Brigham and Women's Hospital, Boston, MA.
Appalachian State University, Boone, NC.
J Athl Train. 2020 Jul 1;55(7):707-716. doi: 10.4085/1062-6050-120-19.
Depressed patient-reported outcomes (PROs) are directly related to suboptimal recovery after anterior cruciate ligament reconstruction (ACLR). Various PROs commonly used after ACLR can provide a gross estimation of function but do not fully elucidate the causes of self-perceived disability.
To more fully characterize the factors driving responses on PROs.
Cross-sectional study. A mixed-methods approach was used, in which qualitative interviews were conducted alongside administration of PROs to uncover the themes behind a participant's PRO responses.
Laboratory.
Twenty-one individuals with unilateral ACLR (age = 20.90 ± 2.86 years, height = 172.0 ± 11.03 cm; mass = 71.52 ± 13.59 kg, postsurgery = 3.66 ± 3.03 years).
MAIN OUTCOME MEASURE(S): Patient-reported outcome measures were administered and qualitative interviews were conducted. The PROs consisted of the International Knee Documentation Committee form, Knee Injury and Osteoarthritis Outcomes Score (KOOS), ACL-Return to Sport after Injury (ACL-RSI) scale, and Tampa Scale of Kinesiophobia (TSK). A hierarchical cluster analysis was used to identify subgroups based on PRO responses. Qualitative interviews provided supplemental insight into perceived disability. Independent t tests examined cluster differences for themes. Spearman ρ correlations indicated associations between PRO responses and themes.
Two clusters (perceived high or low disability) emerged. Individuals with low perceived disability scored better on all PROs (P < .05) except for the KOOS-Activities of Daily Living. Internal and external facilitators or barrier subthemes emerged from the interviews. A significant difference was present between clusters and themes. Lower TSK andgreater ACL-RSI and KOOS-Quality of Life scores were associated with more perceived facilitators.
Participants with greater internal motivation and confidence and a support network had improved PROs. Those with avoidance tendencies, fear, lack of clear expectations, and less social support scored worse on PROs. The TSK, ACL-RSI, and KOOS-Quality of Life scales were best able to capture the constructs associated with perceived wellness, which reinforces their utility in recovery.
抑郁患者报告的结果（PROs）与前交叉韧带重建（ACLR）后的恢复不佳直接相关。ACL 重建后常用的各种 PROs 可以大致评估功能，但不能完全阐明自我感知障碍的原因。
更全面地描述驱动 PROs 反应的因素。
横断面研究。采用混合方法，在进行 PROs 管理的同时进行定性访谈，以揭示参与者 PRO 反应背后的主题。
实验室。
21 名单侧 ACLR 患者（年龄=20.90±2.86 岁，身高=172.0±11.03cm；体重=71.52±13.59kg，术后=3.66±3.03 年）。
患者报告的结果测量工具进行管理和定性访谈进行。PROs 包括国际膝关节文献委员会表格、膝关节损伤和骨关节炎结果评分（KOOS）、ACL 损伤后重返运动（ACL-RSI）量表和坦帕运动恐惧量表（TSK）。使用层次聚类分析根据 PRO 反应识别亚组。定性访谈提供了对感知残疾的补充见解。独立 t 检验检验了主题的聚类差异。Spearman ρ 相关性表明 PRO 反应与主题之间的关联。
出现了两个聚类（感知高或低残疾）。感知残疾程度较低的个体在所有 PROs 上的得分都更好（P<.05），除了 KOOS-日常生活活动。访谈中出现了内部和外部促进因素或障碍子主题。聚类和主题之间存在显著差异。较低的 TSK 和更高的 ACL-RSI 和 KOOS 生活质量评分与更多感知促进因素相关。
具有更高内在动力和信心以及支持网络的参与者具有更好的 PROs。那些有回避倾向、恐惧、缺乏明确期望和较少社会支持的人在 PROs 上的得分较差。TSK、ACL-RSI 和 KOOS 生活质量量表最能捕捉与感知健康相关的结构，这增强了它们在康复中的实用性。
