Physical Activity Promotion Following Anterior Cruciate Ligament Reconstruction

Physical Activity Promotion Following Anterior Cruciate Ligament Reconstruction

Mary Grace Knoll

 

Background

My interest throughout physical therapy school have continually been in the area orthopedics, as well as a large interest in research. Additionally, I have always been interested in Anterior Cruciate Ligament Reconstructions (ACLR), working with an athletic population for much of my undergraduate degree. In conducting research with Dr. Thoma, I became interested and aware of the deficits in physical activity among this specific population, but truly in all populations. Additionally, learning more about the increased risk of post traumatic osteoarthritis (PTOA) associated with this post-ACLR population and physical inactivity. This led me to investigate how we as physical therapists can clinically implement physical activity promotion in the clinic as we are in a unique position with the knowledge, tools, and repetition of patient visits over a consistent amount of time to make, to make significant impact on this patient population. This will allow for better outcomes of individuals following ACLR for their overall health, as well as a decreased risk for PTOA.

 

Statement of Need

Physical activity promotion is not something generally addressed by physical therapy even though it should be. It is especially not addressed in individuals following ACLR where there are deficits in physical activity and associated negative outcomes compared to healthy age-matched peers.^1-4 This rehabilitation process in generally focused on specific impairments and return to sport protocols. Even with that, many individuals are not able to fully return to sport, and if they do return, many are not staying.⁵ A predominate negative outcome is PTOA, affecting young individuals following ACLR. Due to the large portion of ACLRs occurring early on in life, adolescents and young adulthood, the reduction of physical activity during this formative time point can be detrimental for their overall health for the remainder of their life.^3,6 Intervening at this crucial time point, multiple times a week, for months on end is an influential position for a physical therapist to be in. Physical therapists are key in helping form positive habits around physical activity. This shows a definite need for physical activity promotion implementation to happen in the clinic with this patient population.

 

Purpose

The purpose of this capstone project is to inform clinicians and patients of the deficits in physical activity following ACLR and the associated negative health outcomes these deficits cause, including PTOA. Additionally, this capstone will provide recommendations for physical activity promotion and implementation of how to do so in a clinical setting. There are associated guidelines and examples to utilize with patients in clinic to help increase physical activity participation during treatment and well beyond for the remainder of their lives.

 

Health Literacy

Currently, there is lack of clinicians addressing general physical activity, step count, etc. Because of this, there are many individuals, especially following ACLR, where physical activity habits are not being addressed, most commonly, only addressed relative to their specific sport or activity movements. This causes a huge gap in the rehabilitation process and beyond, creating deficits in physical activity daily minutes and step counts between this population and their healthy age-matched peers. By educating on future health risk, such as post-traumatic osteoarthritis, it will help address health literacy in this population. By creating an infographic, it will allow clinicians to easily convey this information to their patients of these deficits and the importance of physical activity promotion.

I have created two infographics for addressing health literacy in with this population. The first is geared toward clinicians with key, simplified highlights about the deficits and effects in this group of physical inactivity. Additionally, simplifying the recommendation and implementation for easy reference. Physical activity guidelines for each age group we additionally included for convenient reference. I utilized pictures to have quick to use examples. This helps with the lack of awareness and recommendation of physical inactivity in the group.

For the infographic intended for patient education, I simplified the language, utilized short phrases and main points to get my information across. I simplified language from the main evidence to convey significant information utilizing a logical sequence. This started with differences in physical activity, then their associated negative outcomes, following by a recommendation and putting it into action. I included the guidelines for individuals to reference and follow as well as pictures to provide examples with labeling for which category of physical activity it fit under. Overall, I had the infographic divided into sections and bulleted to keep the whole thing clean and clear. Overall, using strategies such as simpler language, clear recommendations and picture examples help address patient health literacy for physical activity promotion in this patient population.

 

Products

For Clinicians:

Annotated Outline Physical Activity Promotion Following ACLR

Physical Activity Promotion Following ACLR PowerPoint Presentation

Physical Activity Promotion Following ACLR VoiceThread

Clinician Infographic Physical Activity Promotion Following ACLR

Evaluation Tool Physical Activity Promotion Following ACLR

 

For Patients:

Patient Infographic Physical Activity Promotion Following ACLR

 

Evaluation

Throughout the capstone formulation, I periodically, about once a month, met with my advisor to discuss the project and associated components, making changes and adjustments as necessary based on the conversations. Additionally, I presented my presentation to my PTOA Journal Club consisting of PhD students, professors, and post-Docs to get insight and feedback verbally from them on the presentation as a whole, related content, and any additional pertinent information.

I created an evaluation form addressing each of the intended objectives for the presentation, the organization and flow, the presentation as a whole, clinical relevance, and educational tools of infographics. This utilized a Likert scale and open-ended questions to provide any additional feedback or recommendations.

 

Self-Assessment/Reflection

This has been an overall rewarding project. In participating in research with Dr. Thoma, I was exposed to an area in orthopedics and sports that I otherwise may not have been familiar with. This turned into a large interest and now passion of mine to utilize in the clinic. A goal of mine was to create something that was lacking within clinical practice and something that would utilize the research I am involved in with Dr. Thoma yet be clinically relevant for clinicians working with this population. A challenge was trying to formulate the recommendation and implementation of something that is not straightforward compared to typical ACLR return to sport protocols. By gaining various feedback throughout different points in the project, I was able to formulate the best recommendation to implement in the clinic, given the information that was available. I had to make changes based on feedback to make the presentation the most effective it could be, as well as clinically relevant as it could be. I am proud of how my project turned out and am excited to educate clinicians in the future about the need for physical activity promotion in ACLR population, as well as general population. As this is a more recent area of research, as more information and evidence come up, I will be able to integrate that into this presentation to be able to keep it current and the most clinically relevant.

  

Acknowledgements

• To Dr. Louise Thoma, PT, DPT, PhD, thank you for your invaluable guidance and experience over this past year. Conducting research in this subject area and formulating this promotion recommendation and implementation would not have been possible without all your knowledge, guidance, and patience. You have introduced me to a topic that has become a passion of mine and I am grateful to have you as a mentor.
• To Dr. Caroline Lisee, PhD, ATC, thank you for your expertise and research orientated experience to help guide this project with your plethora of knowledge in the topic of ACLR and PTOA.
• To Dr. Marie Clark, PT, DPT, thank you for your guidance and perspective as a clinician working with this patient population and for invaluable guidance and experience during my clinical rotation.
• To my PTOA Journal Club – Exercise and Sports Science, thank you for your time and helpful and constructive feedback to improve my presentation and associated content. Discussing various research pertaining to PTOA has vastly improved my knowledge over this past year to utilize in my future clinical practice.

 

Statement of Need Resources

1. Bell DR, Pfeiffer KA, Cadmus-Bertram LA, et al. Objectively measured physical activity in patients after anterior cruciate ligament reconstruction. Am J Sports Med. 2017;45:1893-1900.
2. Lisee CM, Montoye AHK, Lewallen NF, Hernandez M, Bell DR, Kuenze CM. Assessment of Free-Living Cadence Using ActiGraph Accelerometers Between Individuals With and Without Anterior Cruciate Ligament Reconstruction. J Athl Train. 2020;55:994-1000.
3. Toomey CM, Whittaker JL, Doyle-Baker PK, Emery CA. Does a history of youth sportrelated knee injury still impact accelerometer-measured levels of physical activity after 3-12 years? Phys Ther Sport. 2022;55:90-97.
4. Kuenze C, Cadmus-Bertram L, Pfieffer K, et al. Relationship between physical activity and clinical outcomes after ACL reconstruction. J Sport Rehabil. 2019;28:180-187.
5. Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE. Sports participation 2 years after anterior cruciate ligament reconstruction in athletes who had not returned to sport at 1 year: a prospective follow-up of physical function and psychological factors in 122 athletes. Am J Sports Med. 2015;43:848-856.
6. Whittaker JL, Runhaar J, Bierma-Zeinstra S, Roos EM. A lifespan approach to osteoarthritis prevention. Osteoarthr Cartil. 2021;29:1638-1653.

 

References
All resources are included at the end of the annotated outline and PowerPoint presentation.

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