JMIR Publications

ABSTRACT

Background:

Evidence shows that patients after anterior cruciate ligament (ACL) reconstruction may have varied access to physical therapy rehabilitation. In particular physical therapy input is known to end many months before patients are likely to be fully recovered. Tele-rehabilitation (TR) may provide an opportunity to address this “Rehabilitation Gap’” and improve access to evidence based rehabilitation content alongside physical therapy at all stages of care.

Objective:

To understand the opinions of patients who have had ACL surgery and rehabilitation on the use of tele-rehabilitation as part of ACL care. To define the population and explore their experiences and views on the acceptability of tele-rehabilitation after ACLR.

Methods:

This study was a cross-sectional, voluntary on-line survey combining both closed and open questions. Ethical approval was obtained through the Yale School of Medicine, Institutional Review Board (IRB). Participants were aged 16 or over at the time of recruitment, who had undergone ACL reconstruction within the last 5 years. The 26 item survey was developed using the Qualtrics survey platform. No items were mandatory. Responses were multiple choice, binary and qualitative. The Checklist For Reporting Results Of Internet E-Surveys, known as the CHERRIES statement was used to ensure the quality of reporting of surveys in the medical literature. Data were analysed using Stata Version 15. Qualitative data were analysed using NVIVO 11. The theoretical basis for this analysis is based on the COM-B (Capability, Opportunity and Motivation - Behaviour), model of behaviour change.

Results:

100 participants opened the survey. All completers were unique. The participation rate was 96%. Completion rate was also 96%. Patients reported PT care ended at an average of 6.4 months and feeling fully recovered at an average of 13.2 months. Only 11% of patients felt that they were fully recovered at the end of PT. 60% of patients were under 30. They were recreational athletes (74%) or competitive athletes (24%). 75% had private insurance. 77% reported that they were ‘Not Familiar At All’ with tele-rehabilitation. 89% felt capable. They preferred to use TR 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, as well as less access to manual therapy, motivation and opportunities to ask questions. Participant’s priorities for a future intervention included use as an adjunct to PT rather than instead, with content for each stage of care and especially return to sport. Importantly the intervention should be personalised to them and include measures of progress.

Conclusions:

This data contributes understanding and defining the ACL reconstruction population. Participants found TR acceptable in principle and highlighted key user requirements and scope of a future intervention.