Dunphy Emma, Gardner Elizabeth C
eHealth Unit, Department of Primary Care and Population Health, University College London, Rowland Hill Street, United Kingdom.
Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 47 College St, New Haven, CT, United States.
JMIR Form Res. 2020 Sep 18;4(9):e19296. doi: 10.2196/19296.
Evidence shows that after anterior cruciate ligament (ACL) reconstruction, patients may have varied access to physical therapy. In particular, physical therapy input may end many months before patients reach full recovery. Telerehabilitation may provide an opportunity to address this rehabilitation gap and improve access to evidence-based rehabilitation alongside physical therapy at all stages of care.
This study aims to understand the opinions of patients who have undergone ACL surgery and rehabilitation on the use of telerehabilitation as part of ACL care and define the population and explore their experiences and views on the acceptability of telerehabilitation after ACL reconstruction.
This study was a cross-sectional, voluntary, web-based survey combining both closed and open questions. Ethical approval was obtained from the Yale School of Medicine Institutional Review Board. Participants were aged 16 years or older at the time of recruitment and had undergone ACL reconstruction within the past 5 years. A 26-item survey was developed using the Qualtrics survey platform. No items were mandatory. Responses were multiple choice, binary, and qualitative. The CHERRIES (Checklist for Reporting Results of Internet E-Surveys) was used to ensure the quality of reporting of surveys in the medical literature. Data were analyzed using Stata version 15. Qualitative data were analyzed using NVivo 11. The theoretical framework for this analysis is based on the Capability, Opportunity, and Motivation-Behavior model of behavior change.
A total of 100 participants opened the survey. All completers were unique. The participation and completion rates were each 96% (96/100). Patients reported their physical therapy care ended at an average of 6.4 months and that they felt fully recovered at an average of 13.2 months. Only 26% (25/96) of patients felt fully recovered at the end of physical therapy. Of these 96 patients, 54 (60%) were younger than 30 years, 71 (74%) were recreational athletes, 24 (24%) were competitive athletes, 72 (75%) had private insurance, 74 (77%) were not familiar at all with telerehabilitation, and 89% (85/96) felt capable. They preferred to use telerehabilitation at different stages of care. Reported benefits included resource saving, improved access to care, improved learning, and greater engagement. Concerns included incorrect performance of exercises or unmanaged pain being missed and less access to manual therapy, motivation, and opportunities to ask questions. Participants' priorities for a future telerehabilitation intervention included its use as an adjunct to physical therapy rather than a replacement, with content available for each stage of care, especially return to sports. Participants stressed that the intervention should be personalized to them and include measures of progress.
These findings helped understand and define the ACL reconstruction population. Participants found telerehabilitation acceptable in principle and highlighted the key user requirements and scope of future interventions.
有证据表明，在前交叉韧带（ACL）重建术后，患者接受物理治疗的机会可能各不相同。特别是，在患者完全康复之前数月，物理治疗可能就已结束。远程康复可能为解决这一康复差距提供契机，并在护理的各个阶段与物理治疗一起，改善获得循证康复的机会。
本研究旨在了解接受ACL手术和康复治疗的患者对将远程康复作为ACL护理一部分的看法，界定这一人群，并探讨他们对ACL重建术后远程康复可接受性的体验和观点。
本研究是一项基于网络的横断面自愿调查，包含封闭式和开放式问题。获得了耶鲁大学医学院机构审查委员会的伦理批准。招募时参与者年龄在16岁及以上，且在过去5年内接受了ACL重建手术。使用Qualtrics调查平台开发了一份包含26个条目的调查问卷。没有必填项目。回答包括多项选择、二元选择和定性回答。使用CHERRIES（互联网电子调查结果报告清单）来确保医学文献中调查结果报告的质量。使用Stata 15版软件进行数据分析。定性数据使用NVivo 11进行分析。该分析的理论框架基于行为改变的能力、机会和动机 - 行为模型。
共有100名参与者打开了调查问卷。所有完成调查者均为独立个体。参与率和完成率均为96%（96/100）。患者报告其物理治疗平均在6.4个月时结束，他们感觉平均在13.2个月时完全康复。只有26%（25/96）的患者在物理治疗结束时感觉完全康复。在这96名患者中，54名（60%）年龄小于30岁，71名（74%）是业余运动员，24名（24%）是竞技运动员，72名（75%）有私人保险，74名（77%）对远程康复完全不熟悉，89%（85/96）感觉自己有能力。他们倾向于在护理的不同阶段使用远程康复。报告的益处包括节省资源、改善就医机会、促进学习以及更高的参与度。担忧包括锻炼动作执行错误或未发现疼痛未得到处理，以及较少获得手法治疗、缺乏动力和提问机会。参与者对未来远程康复干预的优先需求包括将其用作物理治疗的辅助手段而非替代手段，且在护理的每个阶段都有相应内容可供使用，尤其是恢复运动阶段。参与者强调干预应针对个人进行个性化设置，并包括进展评估措施。
这些研究结果有助于了解和界定ACL重建人群。参与者原则上认为远程康复是可接受的，并突出了关键用户需求以及未来干预的范围。
