Ardern Clare L, Hooper Nicholas, O'Halloran Paul, Webster Kate E, Kvist Joanna
Unit of Physiotherapy, Department of Health, Medicine and Caring Science, Linköping University, Linköping, Sweden.
Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia.
JMIR Form Res. 2022 Aug 9;6(8):e28851. doi: 10.2196/28851.
After a serious knee injury, up to half of athletes do not return to competitive sport, despite recovering sufficient physical function. Athletes often desire psychological support for the return to sport, but rehabilitation clinicians feel ill-equipped to deliver adequate support.
We aimed to design and develop an internet-delivered psychological support program for athletes recovering from knee ligament surgery.
Our work for developing and designing the Back in the Game intervention was guided by a blend of theory-, evidence-, and target population-based strategies for developing complex interventions. We systematically searched for qualitative evidence related to athletes' experiences with, perspectives on, and needs for recovery and return to sport after anterior cruciate ligament (ACL) injury. Two reviewers coded and synthesized the results via thematic meta-synthesis. We systematically searched for randomized controlled trials reporting on psychological support interventions for improving ACL rehabilitation outcomes in athletes. One reviewer extracted the data, including effect estimates; a second reviewer checked the data for accuracy. The results were synthesized descriptively. We conducted feasibility testing in two phases-(1) technical assessment and (2) feasibility and usability testing. For phase 1, we recruited clinicians and people with lived experience of ACL injury. For phase 2, we recruited patients aged between 15 and 30 years who were within 8 weeks of ACL reconstruction surgery. Participants completed a 10-week version of the intervention and semistructured interviews for evaluating acceptability, demand, practicality, and integration. This project was approved by the Swedish Ethical Review Authority (approval number: 2018/45-31).
The following three analytic themes emerged from the meta-synthesis (studies: n=16; participants: n=164): (1) tools or strategies for supporting rehabilitation progress, (2) barriers and facilitators for the physical readiness to return to sport, and (3) barriers and facilitators for the psychological readiness to return to sport. Coping strategies, relaxation, and goal setting may have a positive effect on rehabilitation outcomes after ACL reconstruction (randomized controlled trials: n=7; participants: n=430). There were no trials of psychological support interventions for improving the return to sport. Eleven people completed phase 1 of feasibility testing (technical assessment) and identified 4 types of software errors, which we fixed. Six participants completed the feasibility and usability testing phase. Their feedback suggested that the intervention was easy to access and addressed the needs of athletes who want to return to sport after ACL reconstruction. We refined the intervention to include more multimedia content and support access to and the use of the intervention features.
The Back in the Game intervention is a 24-week, internet-delivered, self-guided program that comprises 7 modules that complement usual rehabilitation, changes focus as rehabilitation progresses, is easy to access and use, and includes different psychological support strategies.
在遭受严重膝关节损伤后，尽管身体功能已充分恢复，但仍有多达一半的运动员无法重返竞技运动。运动员通常渴望在重返运动方面获得心理支持，但康复临床医生认为自己没有足够的能力提供充分的支持。
我们旨在设计并开发一个通过互联网提供的心理支持项目，用于帮助从膝关节韧带手术中恢复的运动员。
我们在开发和设计“重返赛场”干预措施时，采用了一系列基于理论、证据和目标人群的策略，以开发复杂的干预措施。我们系统地搜索了与运动员前交叉韧带（ACL）损伤后恢复及重返运动的经历、观点和需求相关的定性证据。两名评审员通过主题元综合法对结果进行编码和综合。我们系统地搜索了报告心理支持干预措施以改善运动员ACL康复效果的随机对照试验。一名评审员提取数据，包括效应估计值；另一名评审员检查数据的准确性。结果进行描述性综合。我们分两个阶段进行可行性测试——（1）技术评估和（2）可行性与可用性测试。在第一阶段，我们招募了临床医生和有ACL损伤亲身经历的人。在第二阶段，我们招募了年龄在15至30岁之间、在ACL重建手术后8周内的患者。参与者完成了为期10周的干预措施，并接受了半结构化访谈，以评估其可接受性、需求、实用性和整合性。该项目获得了瑞典伦理审查局的批准（批准号：2018/45 - 31）。
元综合分析得出以下三个分析主题（研究：n = 16；参与者：n = 164）：（1）支持康复进展的工具或策略，（2）身体准备好重返运动的障碍和促进因素，（3）心理准备好重返运动的障碍和促进因素。应对策略、放松和目标设定可能对ACL重建后的康复效果有积极影响（随机对照试验：n = 7；参与者：n = 430）。没有关于改善重返运动的心理支持干预措施的试验。11人完成了可行性测试的第一阶段（技术评估），并识别出4种软件错误，我们进行了修复。6名参与者完成了可行性与可用性测试阶段。他们的反馈表明，该干预措施易于获取，并满足了ACL重建后想要重返运动的运动员的需求。我们对干预措施进行了完善，增加了更多多媒体内容，并支持对干预功能的访问和使用。
“重返赛场”干预措施是一个为期24周、通过互联网提供的自我引导项目，包括7个模块，可补充常规康复，随着康复进展改变重点，易于获取和使用，并包括不同的心理支持策略。
