Garrett S Bullock1,2, Timothy C Sell3, Ryan Zarega3, Charles Reiter, Victoria King3, Hailey Wrona3, Nilani Mills3,4, Charlotte Ganderton5, Steven Duhig6, Anu Räisäsen7,8, Leila Ledbetter9, Gary S Collins10,11, Joanna Kvist12,13, Stephanie R Filbay14. 1. Department of Orthopaedic Surgery, Wake Forest School of Medicine, Charlotte, NC, USA. garrettbullock@gmail.com. 2. Centre for Sport, Exercise and Osteoarthritis Research-Versus Arthritis, University of Oxford, Oxford, UK. garrettbullock@gmail.com. 3. Atrium Health, Charlotte, NC, USA. 4. University of New South Wales, Sydney, NSW, Australia. 5. Swinborne University of Technology, Melbourne, VIC, Australia. 6. Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, Australia. 7. Department of Physical Therapy, Western University of Health Sciences, Lebanon, OR, USA. 8. Department of Kinesiology, University of Calgary, Calgary, AB, Canada. 9. Medical Libraries, Duke School of Medicine, Durham, NC, USA. 10. Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK. 11. Oxford University Hospitals NHS Foundation Trust, Oxford, UK. 12. Unit of Physiotherapy, Department of Health, Medicine, and Caring Medicine, Linkoping University, Linköping, Sweden. 13. Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden. 14. Centre of Health, Exercise, and Sport Medicine, University of Melbourne, Melbourne, VIC, Australia.
Abstract
BACKGROUND: To improve the understanding of the psychological impacts of anterior cruciate ligament (ACL) injury, a systematic review synthesizing the evidence on knee self-efficacy, fear avoidance beliefs and kinesiophobia following ACL injury is needed. OBJECTIVE: The aim of this systematic review was to investigate knee self-efficacy, fear avoidance beliefs and kinesiophobia following ACL injury, and compare these outcomes following management with rehabilitation alone, early and delayed ACL reconstruction (ACLR). METHODS: Seven databases were searched from inception to April 14, 2022. Articles were included if they assessed Tampa Scale of Kinesiophobia (TSK), Knee Self-Efficacy Scale (KSES), or Fear Avoidance Beliefs Questionnaire (FABQ). Risk of bias (RoB) was assessed using domain-based RoB tools (ROBINS-1, RoB 2, RoBANS), and GRADE-assessed certainty of evidence. Random-effects meta-analyses pooled outcomes, stratified by time post-injury (pre-operative, 3-6 months, 7-12 months, > 1-2 years, > 2-5 years, > 5 years). RESULTS: Seventy-three studies (70% high RoB) were included (study outcomes: TSK: 55; KSES: 22; FABQ: 5). Meta-analysis demonstrated worse kinesiophobia and self-efficacy pre-operatively (pooled mean [95% CI], TSK-11: 23.8 [22.2-25.3]; KSES: 5.0 [4.4-5.5]) compared with 3-6 months following ACLR (TSK-11: 19.6 [18.7-20.6]; KSES: 19.6 [18.6-20.6]). Meta-analysis suggests similar kinesiophobia > 3-6 months following early ACLR (19.8 [4.9]) versus delayed ACLR (17.2 [5.0]). Only one study assessed outcomes comparing ACLR with rehabilitation only. CONCLUSIONS: Knee self-efficacy and kinesiophobia improved from pre-ACLR to 3-6 months following ACLR, with similar outcomes after 6 months. Since the overall evidence was weak, there is a need for high-quality observational and intervention studies focusing on psychological outcomes following ACL injury.
BACKGROUND: To improve the understanding of the psychological impacts of anterior cruciate ligament (ACL) injury, a systematic review synthesizing the evidence on knee self-efficacy, fear avoidance beliefs and kinesiophobia following ACL injury is needed. OBJECTIVE: The aim of this systematic review was to investigate knee self-efficacy, fear avoidance beliefs and kinesiophobia following ACL injury, and compare these outcomes following management with rehabilitation alone, early and delayed ACL reconstruction (ACLR). METHODS: Seven databases were searched from inception to April 14, 2022. Articles were included if they assessed Tampa Scale of Kinesiophobia (TSK), Knee Self-Efficacy Scale (KSES), or Fear Avoidance Beliefs Questionnaire (FABQ). Risk of bias (RoB) was assessed using domain-based RoB tools (ROBINS-1, RoB 2, RoBANS), and GRADE-assessed certainty of evidence. Random-effects meta-analyses pooled outcomes, stratified by time post-injury (pre-operative, 3-6 months, 7-12 months, > 1-2 years, > 2-5 years, > 5 years). RESULTS: Seventy-three studies (70% high RoB) were included (study outcomes: TSK: 55; KSES: 22; FABQ: 5). Meta-analysis demonstrated worse kinesiophobia and self-efficacy pre-operatively (pooled mean [95% CI], TSK-11: 23.8 [22.2-25.3]; KSES: 5.0 [4.4-5.5]) compared with 3-6 months following ACLR (TSK-11: 19.6 [18.7-20.6]; KSES: 19.6 [18.6-20.6]). Meta-analysis suggests similar kinesiophobia > 3-6 months following early ACLR (19.8 [4.9]) versus delayed ACLR (17.2 [5.0]). Only one study assessed outcomes comparing ACLR with rehabilitation only. CONCLUSIONS: Knee self-efficacy and kinesiophobia improved from pre-ACLR to 3-6 months following ACLR, with similar outcomes after 6 months. Since the overall evidence was weak, there is a need for high-quality observational and intervention studies focusing on psychological outcomes following ACL injury.
Authors: Alicia M Montalvo; Daniel K Schneider; Kate E Webster; Laura Yut; Marc T Galloway; Robert S Heidt; Christopher C Kaeding; Timothy E Kremcheck; Robert A Magnussen; Shital N Parikh; Denver T Stanfield; Eric J Wall; Gregory D Myer Journal: J Athl Train Date: 2019-04-22 Impact factor: 2.860
Authors: Trevor A Lentz; Giorgio Zeppieri; Steven Z George; Susan M Tillman; Michael W Moser; Kevin W Farmer; Terese L Chmielewski Journal: Am J Sports Med Date: 2014-12-05 Impact factor: 6.202