موجز عن البحث:
evaluate the effectiveness of pre-operative exercise physiotherapy
rehabilitation on the outcomes of treatment following anterior cruciate
following databases were searched: PubMed, Ovid, The Cochrane Library and Web
of Science. Studies published between the inception of the databases and
December 2015 were sought using appropriate keywords in various combinations.
This search was supplemented with a manual search of the references of
selected studies. Studies were assessed for methodological quality using the
Physiotherapy Evidence Database scale.
Results: A total
of 500 studies were identified, of which eight studies met the inclusion
criteria and were included in the present review. The average Physiotherapy
Evidence Database score for the studies included was 5.8, which reflects an
overall moderate methodological quality.
studies investigated a total of 451 subjects of which 71% (n=319) were males.
The age of the participants in the eight studies ranged from 15 to 57 years.
The duration of the intervention in the studies ranged from 3 to 24 weeks.
This review found that pre-operative physiotherapy rehabilitation is
effective for improving the outcomes of treatment following anterior cruciate
ligament injury, including increasing knee-related function and improving
muscle strength. However, whilst there was a significant improvement in
quality of life from baseline following intervention, no significant
difference in quality of life was found between the control and intervention
Conclusions: There is
evidence to suggest that pre-operative physiotherapy rehabilitation is
beneficial to patients with anterior cruciate ligament injury.
Anterior cruciate ligament (ACL) injury is
associated with pain, muscle weakness, functional impairment, poor quality of
life (QoL), loss of productivity due to absence from work and a great source
of financial burden to individuals and healthcare systems. ACL reconstruction is the main
intervention for this type of injury. Before ACL reconstruction surgery is
considered, patients are expected to meet certain conditions, including
normal knee range of motion (ROM), reduced effusion, normal gait, and
acceptable levels of knee proprioception and muscle strength. The reduced
strength, ROM and joint instability encountered by patients with an ACL
injury may be improved by an appropriate pre-operative rehabilitation
protocol involving the use of physiotherapy. Thus, a pre-operative
rehabilitation programme is proposed for patients undergoing ACL
reconstruction to achieve the following outcomes:
(1) restoring full range of motion in the injured
knee, (2) improving muscle strength and proprioception, and (3) restoring
A pre-operative physiotherapy rehabilitation
programme was developed following a systematic review of international
literature, review of clinical guidelines and a survey of expert opinion for
the management of ACL injury in Saudi Arabia. A pragmatic RCT was conducted
to test the developed protocol. The control group underwent surgery without
pre-operative rehabilitation while the intervention group received the
developed physiotherapy protocol before surgery. Primary and secondary health
outcome measures were used to compare ACL management outcomes in 84 patients
(45 in the Control group and 39 in the Intervention group) 14 days
post-reconstruction surgery. The primary health outcomes were based on the
knee injury and osteoarthritis outcome score (KOOS) and the secondary outcome
measures included: assessment of ROM, muscle strength, pain, health state
(mobility, self-care, usual activity, anxiety/depression and
pain/discomfort), and quality of life (QoL). To assess the cost-effectiveness
of the intervention, the incremental cost-effectiveness ratio (ICER) was used
based on resource use (cost) and quality of life measured as quality-adjusted
life years (QALY).
Overall, patients in the intervention group showed
significant improvement in the primary outcomes than the control group as
indicated by KOOS scores (p < 0.001). In addition, QoL was also
significantly better in the intervention group compare with the controls (p
< 0.001). The measured ICER indicated that the intervention is
cost-effective (£1150 per QALY gained).