Search Results

Context: Injury-related fear and quadriceps strength are independently associated with secondary anterior cruciate ligament (ACL) injury risk. It is not known whether injury-related fear and quadriceps strength are associated, despite their individual predictive capabilities of secondary ACL injury. The purpose of this study was to examine the association between injury-related fear and quadriceps strength in individuals at least 1 year after ACL reconstruction (ACLR). Design: Cross-sectional study. Methods: Forty participants between the ages of 18 and 35 years at least 1 year post unilateral primary ACLR. Participants completed the Tampa Scale of Kinesiophobia-11 (TSK-11) and a standard isokinetic quadriceps strength assessment using the Biodex Isokinetic Dynamometer. Pearson Product-Moment correlations were used to examine the linear association between the TSK-11 scores and peak torque (in nanometers per kilogram) for each limb and between the TSK-11 scores and limb symmetry indices for each limb. Pearson Product-Moment correlation coefficients (r) were interpreted as very high (.90–1.00), high (.70–.90), moderate (.50–.70), low (.30–.50), and no correlation (.00–.30). Results: The average TSK-11 score was 18.2 (5.3), average ACLR peak quadriceps torque was 1.9 (0.50) N·m/kg, average contralateral peak quadriceps torque was 2.3 (0.48) N·m/kg, and average limb symmetry index was 85.3% (12.6%). There was no statistically significant correlation between the TSK-11 and peak quadriceps torque on the ACLR limb (r = .12, P = .46), the TSK-11 and contralateral limb (r = .29, P = .07), or the TSK-11 and limb symmetry index (r = –.18, P = .27). Conclusions: There was no association between kinesiophobia and peak isokinetic quadriceps strength in individuals at least 1 year post-ACLR. Both factors, independently, have been shown to influence risk of secondary injury in patients after ACLR.

Context: Deficits in reaction time, decreased self-reported knee function, and elevated levels of injury-related fear have been observed in individuals who sustain anterior cruciate ligament injury. Understanding the relationship between these variables may provide the impetus to further investigate effective intervention strategies to address these deficits in individuals after anterior cruciate ligament reconstruction (ACLR). Objective: To examine the relationship between injury-related fear and lower-extremity visuomotor reaction time (VMRT) in individuals with a history of ACLR. A secondary purpose was to determine the relationship between self-reported knee function and lower-extremity VMRT in individuals with a history of ACLR. Design: Cross-sectional study. Setting: Laboratory. Participants: Twenty participants between the ages of 18–35 years, with history of unilateral ACLR within the last 10 years, who injured their knee playing or training for organized or recreational sports. Main Outcome Measures: Scores on the athlete fear avoidance questionnaire, the fear-avoidance beliefs questionnaire (FABQ), the knee injury and osteoarthritis outcome score, and reaction time (in seconds) on the lower-extremity VMRT task using the FitLight Trainer^™, bilaterally. Spearman Rho correlations examined the relationship between the dependent variables. Results: There was a moderate positive correlation between VMRT and FABQ-total (r = .62, P < .01), FABQ-sport (r = .56, P = .01), and FABQ-physical activity (r = .64, P < .01) for the injured limb. Correlations between FABQ scores and VMRT for the uninjured limb were weak positive correlations (r = .36–.41, P > .05). Weak correlations between the osteoarthritis outcome score subscales, athlete fear avoidance questionnaire, and VMRT were observed for the injured limb (P > .05). Conclusions: Individuals with a history of ACLR who exhibited elevated levels of injury-related fear demonstrated slower VMRT. There were no relationships between self-reported knee function and VMRT. Future research should explore interventions to address injury-related fear and VMRT in individuals after ACLR.

Clinical Question: Is there evidence to support the use of mindfulness to reduce injury risk in athletic populations? Clinical Bottom Line: There is currently inconsistent, good-quality evidence to support that mindfulness interventions are effective in decreasing injury rates in athletes compared to the standard of care. Future research should investigate the effectiveness of mindfulness in other populations and types of sports activity (e.g., basketball, gymnastics, etc.). Additionally, future research should investigate different mindfulness delivery techniques in addition to the Mindfulness–Acceptance–Commitment (MAC) approach. Due to the inconsistent, good-quality evidence to support the use of mindfulness to reduce injury rates, the grade of B is recommended by the Strength of Recommendation Taxonomy. Mindfulness interventions should be incorporated into clinical practice but stakeholders (e.g., coaches, athletes, administration) should be included in the decision to implement these programs.

Context: Knee self-efficacy and injury-related fear are associated with poor self-reported knee function and decreased physical activity (PA) after ACL reconstruction (ACLR). Limited research has explored contextual factors that may influence psychological responses in this population, such as history of sport-related concussion (SRC). After SRC, individuals may experience increased negative emotions, such as sadness and nervousness. However, it is unknown how SRC history may influence knee-self efficacy and injury-related fear in individuals with ACLR. The purpose of this study was to compare knee self-efficacy and injury-related fear in individuals after ACLR who present with and without history of SRC. Design: Cross-sectional study. Methods: Forty participants ≥1 year postunilateral ACLR were separated by history of SRC (no SRC = 29, SRC = 11). The Knee Self-Efficacy Scale (KSES) and subscales measured certainty regarding performance of daily activities (KSES-ADL), sports/leisure activities (KSES-Sport), physical activities (KSES-PA), and future knee function (KSES-Future). The Tampa Scale of Kinesiophobia-11 measured injury-related fear. Mann–Whitney U tests were used to examine between-group differences. Hedges g effect sizes and 95% confidence interval were used to examine clinically meaningful group differences. Results: Individuals with a history of ACLR and SRC demonstrated worse KSES-PA (7.5 [5.3]) compared with those without a history of SRC (8.1 [6.1], P = .03). No other statistically significant differences were observed. A medium effect size was present for the KSES-PA (0.62), KSES-ADL (0.42), KSES-Present (ADL + PA + Sport) (0.48), KSES-Total (0.53), and Tampa Scale of Kinesiophobia-11 (0.61) but must be interpreted with caution as 95% confidence interval crossed 0. Conclusions: This exploratory study indicated that individuals with a history of ACLR and SRC had worse knee self-efficacy for PA compared with those without history of SRC. Rehabilitation specialists should monitor knee self-efficacy deficits in the post-ACLR population and recognize the potential influence of cumulative injury history on rehabilitative outcomes.

Mindfulness meditation (MM) has decreased kinesiophobia in patients with knee pathologies. Mobile application-delivered MM (Mobile MM) may reduce kinesiophobia in individuals after anterior cruciate ligament reconstructions (ACLR). The purpose of this study was to examine the feasibility (i.e., retention, adherence, and acceptability) and preliminary efficacy of a 4-week Mobile MM intervention in individuals with a history of ACLR. Nine participants ≥1 year post unilateral ACLR completed 12 sessions of Mobile MM over 4 weeks via the Headspace mobile application that were facilitated remotely through a Health Insurance Portability and Accountability ACT of 1996 (HIPAA) compliant teleconference system. Participant retention of 100% and intervention adherence of 100% were observed. Participants reported moderate to high acceptability for the Mobile MM. A large between-group effect size of 1.6 [0.13, 2.98] in the Tampa Scale of Kinesiophobia-11 change score was observed. Mobile MM is a feasible intervention to address kinesiophobia in individuals with a history of ACLR.