2015 ISAKOS Biennial Congress ePoster #1260

Predicting Rehabilitation Intentions in ACL Patients Three Months After Surgery

Tom Williams, MSc, Cardiff UNITED KINGDOM
Lynne Evans, PhD, C.Psychol, Cardiff UNITED KINGDOM
Angus Robertson, BSc, FRCSEd(Tr&Orth) FFSEM(UK), Abergavenny, Monmouthshire UNITED KINGDOM
Stuart Roy, MBChB, MPhil (cantab) FRCS (Ed) Tr& Orth, Cowbridge UNITED KINGDOM
Daniel Lewis, FRCS ED (Tr. & Orth), Cardiff UNITED KINGDOM
Lew Hardy, Prof, PhD, C.Psychol, Bangor UNITED KINGDOM
Cardiff Metropolitan University, Cardiff, Wales, UNITED KINGDOM

FDA Status Not Applicable

Summary: While the psychology of sport injury literature continues to grow, there is still a need to examine psycho-social variables that influence patient’s adherence to rehabilitation. The purpose of the present study was to examine the predictive value of dispositional optimism and coping strategies before ACL reconstruction, on patient’s adherence to rehabilitation three months after surgery.

Abstract:

It is widely accepted that recovery from anterior cruciate ligament (ACL) surgery is contingent on adherence to rehabilitation, with positive associations between adherence and clinical outcomes documented in several studies (Brewer et al., 2004; Pizzari, Taylor, McBurney, & Feller, 2005; Tracey, Barron, Brunet, & Barrack, 1997). However, commonly reported adherence rates can be as low as 40% (Brewer, 1999). As a result, psycho-social variables that predict adherence to rehabilitation require research attention. Therefore, the purpose of the present study was to examine the predictive value of dispositional optimism and coping strategies on patient’s adherence to rehabilitation three months after ACL surgery.

Using a prospective design, a sample of 74 participants (52 males, 22 females) with a mean age of 27 years (SD = 7.1) undergoing ACL reconstruction were assessed on the psychological variables of dispositional optimism (Life Orientation Test-Revised; LOT-R; Scheier, Carver & Bridges, 1994), and coping strategies (Coping with Health Injuries and Problems (CHIP; Endler, Parker & Summerfeldt, 1993) one week prior to surgery. An attendance ratio at scheduled rehabilitation appointments was calculated 3 months post-surgery for each participant.

Hierarchical multiple regression was used to assess the ability of dispositional optimism and coping strategies to predict levels of adherence, after controlling for the influence of age and competitive level. Age and competitive level were entered at Step 1, explaining 1% of the variance in adherence. After entry of the LOT-R and CHIP scales at Step 2 the total variance explained by the model as a whole was 30.1%, F (7, 66) = 4.05, p < .01. The two control measures explained an additional 29.9% of the variance in adherence, after controlling for age and competitive level, R squared change = .30, F change (5, 66) = 5.65, p < .001. In the final model, only dispositional optimism (ß = .35, p < .01) and instrumental coping (ß = .39, p < .01) were statistically significant in predicting adherence.

Findings from the present study suggested dispositional optimism and instrumental coping strategies predicted a significant amount of variance in rehabilitation adherence at 3 months post-surgery. These results are supported by findings from various health-related (Carver, Scheier, & Segerstrom, 2010), and sport-injury outcomes (Johnston & Carroll, 2000; Udry, 1997). Generally, these positive associations have been suggested to be as a result of optimists’ engagement in positive health practices and adaptive coping strategies (Aspinwall & Taylor, 1992; Schou, Ekeberg, & Ruland, 2005). Therefore, the findings from the present study suggest the use of psychometrically tested inventories such as the LOT-R and CHIP administered before surgery could help clinician’s identify ‘at risk’ patients (i.e., those low in optimism, with maladaptive coping strategies), who require additional rehabilitative support during the post-operative period. Future research should identify additional psycho-social variables that predict adherence and recovery outcome to expedite successful patient recovery from ACL reconstruction.