Examination of task-specific motor confidence and performance in patients at 6-months post anterior cruciate ligament reconstruction

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Date
2022-09-12
Authors
Bruinooge, Brittany
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Abstract
Return-to-sport (RTS) batteries that incorporate physical and psychological components optimize information collected to guide rehabilitation and better inform RTS decisions1,2. Measuring task-specific confidence in addition to psychological readiness may assist in identifying athletic skills requiring intervention to optimize one’s readiness to RTS3. This study examined between-limb differences in confidence via self-reported and assessor-rated task-specific confidence, psychological readiness (Anterior Cruciate Ligament Return to Sport After Injury, ACL-RSI), and functional performance. 32 participants of varying graft types (82.4 ± 22.2 kg, 172.6 ± 8.3 cm, 25.6 ± 8.5 yrs., 20F:12M, ACL-RSI 50 ± 22%) were assessed at 6-months following ACL reconstruction (ACLR). Affected limb (A) performance for the SLH (A: 88.3 ± 41.4 cm, was reduced compared to the unaffected (UA) limb (UA: 117.7 ± 42.2 cm, p<0.001), and for the DVJ (A: 1.6 ± 0.6 N·kg-1, UA: 2.30 ± 0.59 N·kg-1, p<0.001), but COD times were marginally faster (A: 3.3 ± 0.5s, UA: 3.4 ± 0.5 s, p=0.047). Participant’s confidence ratings were lower on the affected limb for the single leg hop (SLH) (A: median 6 (range 2-9), UA: 9 (6-10), p<0.001), the drop vertical jump (DVJ) (A: 6 (3-9), UA: 10 (6-10), p<0.001) and the change of direction task (COD) (A: 7 (2-10), UA: 9 (7-10), p<0.001). Absolute performance for the SLH (ρ=0.558, p=0.001) and COD (ρ=-0.643, p<0.001) were correlated with the ACL-RSI but not for the DVJ or when any measure was expressed as a symmetry index (LSI; SLH rs =0.167, p=0.360; DVJ rs =-0.029, p=0.877; COD rs =0.127, p=0.49). Clinical relevance: It remains unclear if physical and psychological readiness are independent of each other or if one directly influences the other. In either case, a RTS battery that solely assesses physical function may not reflect the holistic recovery status of the patient. Assessing confidence when minimal between-limb performance differences are present (i.e., COD) might provide additional information to help guide the decision-making process regarding RTS.
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Keywords
Anterior cruciate ligament, Reconstruction, Return to sport, Psychological readiness, Confidence
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