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Fear avoidance and self-efficacy at 4 weeks after ACL reconstruction are associated with early impairment resolution and readiness for advanced rehabilitation.

Publication ,  Journal Article
Chmielewski, TL; George, SZ
Published in: Knee Surg Sports Traumatol Arthrosc
February 2019

PURPOSE: To examine the association of fear avoidance and self-efficacy psychological factors within 4 weeks after anterior cruciate ligament (ACL) reconstruction with knee impairment resolution and readiness for advanced rehabilitation at 12 weeks post-surgery. METHODS: Seventy-five patients participated. Data collection included demographics; questionnaires on fear avoidance (Pain Catastrophizing Scale, PCS; shortened Tampa Scale for Kinesiophobia, TSK-11) and self-efficacy (modified Self-Efficacy for Rehabilitation Outcome Scale, SER; Knee Activity Self-Efficacy, KASE) at 1, 4, and 12 weeks post-surgery; and knee impairment measures (pain intensity, range of motion, and quadriceps symmetry index) at 12 weeks post-surgery. Readiness for advanced rehabilitation (READY or NOT READY) was determined by knee impairment resolution criteria; demographics and questionnaire scores were compared between groups. Questionnaire scores at 1 and 4 weeks post-surgery and the change between time points were examined for association with knee impairment measures and group assignment. RESULTS: READY included 32 patients; NOT READY included 43 patients. Questionnaire scores improved in both groups over time. Significant correlations across groups were: PCS scores at 1 and 4 weeks post-surgery with pain intensity at 12 weeks post-surgery (r = 0.24 and 0.29, respectively) and KASE score 4 weeks post-surgery with range of motion deficit at 12 weeks post-surgery (r = - 0.26). Contact injury was more prevalent in READY. After accounting for mechanism of injury, higher TSK-11 and fear of re-injury subscale scores at 4 weeks post-surgery increased the odds of NOT READY assignment at 12 weeks post-surgery (odds ratios 1.10 and 1.31, respectively). CONCLUSIONS: Lower pain catastrophizing and higher knee activity self-efficacy levels 4 weeks after ACL reconstruction were associated with better knee impairment resolution at 12 weeks post-surgery, whereas lower kinesiophobia at 4 weeks post-surgery increased the odds of meeting advanced rehabilitation criteria at 12 weeks post-surgery. The clinical implication of these findings is that measuring pain catastrophizing, knee activity self-efficacy and kinesiophobia at 4 weeks post-surgery may improve prediction of patients at risk for delayed rehabilitation progression 12 weeks post-surgery. LEVEL OF EVIDENCE: III.

Duke Scholars

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Published In

Knee Surg Sports Traumatol Arthrosc

DOI

EISSN

1433-7347

Publication Date

February 2019

Volume

27

Issue

2

Start / End Page

397 / 404

Location

Germany

Related Subject Headings

  • Young Adult
  • Surveys and Questionnaires
  • Self Efficacy
  • Orthopedics
  • Male
  • Humans
  • Follow-Up Studies
  • Female
  • Fear
  • Catastrophization
 

Citation

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Chmielewski, T. L., & George, S. Z. (2019). Fear avoidance and self-efficacy at 4 weeks after ACL reconstruction are associated with early impairment resolution and readiness for advanced rehabilitation. Knee Surg Sports Traumatol Arthrosc, 27(2), 397–404. https://doi.org/10.1007/s00167-018-5048-6
Chmielewski, Terese L., and Steven Z. George. “Fear avoidance and self-efficacy at 4 weeks after ACL reconstruction are associated with early impairment resolution and readiness for advanced rehabilitation.Knee Surg Sports Traumatol Arthrosc 27, no. 2 (February 2019): 397–404. https://doi.org/10.1007/s00167-018-5048-6.
Chmielewski, Terese L., and Steven Z. George. “Fear avoidance and self-efficacy at 4 weeks after ACL reconstruction are associated with early impairment resolution and readiness for advanced rehabilitation.Knee Surg Sports Traumatol Arthrosc, vol. 27, no. 2, Feb. 2019, pp. 397–404. Pubmed, doi:10.1007/s00167-018-5048-6.
Journal cover image

Published In

Knee Surg Sports Traumatol Arthrosc

DOI

EISSN

1433-7347

Publication Date

February 2019

Volume

27

Issue

2

Start / End Page

397 / 404

Location

Germany

Related Subject Headings

  • Young Adult
  • Surveys and Questionnaires
  • Self Efficacy
  • Orthopedics
  • Male
  • Humans
  • Follow-Up Studies
  • Female
  • Fear
  • Catastrophization