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

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.

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

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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