Sports Medicine Research: In the Lab & In the Field: Psychological "Insight" into ACL Recovery (Sports Med Res)
Wednesday, March 6, 2013

Psychological "Insight" into ACL Recovery

The Videoinsight Method: Improving Rehabilitation Following Anterior Cruciate Ligament Reconstruction - a Preliminary Study

Zaffafnini S, Russo RL, Muccioli GMM, & Marcacci M. Knee Sug Sports Traumatol Arthrosc. 2013.  Published online January 30, 2013. Epub ahead of print. doi:10.1007/s00167-013-2392-4

Take Home Message: A video of contemporary art, which invokes a positive “insight” that is favorable to psychological recovery, may enhance the rehabilitation process after knee surgery.

Rehabilitation following anterior cruciate ligament (ACL) reconstruction is a relatively long, arduous, physical, as well as mental process.  During ACL rehabilitation, psychological interventions such as imagery, goal-setting, and modeling are effective for improving recovery (e.g., decrease pain, improve function).  A novel psychological intervention not yet tested among patients undergoing ACL rehabilitation is Videoinsight, which includes a video of contemporary art selected with the intent of inspiring “insight” and stimulating psychological changes (e.g., emotions, sensations, learning). Therefore, the purpose of this randomized controlled pilot trial was to compare the effects of Videoinsight to an art video; which did not invoke insight that is favorable to psychological recovery.  A total of 101 patients that were randomized into the Videoinsight (51 patients) or to the control (50 patients) group completed the trial. All patients underwent ACL surgery and were instructed to watch their assigned video 3 times a week for 2 months.  The patients were evaluated pre-operatively and approximately 3 months after ACL surgery. Outcomes of interest were general physical and mental health scores (Short Form-36), physical activity scores (Tegner), subjective International Knee Documentation Committee score for knee-specific symptoms and function, time to full weight bearing, and a score for fear of moving (Tampa Scale for Kinesiophobia).  While patients in both groups improved over time in every score, patients who watched Videoinsight had better patient-reported knee symptoms/function, less fear of moving at follow-up, and a faster time to full weight bearing. 

These findings indicate that images that invoke a positive "insight" may enhance the rehabilitation process.  The authors admitted that they could not pre-profile patients psychologically, which may help determine if certain techniques work more effectively on certain people, thus promoting individualized interventions.  It would be very interesting to see what types of psychogical activities work best in specific subsets of patients. This study reinforces that as clinicians, who aim to promote a safe and rapid return to activity, we need to pay more attention to the psychological component of rehabilitation in all of our patients.  Has anyone integrated any types of psychological interventions within their traditional ACL rehabilitation program?  What things have you found to be successful?

Written by: Nicole Cattano
Reviewed by: Jeffrey Driban

Related Posts:
Zaffagnini S, Russo RL, Marcheggiani Muccioli GM, & Marcacci M (2013). The Videoinsight(®) method: improving rehabilitation following anterior cruciate ligament reconstruction-a preliminary study. Knee Surgery, Sports Traumatology, Arthroscopy PMID: 23361651

3 comments:

Anonymous said...

This is a very interesting technique and I think it should be considered as part of therapy just like the physical therapy is. Sounds similar to the mirror box therapy that is used on amputees suffering from a phantom limb-related phenomena. I broke my ankle playing basketball about a year ago, and for me the most difficult part was having the confidence to trust my ankle being healthy enough to support my weight even weeks after being cleared to play again. Its almost like my brains primary motor Cortex was still telling my ankle "No don't even try it your still hurt" I essentially had to learn to walk,run, and jump again like a little kid making those memories in the hippo campus for the very 1st time.

Anonymous said...

I recently had ACL reconstruction that went very well. However, there were some complications with bleeding that resulted in coagulated blood in my knee and a hematoma on my shin. I was out of work on sick leave for over a month. With my life at a stand-still, I nearly went mad thinking of how 'unproductive' I was and all of the things I was missing out on. It was a very dark time for me. Luckily, I concentrated on reading about some interests I had put on the back-burner and making plans to work towards those goals once I am active again.

Jess Schlesman said...

I think this is a very interesting technique. This should be incorporated in the rehab process for not only ACL reconstruction but any injury as well. I had ACL reconstruction two years ago and remember being scared to start walking again because I didn't trust my knee to bare any weight. I think this idea will be very helpful for athletes looking to regain trust and confidence after an injury.

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