Thorstensson Carina A, Lohmander L Stefan, Frobell Richard B, Roos Ewa M, Gooberman-Hill Rachael
Department of Research and Development, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
BMC Musculoskelet Disord. 2009 Aug 10;10:100. doi: 10.1186/1471-2474-10-100.
The objective was to understand patients' views of treatment after acute anterior cruciate ligament (ACL) injury, and their reasons for deciding to request surgery despite consenting to participate in a randomised controlled trial (to 'cross-over').
Thirty-four in-depth qualitative interviews were conducted with young (aged 18-35), physically active individuals with ACL rupture who were participating in a RCT comparing training and surgical reconstruction with training only. 22/34 were randomised to training only but crossed over to surgery. Of these, 11 were interviewed before surgery, and 11 were interviewed at least 6 months after surgery. To provide additional information, 12 patients were interviewed before randomisation. Interviews were audio-recorded, transcribed and analysed using the Framework approach.
Strong preference for surgery was commonplace and many patients said that they joined the RCT in order to bypass waiting lists. Patients who chose to cross-over described training as time consuming, boring and as unable to provide sufficient results within a reasonable timeframe. Some said their injured knees had given-way; others experienced new knee traumas; and many described their lack of trust in their knee. Patients believed that surgery would provide joint stability. Despite the ostensible satisfaction with surgery, more detailed exploration showed mixed views.
Participants in a trial of treatments for acute ACL injury express a variety of views and beliefs about those treatments, and trial participation happens in the absence of equipoise. Furthermore, opting for surgical reconstruction does not necessarily provide patients with satisfactory outcomes. Definition of successful outcome may require an individualised approach, incorporating patients' as well as surgeons' views before treatment decisions are made.
目的是了解急性前交叉韧带（ACL）损伤患者对治疗的看法，以及他们尽管同意参加随机对照试验（“交叉”）却仍决定要求手术的原因。
对34名年龄在18 - 35岁、身体活跃且ACL断裂的个体进行了深入的定性访谈，这些个体参与了一项比较训练与手术重建加训练与单纯训练的随机对照试验。34人中22人被随机分配至单纯训练组，但后来转而接受手术。其中，11人在手术前接受访谈，11人在手术后至少6个月接受访谈。为提供更多信息，12名患者在随机分组前接受访谈。访谈进行了录音、转录，并采用框架法进行分析。
强烈倾向于手术很常见，许多患者表示他们参加随机对照试验是为了避开等待名单。选择交叉治疗的患者将训练描述为耗时、枯燥且无法在合理时间内取得足够效果。一些人说他们受伤的膝盖会突然发软；其他人经历了新的膝盖创伤；许多人表示对自己的膝盖缺乏信心。患者认为手术能提供关节稳定性。尽管表面上对手术满意，但更深入的探究显示观点不一。
急性ACL损伤治疗试验的参与者对这些治疗表达了各种观点和信念，且试验参与是在缺乏 equipoise 的情况下进行的。此外，选择手术重建不一定能为患者带来满意的结果。成功结果的定义可能需要一种个性化方法，在做出治疗决定前纳入患者以及外科医生的观点。
