The influence of psychological, social and contextual factors on recovery following a sport-related knee injury: a scoping review

Abstract

Purpose: Traumatic knee injuries account for up to 40% of sport-related injuries. Despite best efforts, only 65% of those who8 suffer a traumatic knee injury will return to sport or recreational activities after surgery and 50% will develop early-onset osteoarthritis (OA), irrespective of surgical or rehabilitation approach. Although quadriceps weakness and obesity are well established as modifiable risk factors for OA, little attention has been paid to the role that psychological (e.g. fear of reinjury), social (e.g. isolation) or contextual (e.g. realistic expectations) factors have on the recovery of muscle strength, physical activity participation and subsequent OA after traumatic knee injury. Given the urgent need for early preventive strategies to mitigate the consequences and delay the onset of OA after a traumatic knee injury, an in-depth understanding of the influence of psychological, social and contextual factors on physical recovery after injury is essential. This scoping review aims to identify and describe the non-physical (i.e., psychological, social and contextual) factors that impact recovery and rehabilitation in individuals with a sport-related knee injury, including the stage of rehabilitation where they may be most relevant. Methods: This scoping review followed Arksey & O’Malley’s 5-stage framework. Six databases (MEDLINE, PsycINFO, CINAHL, SportsDiscus, Scopus, ProQuest) were searched using predetermined search terms developed in conjunction with a librarian scientist. Selected studies met the following eligibility criteria: English language, original data, traumatic sport or recreational-related time-loss knee injury, and psychological, social or contextual factor that impacted an outcome of rehabilitation, physical recovery or return to sport. Two authors independently conducted title and abstract reviews, full text reviews, and study quality assessment using the Mixed Methods Appraisal Tool. Prior to title abstract and full-text review we assessed the applicability and inter-rater agreement (Cohen Kappa Coefficient >0.80) of our exclusion criteria with 120 records. Extracted data (e.g., author, year of publication, country, study design, sample characteristics, study aims, and results including non-physical factor and stage of rehabilitation it was assessed) were summarized using a descriptive and thematic analysis approach. Results: Of 7289 potential records, 77 individual studies met the final eligibility criteria for inclusion. Data from approximately 5500 participants (37% females), with age ranging from 14 to 60 years were included. Across studies, participants represented a variety of sport participation levels (i.e., recreational to professional). The majority of included studies involved participants 18 years of age or older (77%, n=59) that had experienced an anterior cruciate ligament (ACL) tear or underwent ACL reconstruction (87%, n=67). Of the 54 quantitative, 17 qualitative and 6 mixed methods studies included, the majority involved longitudinal (40%, n=31) or cross-sectional (22%, n=17) analyses. Figure 1 summarizes the psychological, social and contextual factors identified across studies. Seventy-four (96%) records addressed psychological factors (e.g. fear of reinjury, psychological readiness, behavior-related), 34 (44%) addressed social factors (e.g. social support, therapeutic alliance), and 23 (30%) addressed contextual factors (e.g. beliefs related to recovery, recovery expectations, quality of life). The most commonly assessed psychological factor was affect or emotions (48%, n=37), the most commonly assessed social factor was social support (19%, n=15) and the most commonly assessed contextual factor was recovery expectations (10%, n=8). Figure 2 represents the psychological, social and contextual themes by rehabilitation stage. Conclusions: There are a variety of psychological, social and contextual factors that influence the acute, rehabilitation and return to sport stages of recovery following a sport-related knee injury. Given the health-related implications of these factors, particularly as it relates to recovery of muscle strength, physical activity participation and subsequent obesity or OA, it is essential that they are considered part of the OA risk profile and identified and addressed through all stages of recovery and rehabilitation following a sport-related knee injury. Future research should focus on standardized methods for measuring these non-physical factors and identifying their determinants in an effort to inform the development of holistic rehabilitation programs.View Large Image Figure ViewerDownload Hi-res image Download (PPT)