Cognitive-behavioural physical therapy improves psychological readiness for return to sport, knee function, and resilience in patients after anterior cruciate ligament reconstruction: A randomised controlled trial.

Abstract

Psychological preparation prior to the return to sport (RTS) has a significant impact on knee function following anterior cruciate ligament reconstruction (ACLR). The objective of this study was to evaluate the efficacy of a cognitive-behavioural-based physical therapy (CBPT) program in enhancing patients' psychological well-being, psychological preparation for RTS and knee function. A randomised parallel-group controlled trial was conducted. Seventy-two patients awaiting ACLR were randomly assigned to the CBPT or control group. The evaluation comprised the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI), Lysholm score, Knee Self-Efficacy Scale (K-SES), Tampa Scale for Kinesiophobia (TSK), Brief Resilience Scale (BRS) and locus of control (LOC). These were measured preoperatively and at 6, 12 and 24 weeks postoperatively. Sixty-one subjects were finally included, 29 in the CBPT and 32 in the control group. At the 6th, 12th, and 24th postoperative weeks, the CBPT group had significantly higher ACL-RSI scores (66.4 vs. 62.2, 73.7 vs. 67.8, 85.1 vs. 80.1; p = 0.035, 0.012, 0.032, respectively), K-SES future scores (7.1 vs. 5.6, 7.9 vs. 6.8, 8.2 vs. 7.3; p = 0.002, 0.028, 0.047, respectively), and BRS scores (3.6 vs. 3.2, 4.1 vs. 3.7, 5.0 vs. 4.3; p = 0.025, 0.029, <0.001, respectively) compared to the control group. Lysholm scores were better in the CBPT group at Weeks 12 and 24 (73.7 vs. 65.3, 83.2 vs. 72.2; p = 0.038, <0.001, respectively), and the Week 24 mean difference exceeded the minimal clinically important difference (MCID) (10.0). No significant differences were found in TSK, K-SES present and LOC scores. CBPT-based psychological interventions facilitate enhanced psychological preparation for RTS, improved knee function and elevated confidence and resilience for future rehabilitation in patients who have undergone ACLR. Level I, randomised controlled trial. ChiCTR2400087631.