Narducci Elizabeth, Waltz Amanda, Gorski Katheryn, Leppla Lucas, Donaldson Megan
Walsh University Department of Physical Therapy, North Canton, Ohio.
Int J Sports Phys Ther. 2011 Dec;6(4):333-42.
A tear of the anterior cruciate ligament (ACL) represents a significant injury for an athlete that requires substantial time away from sport, and significant rehabilitation after reconstruction. The physical therapist is responsible to determine when a patient is capable of tolerating the physical demands of daily activities and to attempt to prevent re-injury. Physical or functional performance tests (FPTs) are one mechanism used to evaluate the athlete's physical skills and capabilities prior to returning to sports participation. The purpose of this systematic review is to critically examine the clinical utility of functional performance tests used with patients less than or equal to one year post ACL reconstruction.
A systematic review of the relevant literature was performed using PRISMA guidelines. A total of twelve studies were included for analysis.
Two independent blinded reviewers then analyzed and rated the final included articles (n=12) utilizing the Newcastle-Ottawa Scale (NOS). Percent overall agreement between raters for the NOS was 88% with a fixed-marginal kappa (κ) of 0.80. Of the 12 included articles, the FPTs were utilized as an outcome measure within the study design (41.7%) or studied as a measure of function (58.3%). Among those studies that used FPTs as a "measure of function" 71.4% studied a battery of FPTs, while 28.6% studied a single test. None of the studies utilized FPTs as a measure to determine readiness to return to sport.
FPTs are being utilized with patients, less than or equal to one year post ACL reconstruction, either as an assessment of functional performance or as an outcome measure. No studies identified a FPT or test battery that has construct or predictive validity for "return to sport" in athletic population one-year post-ACL reconstruction. The identification of the critical elements within the return to sport construct may allow lower extremity performance tests to be developed or test batteries assembled to incorporate the appropriate tests to examine all of these elements deemed critical. Additionally the current FPTs should undergo content and predictive validation to assist the sports physical therapist in determining the readiness of the athlete for return to sport.
前交叉韧带（ACL）撕裂对运动员来说是一种严重的损伤，需要长时间远离运动，重建后还需要进行大量康复训练。物理治疗师负责确定患者何时能够耐受日常活动的体力需求，并试图预防再次受伤。身体或功能表现测试（FPTs）是用于评估运动员在恢复运动参与之前的身体技能和能力的一种方法。本系统评价的目的是严格审查在ACL重建后一年及以内的患者中使用的功能表现测试的临床效用。
按照PRISMA指南对相关文献进行系统评价。共纳入12项研究进行分析。
两名独立的盲法评审员随后使用纽卡斯尔-渥太华量表（NOS）对最终纳入的文章（n = 12）进行分析和评分。评审员之间关于NOS的总体一致性百分比为88%，固定边际kappa（κ）为0.80。在纳入的12篇文章中，FPTs在研究设计中被用作结果指标（41.7%），或作为功能指标进行研究（58.3%）。在那些将FPTs用作“功能指标”的研究中，71.4%研究了一系列FPTs，而28.6%研究了单一测试。没有一项研究将FPTs用作确定恢复运动准备情况的指标。
在ACL重建后一年及以内的患者中，FPTs被用作功能表现评估或结果指标。没有研究发现一种FPT或测试组合在ACL重建后一年的运动员群体中对“恢复运动”具有结构效度或预测效度。确定恢复运动结构中的关键要素可能有助于开发下肢表现测试或组装测试组合，以纳入适当的测试来检查所有这些被认为关键的要素。此外，当前的FPTs应进行内容和预测效度验证，以帮助运动物理治疗师确定运动员恢复运动的准备情况。
