Exploring Psychological Aspects Of Recovery Following ACL Reconstruction In Participants With Low And High Kinesiophobia: A Mixed-Methods Study

PURPOSE: Despite following the rigorous rehabilitation protocol following Anterior cruciate ligamen reconstruction (ACLR), there is a poor rate of return to sports. Kinesiophobia (fear of movement) is known to influence the return to sports. The purpose of this study was to describe the perspectives on rehabilitation and recovery in patients with ACLR categorized as having high or low kinesiophobia in relation to activity, function, and psychological status. METHODS: A mixed-method study design was used with patient-reported outcome measures and semi-structured interviews. Participants with primary ACLR (5-12 months post-operative) were recruited and divided into high and low kinesiophobia groups based on the Tampa Scale of Kinesiophobia-11 scores. Participants completed patient-reported outcomes (PRO) namely: Tegner activity scale, Marx activity scale, International Knee Documentation Committee (IKDC), the Knee Injury and Osteoarthritis Outcome Scale (KOOS), Anterior Cruciate Ligament Return to Sports after Injury scale, and Generalized Anxiety Disorder-7; and participated in individual semi-structured interviews. PROs and interview data were analyzed using the general inductive approach. RESULTS: Three main themes were identified: fear of re-injury, activity avoidance and interlimb asymmetry, and coping mechanisms. Participants in both groups reported behaviors related to these themes (Figure 1). Significant differences were found between KOOS quality of life scores between groups [High kinesiophobia group = 53 (12.1), low kinesiophobia group = 70 (5.6)]. CONCLUSIONS: This study provided deep insights into participants’ perspectives on the challenges they face due to high Kinesiophobia. Clinicians primarily dealing with physical rehabilitation protocols can be trained to recognize key positive resilience and negative vulnerability psychological factors to develop a more personalized physical therapy-based treatment. This research was funded by the IDEA grant awarded to Mandeep Kaur and Joe Hart at University of Virginia.