Paper 222: A Randomized Controlled Study on a Rehabilitation Model for Strengthening Self-efficacy of Knee Function in Patients with an ACL Injury

Abstract

The Knee Self-Efficacy Scale (K-SES) has been shown to have good reliability, validity and responsiveness for patients' perceived self-efficacy of knee function during rehabilitation of an Anterior Cruciate Ligament (ACL) injury. Determinants of self-efficacy of knee function one year after ACL injury have been found to be the patients' internal locus of control and knee symptoms in sports and recreation. Perceived self-efficacy of knee function measured by the K-SES has also been shown to have a predictive ability for patients' outcome after an ACL reconstruction. To evaluate the effectiveness of a rehabilitation model containing strategies to reinforce or to maintain high self-efficacy of knee function compared with a standard rehabilitation protocol. Forty patients with a recently ACL injured knee were randomly allocated to an experimental group (n=20) for the rehabilitation model or a control group (n=20). Data were collected from patients recently injured and at 4, 6 and 12 months after the injury. The self-administrated instruments K-SES, Tegner activity score, Physical Activity Score (PAS), Knee Injury and Osteoarthritis Outcome Score (KOOS) Lysholm and Multidimensional Health Locus of Control (MHLC) were used as outcome measures. Twenty-four patients, 12 in each group, completed the 12 month follow-up. There was a significant increase in both the experimental and control group for K-SESpresent (p=0.005 and p=0.003), KOOSsport (p=0.005 and p=0.044), and KOOSqol (p=0.014 and p=0.041) at the 12 month follow-up. Both groups revealed a significantly lower physical activity level (Tegner) (p=0.009 and p=0.036) at the 12 month follow up. The control group had also a significantly lower score for physical intensity and frequency (PAS) (p=0.020) and internal locus of control (MHLC) (p=0.026) at the 12 month follow-up. No significant differences were found between the experimental group and the control group at inclusion or at the 12 month follow-up for any of the outcome measures. Increased self-efficacy of knee function as well as subjective satisfaction with knee symptoms and function was achieved in both groups. The experimental group, however, did not decrease in physical intensity and frequency and internal locus of control, which may be an important aspect for future function and possible surgical intervention.