Thomeé P, Währborg P, Börjesson M, Thomeé R, Eriksson B I, Karlsson J
Department of Orthopaedics, Sahlgrenska University Hospital, Göteborg, Sweden.
Scand J Med Sci Sports. 2007 Jun;17(3):238-45. doi: 10.1111/j.1600-0838.2006.00557.x. Epub 2006 Jun 15.
Self-efficacy belief may be of major importance for the outcome of rehabilitation after sports-related injuries. A new instrument, the Knee Self-Efficacy Scale (K-SES), was used to evaluate the role of perceived self-efficacy in patients with an anterior cruciate ligament (ACL) injury. The purpose of this prospective exploratory study was to describe the patients' perceived self-efficacy at various times post-injury and surgery, respectively, for responsiveness of the K-SES and to correlate the K-SES score with the patients' subjective symptoms. The purpose was also to describe the influence of gender, age and physical activity on the patients' perceived self-efficacy. Thirty recently injured patients with an ACL-deficient knee and 33 patients who had undergone ACL reconstruction reported their physical activity level and their perceived self-efficacy on four test occasions during a 1-year period. The patients' subjective knee symptoms were documented on two of the test occasions. A significant increase in the K-SES score was seen after injury as well as after surgery, during the course of rehabilitation. Pre-operatively, men's perceived self-efficacy was significantly (P=0.013) higher compared with women's self-efficacy. Patients with a high baseline (pre-injury) physical activity level (Tegner 7-10) perceived their self-efficacy as being significantly (P=0.005) higher pre-operatively compared with patients with a low baseline activity level (Tegner 3-6). "Younger" (age 17-29), recently injured patients, perceived their self-efficacy as being significantly (P=0.034) higher compared with "older" patients (age 30-54). At the 12-month test, 15 of 30 patients with an ACL-deficient knee and 15 of 33 patients who had undergone ACL reconstruction reported that they had returned or nearly returned to their baseline physical activity level. The subjective knee outcome score, as measured by the Knee Injury and Osteoarthritis Outcome Score (KOOS), improved significantly (P<0.01) during rehabilitation, apart from the KOOS subscale of "pain" (P=0.077) for patients who had undergone ACL reconstruction. There was a "low" to "strong" correlation (r(s)=0.0-0.7) between the K-SES and the five subscales in the KOOS. We conclude from the present study that K-SES has good responsiveness with significantly increased self-efficacy during the rehabilitation process for patients with an ACL-deficient knee as well as for patients who had undergone ACL reconstruction. The improvement in perceived self-efficacy could, however, only be partly explained by the improvement in subjective symptoms. Furthermore, self-efficacy differed significantly with gender, age and physical activity level early in the rehabilitation process.
自我效能信念对于运动相关损伤后的康复结果可能至关重要。一种新的工具，即膝关节自我效能量表（K-SES），被用于评估前交叉韧带（ACL）损伤患者中感知到的自我效能的作用。这项前瞻性探索性研究的目的是分别描述患者在受伤和手术后不同时间的自我效能感知情况，以了解K-SES的反应性，并将K-SES评分与患者的主观症状进行关联。目的还包括描述性别、年龄和身体活动对患者自我效能感知的影响。30名近期ACL损伤的膝关节患者和33名接受了ACL重建手术的患者在1年期间的四个测试时间点报告了他们的身体活动水平和自我效能感知情况。在其中两个测试时间点记录了患者的主观膝关节症状。在康复过程中，受伤后以及手术后K-SES评分均有显著提高。术前，男性的自我效能感知显著高于女性（P = 0.013）。基线（受伤前）身体活动水平高（Tegner 7 - 10）的患者术前自我效能感知显著高于基线活动水平低（Tegner 3 - 6）的患者（P = 0.005）。“年轻”（17 - 29岁）的近期受伤患者自我效能感知显著高于“年长”患者（30 - 54岁）（P = 0.034）。在12个月的测试中，30名ACL损伤膝关节患者中的15名以及33名接受ACL重建手术的患者中的15名报告他们已恢复或几乎恢复到基线身体活动水平。通过膝关节损伤和骨关节炎结局评分（KOOS）测量的主观膝关节结局评分在康复期间显著改善（P < 0.01），接受ACL重建手术的患者在“疼痛”KOOS子量表方面除外（P = 0.077）。K-SES与KOOS的五个子量表之间存在“低”到“强”的相关性（r(s)=0.0 - 0.7）。我们从本研究得出结论，对于ACL损伤膝关节患者以及接受ACL重建手术的患者，K-SES在康复过程中具有良好的反应性，自我效能显著提高。然而，自我效能的改善只能部分由主观症状的改善来解释。此外，在康复早期，自我效能因性别、年龄和身体活动水平而有显著差异。
