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Early detection and rehabilitation of functional recovery for acutely injured anterior cruciate ligament deficient individuals using clinical and biomechanical outcomes

Button, Kate 2008. Early detection and rehabilitation of functional recovery for acutely injured anterior cruciate ligament deficient individuals using clinical and biomechanical outcomes. PhD Thesis, Cardiff University.

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Abstract

BACKGROUND: The purpose of this study was firstly to evaluate functional recovery following anterior cruciate ligament (ACL) rupture from acute injury over the course of rehabilitation. Insights from this analysis were then used to integrate movement feedback into rehabilitation to investigate if this resulted in improved functional outcome and participation level following this injury. METHOD: In the initial modelling phase a prospective repeated measures longitudinal design was used to measure functional recovery from acute injury over time of 63 ACL patients and 61 matched controls, using a two dimensional (2D) video based analysis system. Time-distance variables and joint angles for gait, jog, distance hop and run and stop were analysed monthly. A least squares 3rd order polynomial was used to model the functional recovery of ACLD (anterior cruciate ligament deficient) individuals and functional sub-groups. A second exploratory study using a prospective cohort design compared recovery between 115 ACLD individuals randomized into movement feedback (FB) and no feedback (no-FB) rehabilitation. The feedback criterion was based on the movement data from the longitudinal analysis of functional recovery. Independent t-tests were used to evaluate group differences at 5 months post injury. Semi structured interviews evaluated the physiotherapists usage of the feedback and rehabilitation given to the ACLD patients. RESULTS: Functional recovery was found on average to take 3 months for gait and 5 months for hopping. ACLD non-copers were distinguishable at 40 days post injury due to failure of gait variables to recover to within 'normal limits'. In study two 52 ACLD subjects were followed up at 5 months post injury. No statistically significant differences in functional performance between the FB and no-FB groups were found (p<0.05), for any of the movement variables for gait, one legged squat, distance hop or run and stop. Physiotherapists treating the FB group reported difficulties interpreting the movement feedback, incorporating it into rehabilitation due to its timing and identified a perceived learning effect on treatment. DISCUSSION: Functional recovery was successfully modelled and shown to take longer than expected. This has implications for advising patients on recovery times and length of time for attendance at rehabilitation. Further clarification is required but failure of simple gait variables to recover by 40 days post injury could direct ACLD management. If the potential for recovery can be identified early then the appropriate treatment can be given. Incorporating this type of movement feedback into rehabilitation did not result in improved functional outcome or level of participation. Factors related to its application and insufficient patient numbers at follow-up may have weakened the experimental treatment effect and the power of the study. The modelling and exploratory phases of this investigation need to be revisited to identify the most relevant variables for feedback, refine functional cut-off scores, develop methods that allow feedback to be delivered immediately and more focused training for physiotherapists before progress to a randomized control trial can be considered. This study demonstrated that the clinically based video analysis system provided detailed insight at all stages of rehabilitation on the speed, timing and completeness of recovery for functional tasks that are directly relevant to the rehabilitation goals.

Item Type: Thesis (PhD)
Status: Unpublished
Schools: Healthcare Sciences
Subjects: R Medicine > RT Nursing
ISBN: 9781303186349
Last Modified: 04 Jun 2017 06:02
URI: http://orca-mwe.cf.ac.uk/id/eprint/55816

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