Questions and Answers
What were the objectives of the pre-operative treatment phase?
What was the mean treatment duration during the pre-operative phase?
7.27 weeks
What was the most used psychological test during the post-operative phase? ACL-___
RSI
What is the common sports injury discussed in the content?
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Why is surgery generally recommended for patients with ACL tear participating in sports involving jumping, cutting, or pivoting movements?
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What percentage of patients expect to return to sport (RTS) at the pre-injury level?
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True or False: There is wide variability in clinical practice among physiotherapists treating patients with ACLR in various countries.
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What were physiotherapists treating fewer than six ACLR patients per year more likely to include as a criterion for Return to Running (RTR)?
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Physiotherapists with more than six years of experience were more likely to consider sport-specific tests as important criteria for Return to Sport (RTS).
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What percentage of physiotherapists reported using Open Kinetic Chain (OKC) exercises during ACLR rehabilitation?
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According to the study, physiotherapists with less than six years of experience were more likely to consider strength and __________ tests as important criteria for Return to Sport (RTS).
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What was the most frequently reported reason for not implementing re-injury prevention strategies?
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What was the mean number of physiotherapy treatments during rehabilitation?
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Match the Patient-Reported Outcome Measures with their names:
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Physiotherapists with post-graduate certification in sports physiotherapy were less likely to use Patient-Reported Outcome Measures (PROMs).
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Study Notes
Anterior Cruciate Ligament Reconstruction
- Anterior cruciate ligament (ACL) tear is a common sports injury that hinders athletes from returning to their sports activity.
- Surgery is generally recommended for patients involved in sports that involve jumping, cutting, or pivoting movements, such as football.
- Approximately 90% of patients who sustain an ACL rupture expect to return to sport at the pre-injury level.
Rehabilitation and Return to Sport
- There is no specific, detailed consensus on the optimal rehabilitation content after anterior cruciate ligament reconstruction (ACLR).
- Physiotherapists should comply with current guidelines for ACLR and return to sport (RTS) to achieve "good clinical practice".
- Rehabilitation after injury is a continuum process, requiring shared decision-making throughout.
- Assessment of both physical condition and psychological readiness is generally recommended throughout rehabilitation to achieve successful RTS.
Current Clinical Practice in Switzerland
- To investigate current clinical practice of Swiss physiotherapists treating patients with ACLR.
- The study aimed to assess optimisation strategies in clinical practice and the barriers to these optimisations.
- It was hypothesised that there is wide variability in rehabilitation practice among physiotherapists in Switzerland.
Survey Results
- 247 physiotherapists participated in the study, with a mean treatment frequency of 1.82 (±0.74) per week, and a mean treatment duration of 7.27 (±6.47) weeks.
- Only a minority of physiotherapists treated patients during the pre-operative rehabilitation phase.
- 91% of physiotherapists included quadriceps open kinetic chain exercise in their treatment.
- 37% used patient-reported outcomes measures (PROMs) and 39% considered psychological criteria when making decisions about RTS.
- Most physiotherapists (67%) felt limited due to the time available, the number of prescriptions, and the tariffication system.
Post-Operative Phase
- Most physiotherapists reported seeing patients for the first time post-operatively after 4–7 days.
- The most important criteria for return to running (RTR) activities were quality of neuromuscular control, pain, and quadriceps strength.
Return to Sport
- The most important results for return to sport showed that among physiotherapists who considered sport-specific tests to be important criteria for RTS, 60.5% did not perform them.
- The ACL-RSI was the most used psychological test, and quadriceps strength was mainly assessed with leg press, squat test, and knee extension seated test.### Demographics of Physiotherapists
- 247 physiotherapists participated in the study, with 78 from France, 161 from Germany, and 8 from Italy
- Mean age of physiotherapists: 36.3 years
- 58.1% of physiotherapists were female, and 41.9% were male
- 56.7% of physiotherapists did not have a post-graduate certification in sports physiotherapy
- Mean number of years treating ACLR (anterior cruciate ligament reconstruction) patients: 10.5 years
- Mean number of ACLR patients treated per year: 10.9
Importance of Pre-Operative Rehabilitation
- 52% of physiotherapists considered pre-operative rehabilitation as very important
- 45% of physiotherapists considered pre-operative rehabilitation as rather important
- Only 4% of physiotherapists considered pre-operative rehabilitation as rather unimportant
- No physiotherapists considered pre-operative rehabilitation as not important
Objectives of Pre-Operative Treatment Phase
- Strengthening of the quadriceps: 82%
- Resorption of post-traumatic oedema: 80.7%
- Psychological preparation of the patient for surgery and post-operative rehabilitation: 79.4%
- Improvement of neuromuscular control: 79.4%
- Strengthening of the hamstring: 75%
- Improvement of mobility in extension: 74.6%
- Patient education: 70.6%
- Improvement of mobility in flexion: 49.6%
Re-Injury Prevention Strategies
- 91% of physiotherapists judged re-injury prevention strategies as important
- 64% of physiotherapists reported implementing re-injury prevention strategies
- The most commonly used strategies were FIFA11+ (48.7%) and individualized programs (37.3%)
Post-Operative Phase
- Mean duration of rehabilitation: 10.58 months
- Mean number of physiotherapy treatments during rehabilitation: 47.61
- 91% of physiotherapists used Open Kinetic Chain (OKC) quadriceps exercise during rehabilitation
- Mean time to begin OKC quadriceps exercise: 9.74 weeks
- 37% of physiotherapists used Patient-Reported Outcome Measures (PROMs) during rehabilitation
Return to Sport
- 91.1% of physiotherapists considered hop tests as important criteria for return to sport
- 84.6% of physiotherapists considered strength tests as important criteria for return to sport
- 62.8% of physiotherapists considered time, number of months post-operative, as important criteria for return to sport
- 59.5% of physiotherapists considered sport-specific tests as important criteria for return to sport
- 55.5% of physiotherapists considered balance tests as important criteria for return to sport
Optimisation Strategies and Barriers
- Physiotherapists judged their mean overall treatment quality as 6.2 on a 10-point scale
- 87% of physiotherapists reported a need for changes in their current clinical practice
- 67.2% of physiotherapists felt limited in their current treatment practice of ACLR
- The main limiting factors in current practice were the lack of criteria-based rehabilitation and challenges in the implementation of pre-operative physiotherapy
Subgroup Analysis
- Physiotherapists with post-graduate certification in sports physiotherapy were more likely to use PROMs, the Y-Balance test for return to sport, and to consider agility tests as important criteria for return to sport
- Physiotherapists treating more than six ACLR patients per year were more likely to consider strength tests as important criteria for return to sport and to use PROMs
- Physiotherapists with less than six years of experience were more likely to consider strength and psychological tests as important criteria for return to sport, use PROMs, and assess knee mobility and effusion for return to sport### OKC Exercise in Rehabilitation
- A higher rate of OKC exercise is reported during rehabilitation compared to Closed Kinetic Chain (CKC) exercises.
- This rate is higher than similar studies in Greece (64.3%) and Belgium (38.3%).
Safety of OKC Exercise
- OKC exercise is safe when integrated progressively during rehabilitation.
- It does not lead to more graft complications.
Quadriceps Strength and Function
- Quadriceps strength is strongly associated with patient function.
- Important deficits in quadriceps strength are still present many months post-operatively.
- These deficits can persist even after two years or more.
Subgroup Analysis of Post-Graduate Certification
- Having post-graduate certification does not influence objective testing, rehabilitation duration, or consideration of important criteria for return to sport.
- However, there are significant differences in the use of Y-Balance Test and PROMs between post-graduate certified and non-certified practitioners.
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Quiz on clinical practices and barriers faced by Swiss physiotherapists in treating patients with anterior cruciate ligament reconstruction.
