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

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2019-02, Vol.27 (2), p.397-404
• Main Authors: Chmielewski, Terese L., George, Steven Z.
• Format: Article
• Language: English
• Subjects: Anterior cruciate ligament; Avoidance; Data collection; Demographics; Demography; Effectiveness; Fear; Impairment; Injuries; Knee; Medicine; Medicine & Public Health; Orthopedics; Pain; Patients; Psychological factors; Quadriceps muscle; Questionnaires; Rangefinding; Rehabilitation; Self-efficacy; Surgery
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-018-5048-6

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.