative long-term physical and psychological impacts. The diagnosis is made with a ...combination of patient's history, clinical examination, and, if appropriate, magnetic resonance imaging. The objectives of management are to restore knee function, address psychological barriers to activity participation, prevent further injury and osteoarthritis, and optimize long-term quality of life. The three main treatment options for ACL rupture are (1) rehabilitation as first-line treatment (followed by ACL reconstruction (ACLR) in patients, who develop functional instability), (2) ACLR and post-operative rehabilitation as the first-line treatment, and (3) pre-operative rehabilitation followed by ACLR and post-operative rehabilitation. We provide practical recommendations for informing and discussing management options with patients, and describe patient-related factors associated with a worse ACL-rupture outcome. Finally, we define evidence-based rehabilitation and present phase-specific rehabilitation recommendations and criteria to inform return to sport decisions.
To compete in lightweight rowing, strict limits are placed on the maximum body weight of each individual. As a result, lightweight rowers commonly restrict calorie intake despite high energy ...expenditure. This can result in Relative Energy Deficiency in Sport (RED-S). The aim of this study is to investigate the physical and psychosocial impact of RED-S, from the perspective of lightweight rowers.
Semi-structured individual qualitative interviews.
Adults living in the United Kingdom who are current or former lightweight rowing participants and experienced ≥1 symptom of RED-S.
Audio-recorded semi-structured individual telephone interviews were performed. Data was analysed using an inductive thematic approach, coding was iterative and data-driven, facilitated by NVivo software.
Twelve current or former lightweight rowers (intermediate to international standard, 67% female, aged 19-32 years) participated. Participants restricted calories and increased energy expenditure to elicit weight-loss in order to meet weight requirements. This resulted in psychosocial implications (reduced social interaction, difficulty maintaining relationships, poor emotional regulation, low mood, poor concentration, disordered eating, guilt and anxiety around food, and a negative body image). Some psychosocial implications persisted after retirement from lightweight rowing. Participants described a range of physical implications, including disrupted sleep, decreased performance and recovery, bowel disruption, menstrual dysfunction, fatigue, musculoskeletal pain, injury and weakened immune systems.
This study describes short and long-term physical and psychosocial impacts of RED-S from the perspective of lightweight rowers. Findings highlight the importance of effective RED-S prevention and management strategies for lightweight rowers. These findings may be used to educate health-care professionals, coaches and athletes on the personal impacts and serious health consequences of RED-S.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract Questions: How do people with knee symptoms describe their quality of life and experiences 5 to 20 years after anterior cruciate ligament reconstruction (ACLR)? What factors impact upon the ...quality of life of these people? Design: Qualitative study. Participants: Seventeen people with knee symptoms 5 to 20 years after ACLR and high (n = 8) or low (n = 9) quality of life scores were recruited from a cross-sectional study. Methods: Semi-structured telephone interviews were conducted and transcribed. The data obtained from the interventions underwent inductive coding and thematic analysis. Results: Four consistent themes emerged from the interviews as common determinants of quality of life following ACLR: physical activity preferences; lifestyle modifications; adaptation and acceptance; and fear of re-injury. All participants described the importance of maintaining a physically active lifestyle and the relationship between physical activity and quality of life. Participants who avoided sport or activity reported experiencing reduced quality of life. Participants who suppressed or overcame re-injury fears to continue sport participation described experiencing a satisfactory quality of life while taking part in sport despite knee symptoms. For some participants, resuming competitive sport resulted in subsequent knee trauma, anterior cruciate ligament re-rupture or progressive deterioration of knee function, with negative impacts on quality of life following sport cessation. Participants who enjoyed recreational exercise often adapted their lifestyle early after ACLR, while others described adapting their lifestyle at a later stage to accommodate knee impairments; this was associated with feelings of acceptance and satisfaction, irrespective of knee symptoms. Conclusion: Activity preferences, lifestyle modifications and fear of re-injury influenced quality of life in people with knee symptoms up to 20 years following ACLR. People with a preference for competitive sport who do not enjoy recreational exercise might be at heightened risk of poor quality of life outcomes and could benefit from support to facilitate a transition to a physically active, satisfying lifestyle. Filbay SR, Crossley KM, Ackerman IN (2016) Activity preferences, lifestyle modifications and re-injury fears influence longer-term quality of life in people with knee symptoms following anterior cruciate ligament reconstruction: a qualitative study. Journal of Physiotherapy 62: 103–110
To investigate the knowledge and management of Relative Energy Deficiency in Sport (RED-S), from the perspective of lightweight rowers and physiotherapists.
Semi-structured individual qualitative ...interviews.
Physiotherapists who had worked with lightweight rowers, and current and former lightweight rowers (who had experienced at least one symptom of RED-S), undertook audio-recorded semi-structured telephone interviews. An inductive thematic analysis was performed, facilitated by NVivo software.
Twelve physiotherapists (n = 6 females, 1–20 years of experience managing lightweight rowers) and twelve lightweight rowers (n = 8 females, 1–8 years lightweight rowing experience, intermediate to elite/international level) were interviewed. Five key themes were identified: insufficient knowledge of RED-S, inadequate RED-S education, inappropriate management of RED-S, referral to other health professionals, prioritising performance over health. Participants provided suggestions for improving knowledge and management of RED-S in lightweight rowers, including formal physiotherapy education and training, and targeted education for athletes and coaches.
There was a significant lack of awareness of RED-S amongst physiotherapists and lightweight rowers. Most physiotherapists were not confident discussing or managing RED-S in athletes, and lightweight rowers were dissatisfied with the management they received. Improving RED-S education for physiotherapists and athletes may have important health implications for lightweight rowers.
•Physiotherapists working with lightweight rowers had insufficient knowledge of RED-S•Lightweight rowers described poor management of RED-S and a culture that prioritised performance over athlete healthpoor management of RED-S and a culture that prioritised performance over athlete health•These findings highlight a need for strategies to educate physiotherapists and lightweight rowers about RED-S.
Widespread misinformation and unsubstantiated claims1 have fuelled misconceptions among clinicians and the public regarding anterior cruciate ligament (ACL) injury management options. Patient ...characteristics associated with favourable ACL injury outcomes appear to differ depending on whether someone is managed with surgery or rehabilitation.9,10 The limited research available suggests greater self-efficacy, better preoperative knee function, and an isolated ACL rupture might be associated with a favourable outcome after ACL reconstruction.9,11–13 However, few studies have investigated prognostic factors for a favourable outcome in people undergoing rehabilitation for ACL injury. Two randomised controlled trials found that early ACL reconstruction was not cost-effective for people with acute ACL injury14,15 and did not have a clinically meaningful effect on 2-year or 5-year outcomes compared with rehabilitation and optional delayed ACL reconstruction.3–5 However, on the basis of the findings from the ACL SNNAP trial, ACL reconstruction can be recommended for people with long-standing knee instability and no previous rehabilitation presenting within the UK National Health Service or an equivalent health service.
Purpose
To translate the ACL-QOL from English to Swedish and evaluate measurement properties for use after surgical and non-surgical management of anterior cruciate ligament (ACL) injury.
Methods
The ...ACL-QOL was translated from English to Swedish and data were pooled from 13 cohorts to enable a comprehensive evaluation of measurement properties in line with COSMIN guidelines. We evaluated internal consistency, test–re-test reliability, measurement error, structural validity confirmatory factor analysis (CFA), construct validity and responsiveness (hypothesis testing), and floor/ceiling effects. Results were stratified by time since injury (≤ 1.5 years; 2–10 years, 15–25 years; > 30 years) and ACL management strategy surgical (
n
= 1163), non-surgical (
n
= 570).
Results
The Swedish ACL-QOL had sufficient internal consistency (total and domain scores) for use in surgically managed (Cronbach’s alpha ≥ 0.744) and non-surgically managed (≥ 0.770) ACL-injured individuals at all time-points. Test–re-test reliability was sufficient intraclass correlation coefficients: all domains > 0.80, total score 0.93 (95% CI 0.86–0.96). The standard error of measurement was 5.6 for the total score and ranged from 7.0 to 10.3 for each domain. CFA indicated sufficient SRMR values when using the total score or five domains; however, CFI and RMSEA values did not meet cut-offs for good model fit. Hypothesis testing indicated sufficient construct validity and responsiveness. Floor effects were negligible and ceiling effects were negligible or minor.
Conclusion
The Swedish version of the ACL-QOL has sufficient internal consistency, test–re-test reliability, construct validity and responsiveness, for use in people with ACL injury managed with or without ACL surgery. Model fit could be improved and investigation into the source of misfit is warranted.
Background and purpose - 1 in 5 patients are dissatisfied following unicompartmental or total knee arthroplasty (UKA or TKA). This may be partly explained by failing to return to desired activity ...post-arthroplasty. To facilitate return to desired activity, a greater understanding of predictors of return to desired activity in UKA and TKA patients is needed. We compared rates of return to desired activity 12 months following UKA vs. TKA, and identified and compared predictors of return to desired activity 12 months following UKA vs. TKA.
Patients and methods - Patients were prospectively recruited from 2 hospitals prior to undergoing UKA or primary TKA. Patients reported preoperatively the activity/activities that were limited due to their knee that they wished to return to after arthroplasty. At 12-months postoperatively, patients reported whether they had returned to these activities ('return to desired activity'). Preoperative predictors evaluated were age, sex, BMI, education, comorbidities, pain expectations, Oxford Knee Score (OKS), UCLA Activity Score, and EQ-5D. Generalized linear models assessed the relationship between potential predictors and return-to-desired-activity.
Results - The response rate of all patients eligible for 12-month follow-up was 74%. TKA patients (n = 575) were older (mean (SD) 70 (9) vs. 67 (10)) with a greater BMI (31 (6) vs. 30 (5)) than patients undergoing UKA (n = 420). 75% of UKA and 59% of TKA patients returned to desired activity. TKA patients had a greater risk of non-return to desired activity than patients undergoing UKA (risk ratio (95% CI) 1.5 (1.2-1.8)). Predictors of non-return to desired activity following UKA were worse OKS (0.96 (0.93-0.99)), higher BMI (1.04 (1.01-1.08)), and worse expectations (1.9 (1.2-2.8)). Predictors of non-return to desired activity following TKA were worse EQ-5D (0.53 (0.33-0.85)) and worse OKS (0.98 (0.96-1.0)).
Interpretation - UKA patients were more likely to return to desired activity than TKA patients. Predictors of return to desired activity differed following UKA and TKA. Optimizing selection of arthroplasty procedure based on patient characteristics and targeting predictors of poor outcome may facilitate return to desired activity with potential to enhance postoperative satisfaction.
Celotno besedilo
Dostopno za:
DOBA, FSPLJ, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Sports participants are faced with the decision to continue or cease play when injured. The implications of playing sport while injured on joint health and health-related quality of life (HRQoL) has ...not been investigated. The purpose of this study was to investigate the relationship between having played sport while injured and HRQoL, osteoarthritis, and persistent joint pain; and compare findings in elite and recreational cricketers.
The Cricket Health and Wellbeing Study cohort was used for this study. Inclusion criteria were: age ≥ 18 years, played ≥1 cricket season. Questionnaire data collected included a history of playing sport injured, SF-8 (physical (PCS) and mental (MCS) component scores), physician-diagnosed osteoarthritis, and persistent joint pain (most days of the last month). Multivariable linear regressions and logistic regressions were performed. Continuous covariates were handled using fractional polynomials. Models were adjusted for age, sex, cricket-seasons played, playing status, joint injury, and orthopaedic surgery. All participants (n = 2233) were included in HRQoL analyses, only participants aged ≥30 years (n = 2071) were included in osteoarthritis/pain analyses.
Of the 2233 current and former cricketers (mean age: 51.7 SD 14.7, played 30 IQR 24 cricket seasons, 60% were current cricketers, 62% played recreationally; median PCS: 51.4 IQR 9.0; MCS: 54.3 IQR 8.6) 1719 (77%) had played sport while injured. People who had played sport injured reported worse adjusted PCS (Effect(95% CI): - 1.78(- 2.62, - 0.93) and MCS (- 1.40(- 2.25, - 0.54), had greater odds of osteoarthritis (adjusted OR(95% CI): 1.86(1.39, 2.51) and persistent joint pain (2.34(1.85, 2.96)), compared to people who had not played sport injured. Similar relationships were observed regarding PCS, osteoarthritis and pain in elite and recreational subgroups. Playing injured was only related to worse MCS scores for elite cricketers (- 2.07(- 3.52, - 0.63)); no relationship was observed in recreational cricketers (- 0.70(- 1.79, 0.39)).
Cricketers that had played sport injured had impaired HRQoL, increased odds of osteoarthritis and persistent joint pain, compared to those who had not played sport injured. Playing sport injured was only related to impaired mental-components of HRQoL in elite cricketers. The long-term impact of playing while injured on musculoskeletal health, should be considered when advising athletes on their ability to compete following injury.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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