The PreOperative Management of Patients Awaiting Anterior Cruciate Ligament Reconstruction

Completed

Conditions: Anterior Cruciate Ligament Rupture
Rehabilitation
Anterior Cruciate Ligament Injuries

Interventions: Other: Phase 2 - consensus meeting
Other: Phase 1 - semi-structured interviews

Registration Number: NCT05529511

Lead Sponsor: University Hospitals of Derby and Burton NHS Foundation Trust

Brief Summary: Patient experiences of the NHS ACL treatment pathway are unknown.

This study aims to explore patient experiences of anterior cruciate ligament ruptures at three different time points on the patient pathway: (1) 12 participants up to 2 weeks before surgery, (2) 12 participants 3 months after surgery, (3) 12 participants 12 months after surgery.

Detailed Description: The anterior cruciate ligament is one of four key ligaments in the knee. It is the most commonly injured knee ligament with an estimated 200,000 injuries occurring each year in the US (UK data unavailable). Surgery is currently standard treatment for this injury and helps patients return to work and their preinjury activity levels (such as running, playing football or netball). Patients expect surgery to be successful. However, the number of patients who are able to return to their normal activities is low, with only 24% returning at 1 year after surgery. Research has shown that after surgery, patients lack confidence, feel fearful about reinjuring their knee and need to continue to seek advice from healthcare professionals.

Receiving physiotherapy before surgery (called 'prehabilitation') is recommended by researchers and physiotherapists to help patients prepare for surgery and postoperative rehabilitation. Although physiotherapy is recommended, some patients don't receive any treatment before their operation, but it is not known why this might be. There are also no guidelines for the treatment patients receive and current treatment varies.

If an intervention to be delivered to patients prior to anterior cruciate ligament surgery (prehabilitation treatment package) is developed, patient care may be improved. Patient outcomes could also be improved resulting in more patients returning to physical activity after surgery.

This study will firstly, interview participants at three different time points along the patient pathway (1) 12 participants up to 2 weeks before surgery, (2) 12 participants 3 months after surgery, (3) 12 participants 12 months after surgery.

The interviews will allow participants to tell the story of their experiences from the point of receiving their injury diagnosis to returning to physical activity and what they expect from their surgery.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 26

Inclusion Criteria

Phase 1:

≥ 18-years-old
Patient who is awaiting or has previously had an ACLR in the NHS

Phase 2

≥ 18-years-old
Participants will be in one of the following categories:
1. Healthcare professional in the NHS with a special interest/expertise in treating ACL injuries (must have treated a patient prior to or post ACLR within the last 2 years)
2. Therapy manager of an NHS musculoskeletal outpatient therapy department
3. Patient who is awaiting or has previously had an ACLR in the NHS

Exclusion Criteria

Phase 1:

Concomitant injuries requiring surgical intervention that will significantly alter the postoperative rehabilitation protocol e.g. meniscal repair requiring a non-weight bearing period
Previous knee surgery to the affected limb
Co-existing injuries requiring surgical intervention impacting on the individual's participation in pre-or post-operative rehabilitation
Pregnancy

Phase 2:

(1) Anyone with a recognised conflict of interest

Study & Design

Study Type: OBSERVATIONAL

Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Phase 2 - Nominal Group Technique panel	Phase 2 - consensus meeting	Consensus meeting with up to 12 participants (clinicians, patients and stakeholders) to develop the prehabilitation intervention
Phase 1 - Preoperative	Phase 1 - semi-structured interviews	Interviews to be completed with approximately 12 participants at three time points: 1. Prior to anterior cruciate ligament surgery 2. 3-month after anterior cruciate ligament surgery 3. 12-months anterior cruciate ligament surgery

Primary Outcome Measures

Name	Time	Method
Number of Participants Who Completed Semi-structured Interviews	Interviews completed within approximately 60 minutes	Understanding of patients' lived experiences of the treatment pathway following a diagnosis of an ACL rupture and agreed surgical management. Qualitative data collected from individual semi-structured interviews.
Number of Participants in the Nominal Group Technique Panel	Two online meetings completed, up to 2 hours on 2 days approximately 1-month apart.	Intervention developed with clinicians, patients and stakeholders for use with patients awaiting anterior cruciate ligament reconstruction in the National Health Service (NHS). Consensus was determined through voting set at an 70% threshold.

Secondary Outcome Measures