Two- to 4-Year Follow-up to a Comparison of Home Versus Physical Therapy-Supervised Rehabilitation Programs After Anterior Cruciate Ligament Reconstruction
Two- to 4-Year Follow-up to a Comparison of Home Versus Physical Therapy-Supervised Rehabilitation Programs After Anterior Cruciate Ligament Reconstruction
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DOI：
10.1177/0363546509359763
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发表时间：
2010-07-01
影响因子：
4.8
通讯作者：
Mohtadi, Nicholas G. H.
中科院分区：
文献类型：
--
作者：
Grant, John A.;Mohtadi, Nicholas G. H.
背景资料：目前还没有长期随访研究比较前交叉韧带（ACL）重建后主要以家庭为基础的康复计划与标准物理治疗计划。证明这样一个具有成本效益的计划的长期成功将有利于指导未来的康复practice.Purpose：以确定是否有任何差异，在长期结果之间的娱乐运动员谁进行了物理治疗监督康复计划和那些谁进行了主要是家庭为基础的康复计划，在前3个月后ACL重建。证据等级，1.方法：患者在ACL重建手术前随机分为物理治疗监督（17次物理治疗）或家庭（4次物理治疗）方案。最初的129名患者中有88名在手术后2至4年返回，以评估其长期临床结局。主要结局是ACL生活质量问卷（ACL QOL）。次要结局是膝关节伸展和屈曲活动度、矢状面膝关节松弛、相对股四头肌和腘绳肌力量以及国际膝关节文献委员会客观评分的双侧差异。采用非配对t检验和卡方检验进行比较。结果如下：术后38个月，家庭治疗组的平均ACL QOL评分（80.0 +/- 16.2）显著高于物理治疗监督组（69.9 +/- 22.0）（P= 0.02，95%置信区间[CI]：1.7，18.4）。两组之间ACL COL评分从术前到随访的平均变化无显著差异（物理治疗= 40.0，家庭= 45.8，P= 0.26，95% CI：-15.8，4.4）。有没有显着差异的次要结局measurement.Conclusion：这项长期研究支持了短期的结果，原来的随机临床试验表明，患者谁参加了主要以家庭为基础的康复计划，在前3个月后ACL重建有类似的2- 4年的结果相比，那些患者谁参加了更多的临床监督计划。
Background: There have been no long-term follow-up studies comparing a predominantly home-based rehabilitation program with a standard physical therapy program after anterior cruciate ligament (ACL) reconstruction. Demonstrating the long-term success of such a cost-effective program would be beneficial to guide future rehabilitation practice.Purpose: To determine whether there were any differences in long-term outcome between recreational athletes who performed a physical therapy-supervised rehabilitation program and those who performed a primarily home-based rehabilitation program in the first 3 months after ACL reconstruction.Study Design: Randomized clinical trial; Level of evidence, 1.Methods: Patients were randomized before ACL reconstruction surgery to either the physical therapy-supervised (17 physical therapy sessions) or home-based (4 physical therapy sessions) program. Eighty-eight of the original 129 patients returned 2 to 4 years after surgery to assess their long-term clinical outcomes. Primary outcome was the ACL quality of life questionnaire (ACL QOL). Secondary outcomes were bilateral difference in knee extension and flexion range of motion, sagittal plane knee laxity, relative quadriceps and hamstring strength, and objective International Knee Documentation Committee score. Unpaired t tests and a chi-square test were used for the comparisons. Results: The home-based group had a significantly higher mean ACL QOL score (80.0 +/- 16.2) than the physical therapy-supervised group (69.9 +/- 22.0) a mean of 38 months after surgery (P=.02, 95% confidence interval [CI]: 1.7, 18.4). The mean change in ACL COL score from before surgery to follow-up was not significantly different between the groups (physical therapy = 40.0, home = 45.8, P=.26, 95% CI: -15.8, 4.4). There were no significant differences in the secondary outcome measures.Conclusion: This long-term study upholds the short-term findings of the original randomized clinical trial by demonstrating that patients who participate in a predominantly home-based rehabilitation program in the first 3 months after ACL reconstruction have similar 2- to 4-year outcomes compared with those patients who participate in a more clinically supervised program.