Sports Medicine Research: In the Lab & In the Field: Want Better Clinical Outcomes? Try to Motivate Your Patient (Sports Med Res)


Wednesday, October 5, 2016

Want Better Clinical Outcomes? Try to Motivate Your Patient

Psychological factors are important to return to pre-injury sport activity after anterior cruciate ligament reconstruction: expect and motivate to satisfy.

Sonesson S, Kvist J, Ardern C, Osterberg A, and Silbernagel KG. Knee Surg Sports Traumatol Arthrosc. 2016. [Epub Ahead of Print].

Take Home Message: Patients who return to pre-injury activities one year after an anterior cruciate ligament (ACL) reconstruction reported being more motivated prior to and during the rehabilitation process to return to these activities than athletes who did not return to pre-injury activities.

Rehabilitation after an ACL injury is a long and arduous process, which athletes may not be mentally prepared for. Gaining a better understanding of an athlete’s expectations may help better serve these patients. Therefore, authors completed a prospective cohort study to describe individuals’ expectations, motivations, and satisfaction, before, during and after rehabilitation for an ACL reconstruction. The authors recruited 65 patients who sustained a unilateral ACL injury. Among these participants, 43 completed the 52-week follow-up questionnaire. All participants were between 15 and 45 years of age and had no previous ACL reconstruction or other co-commit injury. All participants received a hamstring graft and underwent ~3 months of structured rehabilitation prior to surgery. Prior to surgery participants completed a study specific questionnaire and the Swedish International Knee Documentation Committee Subjective form. These questionnaires were also completed at 16 and 52 weeks post-surgery. The authors found that prior to surgery most participants felt prepared for rehabilitation (95%) and stated their goal was to return to pre-injury levels of activity (86%) and that this was of great importance to them. Participants who returned to pre-injury activity levels at one-year post-surgery were more likely to indicate it was possible to return to pre-injury level of activity before surgery and were motivated to return to pre-injury activities during the rehabilitation process. Finally, the authors found that participants who returned to their desired level of activity were more satisfied with their activity level and knee function at 1 year.

The authors suggest that motivation during the rehabilitation process plays a key role in a patient’s success in returning to their desired level of activity. A patient who was highly motivated was more likely to return to their pre-level of activity. While interesting it should also be noted that perhaps the less motivated patients had no desire to return to the pre-injury level of activity. Unfortunately, these patients also ended up unsatisfied with their clinical results. Hence, if clinicians harness and affect patient motivation then they may have greater success improving outcomes or returning their patients to their desired level of activity. This could be especially helpful for patients who are not motivated immediately after an injury. Rather than focus on motivating them to return to pre-injury activities we could motivate them towards other goals to help them get better outcomes. While it was not the purpose of the current study, future research should explore how clinicians could affect a patient's motivation. Furthermore, future research may also benefit from better understanding what factors and characteristics define a self-motivated athlete compared to a less motivated individual. In short, this research could lead to clinicians identifying patients who need motivational support prior to and during the rehabilitation process and intervene with a program that increases a patient's motivation to achieve better outcomes. Until this research is completed, clinicians should first and foremost discuss a patient’s expectations prior to surgery and rehabilitation. Clinicians may also wish to focus not only on the physical rehabilitation of a patient but should also be wary of patients with low motivation. It is important to educate our patients about their chances of returning to pre-injury level of activities and what it will take to achieve those goals. Clinicians then need to recognize how that patient may best be motivated to achieve their goals.

Questions for Discussion: How do you motivate students during the rehabilitation process? What strategies have you found particularly helpful in increasing a patient motivation?

Written by: Kyle Harris
Reviewed by:  Jeffrey Driban

Related Posts:
Articular Cartilage Damage and Long-term Changes After an ACL Tear

Sonesson S, Kvist J, Ardern C, Österberg A, & Silbernagel KG (2016). Psychological factors are important to return to pre-injury sport activity after anterior cruciate ligament reconstruction: expect and motivate to satisfy. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA PMID: 27562372


Kelly Martin said...

In order to motivate student athletes throughout the rehabilitation process, I like to do rehab exercises along with them if at all possible. I find that this shows that you care about the athlete and are willing to put in the work right beside them, which tends to increase compliance. Additionally, I like to make “games” out of rehab when possible to put a creative spin on an exercise. (For example, when working on a fractured phalanx, the athlete and I would have marble races, where we would place marbles into a container while working on opposition ROM and strength in a controlled and safe environment). Although this may take extra time on the part of the clinician, it may have the ability to make a difference on the behalf of the patient. I think that a portion of the motivation to get back to sport can definitely come from the athletic trainer investing time, interest, and conversation into the rehabilitation that is performed by the student athlete.
This particular article used hamstring grafts only. With that being said, I am curious to see if future research could find a correlation between type of graft and motivation outcomes post surgery to see if there is a decline or increase in one graft versus the other. To go even further - what types of motivation protocols produce the most optimal outcomes for RTP. Additionally, this article only looked at PROs and subjective questionnaires, and if the athlete was pre-injury RTP. I think it may be beneficial to have performance outcomes and objective measures included in a study of this nature to see if any correlation exists. Overall this is an interesting article and helps to explore the more psychological aspect of ACL injuries.

Kyle said...


Thanks for the great comment! I agree that making rehab into competition can be very motivating for athletes as they are typically extremely competitive in nature. Your suggestion of more objective measurements are excellent. I think this would help clinicians better understand how the competitive nature affect the healing process. In terms of the graft type I think this is interesting. Are you suggesting that the graft type chosen and the care provided by the surgeon, may have an effect of the motivation of the athlete? I like this concept. Perhaps, this could help promote an even more integrative approach. Thanks again for the excellent comment.


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