Barriers and Facilitators to ACLR Rehab
In a recent survey of 304 non-professional ACLR patients (90% of respondents Australian, nearly 60% female and at the time of surgery average age 25yrs) the authors reported some very interesting findings:
- 21% reported a 2nd ACL injury
- Contralateral 2nd injury was 2x more likely as 2nd ipsilateral graft injury (67% vs 32%).
- Prior to surgery, 87% aimed to return to the pre-injury level of sport; however only 43% of respondents did.
- 41% expected to be back at sport between 9-12 months post-op; 34% did.
- 35% expected to be back at sport between 12-18 months post-op; 38% did.
- 14% did not return to any knee strenuous sport after ACLR.
The biggest barriers to rehab reported by the respondents were: - fears of re-injury during rehab (43%) - not having access to facilities (9.5%) - not having enough time to complete rehab (9%)
When it came to facilitators, a good relationship with rehab provider and regular assessment of progress and function were the 2 main facilitators to rehab deemed important by the respondents.
Compared to those who experienced high levels of barriers to rehab, the low level group were more likely to return to sport by 12 months (47% vs 28%), more likely to return to pre-injury level of sport (67% vs 45%), had no ongoing problems with their knee (25% vs 10%) and were more satisfied with their overall outcome (44% vs 19%).
Furthermore, those that regularly attended their health professional for longer than 9 months (compared to less than 9 months) were more likley to return to sport (92% vs 82%), more likely to return to pre-injury level sport (66% vs 47%) and were more likely to be satisfied with their overall outcome (41% vs 25%).
So some food for thought for us health providers here from this survey; especially when it comes to identifying barriers to rehabilitation and removing them as much as possible.
Simple ways that we can do this as clinicians is to listen to their fears and concerns, reassure the patient and provide them with a safe and effective rehab program with as much supervision as they need or require.
Also listen to the patient and understand their time commitment to rehab and access to facilities; dont create a complicated program that wont get done. For some patients, 2-3 exercises that get done regularly and consistently are better than 6-10 exercises that get done infrequently, or not at all.
What are your thoughts on this survey? Let me know in the comments section below
If you're looking to learn more about ACL rehab, check out Learn.Physio online ACL Masterclasses here