根据实践指南标准，不到一半的前交叉韧带重建运动员被批准重返赛场：一项前瞻性队列研究的结果
LESS THAN HALF OF ACL-RECONSTRUCTED ATHLETES ARE CLEARED FOR RETURN TO PLAY BASED ON PRACTICE GUIDELINE CRITERIA: RESULTS FROM A PROSPECTIVE COHORT STUDY.
作者信息
N van Melick, Tj Hoogeboom, Y Pronk, B Rutten, Tg van Tienen, Mwg Nijhuis-van der Sanden, Reh van Cingel
机构信息
Radboud University Medical Center, Research Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands.
Research Department, Kliniek ViaSana, Mill, the Netherlands.
出版信息
Int J Sports Phys Ther. 2020 Dec;15(6):1006-1018. doi: 10.26603/ijspt20201006.
BACKGROUND
A recently published Dutch practice guideline emphasizes criterion-based rehabilitation after anterior cruciate ligament reconstruction (ACLR) instead of time-based. As a consequence of this criterion-based rehabilitation, return to play is only suggested when athletes meet specific return to play (RTP) criteria.
PURPOSE
The goal of this prospective observational study was to analyze if physical therapists adhere to ACLR practice guideline RTP criteria for testing and return to sport decisions, and to explore whether there is a difference in adherence between physical therapists specialized in sports versus those who are not.
METHODS
When the treating physical therapist cleared an athlete for RTP after ACLR, the primary researcher performed RTP measurements according to the ACLR practice guideline to investigate if all nine quantitative and qualitative RTP criteria were met.
RESULTS
Of the 158 athletes (54 females and 104 males, mean age 24 ± 6 years, 12 ± 3 months after surgery), 69 (44%) had performed the RTP measurements with their primary physical therapist. Of the athletes tested by their primary physical therapist 23% met all RTP criteria compared to 10% of the athletes who were not tested at all by their primary physical therapist (p = 0.026). Of the athletes rehabilitating with a sports physical therapist, 52% had been tested by their primary physical therapist compared to 34% of the athletes rehabilitating with a non-sports physical therapist (p = 0.024).
CONCLUSION
Only 44% of the athletes were tested according to the guideline RTP criteria and only 23% of them were given an RTP advice consistent with the ACLR guideline. Although sports physical therapists adhered to the guideline more often than non-sports physical therapists, the adherence is still alarmingly low. More attention for the implementation of ACLR guidelines and RTP criteria is needed.
LEVEL OF EVIDENCE
Therapy, level 2b.
背景
最近发布的荷兰实践指南强调前交叉韧带重建（ACLR）术后基于标准的康复，而非基于时间的康复。基于此标准的康复，仅当运动员满足特定的重返运动（RTP）标准时才建议其重返运动。
目的
这项前瞻性观察研究的目的是分析物理治疗师在测试和做出重返运动决定时是否遵循ACLR实践指南的RTP标准，并探讨专门从事运动治疗的物理治疗师与非专门从事运动治疗的物理治疗师在遵循标准方面是否存在差异。
方法
当治疗的物理治疗师批准ACLR术后的运动员进行RTP时，主要研究人员根据ACLR实践指南进行RTP测量，以调查是否满足所有九项定量和定性RTP标准。
结果
在158名运动员中（54名女性和104名男性，平均年龄24±6岁，术后12±3个月），69名（44%）与他们的主要物理治疗师进行了RTP测量。由主要物理治疗师测试的运动员中，23%满足所有RTP标准，相比之下，根本没有由主要物理治疗师测试的运动员中这一比例为10%（p = 0.026）。在由运动物理治疗师进行康复治疗的运动员中，52%由主要物理治疗师进行了测试，相比之下，由非运动物理治疗师进行康复治疗的运动员中这一比例为34%（p = 0.024）。
结论
只有44%的运动员根据指南RTP标准进行了测试，其中只有23%得到了与ACLR指南一致的RTP建议。尽管运动物理治疗师比非运动物理治疗师更常遵循指南，但遵循率仍然低得惊人。需要更多地关注ACLR指南和RTP标准的实施。
证据水平
治疗，2b级。
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