Flosadottir Vala, Frobell Richard, Roos Ewa M, Ageberg Eva
Department of Health Sciences, Lund University, Box 157, 221 00, Lund, Sweden.
Department of Clinical Sciences, Lund University, Lund, Sweden.
BMC Musculoskelet Disord. 2018 Feb 13;19(1):50. doi: 10.1186/s12891-018-1973-2.
In people with anterior cruciate ligament (ACL) injury, high self-efficacy facilitates recovery, indicated by improved muscle function, reduced knee symptoms and increased physical activity. Impact of treatment on future self-efficacy is however not well investigated. The aims of the study were to 1) investigate knee-related self-efficacy 6 years after acute ACL injury in patients treated with exercise therapy alone or in combination with either early or the option of delayed ACL reconstruction (ACLR), and 2) to investigate associations between single-leg physical performance at various time points after ACL injury and knee self-efficacy at 6 years after injury.
Participants (n = 121) originated from the KANON-study (ISRCTN84752559), a treatment RCT including active adults with acute ACL injury treated with structured exercise therapy combined with early or the option of delayed ACLR. In this ancillary study, participants with knee self-efficacy data at 6 years (n = 89) were analyzed as treated; exercise therapy alone (n = 20), exercise therapy plus early ACLR (n = 46), and exercise therapy plus delayed ACLR (n = 23). The participants performed physical performance tests (hop, strength and balance) at the end the of exercise therapy (mean 10 (SD 6) months), and at 5 years, and rated their knee self-efficacy using Knee Self-Efficacy Scale (K-SES) questionnaire (0 to 10, worst to best) at 6 years.
Median K-SES score for the total group (n = 89) was 7.8 (IQR 5.9-9.0). There were no differences between treatment groups in K-SES scores at 6 years nor in physical performance at any time point (p ≥ 0.097). Worse knee flexion strength LSI (r = 0.341, p = 0.042) at the end of the exercise therapy, and worse LSI for single-leg hop test (r = 0.310, p = 0.005) at the end of the exercise therapy and at 5 years, correlated moderately with worse knee-related self-efficacy at 6 years. Low associations were observed between the remaining physical performance tests and K-SES scores (r ≤ 0.265, p ≥ 0.045).
Knee-related self-efficacy at 6 years after ACL injury did not differ between those treated with ACLR, performed early or as a delayed procedure, or exercise therapy alone. Good physical performance at the end of the exercise therapy, and at 5 years, appears to have a positive, yet small, impact on future knee-related self-efficacy.
在前交叉韧带（ACL）损伤患者中，高自我效能感有助于康复，表现为肌肉功能改善、膝关节症状减轻和身体活动增加。然而，治疗对未来自我效能感的影响尚未得到充分研究。本研究的目的是：1）调查单纯接受运动疗法或联合早期或延迟ACL重建（ACLR）治疗的急性ACL损伤患者在受伤6年后与膝关节相关的自我效能感；2）调查ACL损伤后不同时间点的单腿身体表现与受伤6年后膝关节自我效能感之间的关联。
参与者（n = 121）来自KANON研究（ISRCTN84752559），这是一项治疗随机对照试验，纳入了接受结构化运动疗法联合早期或延迟ACLR治疗的急性ACL损伤的活跃成年人。在这项辅助研究中，对6年时有膝关节自我效能感数据的参与者（n = 89）进行分析；单纯运动疗法组（n = 20）、运动疗法加早期ACLR组（n = 46）和运动疗法加延迟ACLR组（n = 23）。参与者在运动疗法结束时（平均10（标准差6）个月）、5年时进行身体表现测试（单腿跳、力量和平衡测试），并在6年时使用膝关节自我效能量表（K-SES）问卷（0至10分，最差至最佳）对其膝关节自我效能感进行评分。
整个组（n = 89）的K-SES评分中位数为7.8（四分位间距5.9 - 9.0）。6年时治疗组之间的K-SES评分以及任何时间点的身体表现均无差异（p≥0.097）。运动疗法结束时较差的膝关节屈曲力量LSI（r = 0.341，p = 0.042），以及运动疗法结束时和5年时单腿跳测试较差的LSI（r = 0.310，p = 0.005），与6年时较差的膝关节相关自我效能感中度相关。其余身体表现测试与K-SES评分之间的关联较低（r≤0.265，p≥0.045）。
ACL损伤6年后，接受ACLR（早期或延迟手术）或单纯运动疗法治疗的患者在膝关节相关自我效能感方面没有差异。运动疗法结束时和5年时良好的身体表现似乎对未来膝关节相关自我效能感有积极但较小的影响。
