Comparison of Adolescent Patient, Parent, and Clinician Perceptions of Rehabilitation following ACL Reconstruction: A Qualitative Study
Kuenze C, Farner N, Lewis J, Lisee C, Schorfhaar A, Erickson K. J Athl Train. 2022 Feb 10. doi: 10.4085/1062-6050-0491.21. Epub ahead of print
Adolescent patients, parents, and rehab professionals involved with care after an anterior cruciate ligament reconstruction believe that more frequent and consistent communication about setting expectations, restrictions, and timelines could promote better patient outcomes.
Anterior cruciate ligament reconstructions (ACLR) among physically active adolescents are rising; however, despite high expectations about returning to play, many of these patients are not returning to pre-injury sport participation within 1-year after surgery. Factors related to this disconnect between expectations and reality are a lack of knowledge about the rehabilitation process and providers’ conflicting information. While investigators have focused on adolescent patients’ and parents’ perspectives, they often neglect another key stakeholder – a clinician.
Kuenze and colleagues conducted a qualitative study of nine adolescent patients, one of their parents, and the treating physical therapist to examine perceptions of information sharing and interpersonal communication.
The adolescent participants could walk without assistance but still needed clearance to return to unrestricted activity. The participants completed a demographic survey and a semi-structured interview (~30 minutes). Patients (78% female; ~6 months post-surgery), parents (78% female), and physical therapists (2-26 years’ experience) addressed the same topics but with different interview scripts. The researchers recorded audio from each interview and then transcribed and coded the audio. Next, the research team discussed the similarities and differences between each stakeholder group to ascertain primary themes.
Patients and parents indicated that the interpersonal dynamics of the treating physical therapist, surgeon, and support system (e.g., friends, coaches) altered their perception of the rehabilitation process. For example, trusting and communicative relationships helped. Furthermore, the physical therapists and the patients/parents reported that inconsistent communication between physical therapist and physician as well as lack of knowledge was a common source of frustration. Lastly, intrapersonal experience such as goal setting helped. However, others reported that lack of intrapersonal experience resulted in poor emotional responses (e.g., isolation, uncertainty of recovery).
Generally, the authors demonstrated that effective communication, strong social support, and active participation in goal setting could positively influence a patient’s recovery. However, these strategies may only be effective if the patient/parents were knowledgeable enough to actively participate and ask critical questions to decrease their feelings of isolation and wrongdoing (e.g., running too soon or too late). For example, leading patients to resources that provide information regarding a generalized rehabilitation progression may be helpful to manage expectations and better inform the patients/parents. Finally, barriers still exist in improving communication strategies. The authors noted that everyone agreed that improved communication between members of the healthcare team would help ensure that patients meet expectations and that everyone is consistent when setting expectations, restrictions, and recovery timelines, as well as addressing patient needs and desires.
The authors suggest clinicians should consider strategies to improve patient/parent education. Additionally, after an ACLR, more frequent communication among all stakeholders could improve inter- and intra-personal dynamics, leading to better patient outcomes.
Questions for Discussion
What strategies have you implemented to encourage communication through interdisciplinary care? Have you considered peer lead group education following ACLR? Do you meet with parents regularly to discuss the progress and goal setting?
- Does Sex Impact Psychological Readiness to Return to Sport After ACL
- ACL Reconstruction: Is Timing Everything?
- What Drives Good and Bad Patient-Reported Outcomes after ACL Reconstruction?
- Fear of Re-injury in People who have Returned-to-Sport Following ACL Reconstruction
Written by: Jane McDevitt
Reviewed by: Jeffrey Driban