Proposed Topic (Most preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
Chan H, Tse HY, Wong CK, Pang PY , Fong Y
Affiliation :
Physiotherapy department, MacLehose Medical Rehabilitation Centre
Introduction :
A comprehensive programme for patients with ACL reconstruction surgery (ACLR) was launched since July 2022 in Physiotherapy department, MacLehose Medical Rehabilitation Centre. Collaborating with the Department of Orthopaedics and Traumatology at Queen Mary Hospital, the programme provides seamless rehabilitation journey from prehabilitation to return to sports (RTS).
Patients with ACLR often express concerns regarding rehabilitation after surgery and have different expectations on return to pre-injury levels of physical activity. After the surgery, common challenges encountered in RTS include inadequate muscle strength and unsatisfactory single leg performance, as well as lack of confidence in transiting to on-field sports from gym training.
Our new contemporary programme was specifically designed to address these obstacles with prehabilitaion , accelerated quadriceps strengthening, sport-simulating exercise class, and comprehensive pre- and post-op assessments. We aim to improve patient journey and enhance physical and psychological readiness for RTS after ACLR.
Objectives :
1. To start the rehabilitation journey with comprehensive pre-operation assessment, patient education and prehabilitation
2. To facilitate timely return of quadriceps strength with Accelerated ACLR rehabilitation programme in collaboration with the Department of Orthopaedics and Traumatology at Queen Mary Hospital
3. To enhance functional performance and return to sports by sport-simulating exercise class
Methodology :
Highlights of our programme:
1. Prehabilitation and comprehensive assessment
2. Accelerated ACLR rehabilitation programme
3. Comprehensive 6-month assessment
4. Sport-simulating exercise class to facilitate return to sports
5. Comprehensive 9-month assessment
6. 12-months assessment if indicated
Phase 1: Prehabilitation
Before the operation, a one-on-one 1.5-hour comprehensive assessment for patients will be arranged for patients who join our post-op rehabilitation programme. Patient education would also be provided on post-op management and rehabilitation journey. Prehabilitation training will be arranged for patients with significant deficits in muscle strength, knee range of motion or patients with other major concerns.
Comprehensive assessment (Pre-op and post-op) include:
1. Quadriceps and Hamstrings strength measurement with isokinetic dynamometer
2. Functional assessment including single hopping, agility task, running and cutting
3. Self-perceived knee function by questionnaire.
Phase 2: Post-operation with Accelerated ACLR rehabilitation programme
For patients who had surgery in QMH/DKCH, Post-op physiotherapy referral would be sent directly from ward upon discharge, patients would be contacted directly for appointment booking. Rehabilitation programme usually takes 9 months to complete following the protocol developed in collaboration with the Department of Orthopaedics and Traumatology, QMH.
Accelerated ACLR rehabilitation programme allows selected patients to start open-kinetic chain quadriceps strengthening exercises from week 9 and facilitates timely return of quadriceps strength.
Phase 3: Return to function and sports
Starting from six months post-op, a twelve-week sport-simulating exercise class will be given alongside our regular rehabilitation till post-op nine months to facilitate return to sports. The class includes intensive strengthening for Hamstring and Quadriceps, jumping and agility training and sport-simulating drills.
After post-op nine months and upon completion of our class, patient who have met our RTS criteria would be discharged with home exercise programme. Doctors from the Department of Orthopaedics and Traumatology at Queen Mary Hospital will be notified of patients’ assessment results and decision can be made regarding suitability for RTS. Those who do not pass our requirements will be given boosting sessions and will be re-assessed at twelve-month post-op.
Result & Outcome :
(Data extracted between 1 Jul, 2022 to 31 Dec, 2023)
Prehabilitation
-Pre-operative assessment headcount: 19 patients
-Total hours completed: 28.5 man-hours
Overall results of participants in the ACL rehabilitation programme
-Isokinetic muscle testing
Quadriceps peak torque deficit at 60o/s (mean value):
At 6 months: 16.50%; At final assessment: 8.50%
(RTS peak torque deficit cut-off : ≤ 15%)
Improvement in peak torque deficit: 48.48%
-Self-reported confidence in return to sports:
International Knee Documentation Committee (IKDC) questionnaire (mean score):
At 6 months: 72.44%; At final assessment: 89.66%
(RTS cut-off score: ≥85%)
ACL Return to Sports after injury questionnaire (mean score):
At 6 months: 60.84%; At final assessment: 68.26%
(RTS cut-off score: ≥56%)
Conclusion:
The performance of our patients has met the RTS criteria according to international guidelines. (Mean Quadriceps peak torque deficit , IKDC , RSI)
-RTS Patient satisfaction questionnaire
100% agreed that:
1. RTS exercise class could physically and psychologically prepare them to RTS
2. Training in class environment was more motivating and has better training effect
3. Sports-simulating tasks supervised by physiotherapists was specific and could improve confidence in RTS.
4. Were satisfied and would recommend RTS class
