Spatient, Parent, and Physical Therapist Perceptions of Rehabilitation Following Acl Reconstruction: a Multiple Stakeholder Qualitative Study

BACKGROUND: Rehabilitation after anterior cruciate ligament reconstruction (ACLR) is challenging for adolescent patients concurrently experiencing growth and development, changes in attitudes and social interactions, and a gradual shift toward independence. While there have been attempts to describe and compare the perceptions of the rehabilitation process among adolescent patients and their parents, the perceptions of stakeholders outside the family unit such as the treating physical therapist (PT), have not been investigated. Developing a more nuanced understanding of stakeholder perceptions of interpersonal communication and consistency of expectations would enable researchers and clinicians to provide specific recommendations for interpersonal communication and information sharing. HYPOTHESIS/PURPOSE: To describe and compare the perceptions of information sharing and interpersonal communication among adolescent patients recovering from ACLR, one of their parents, and the PT primarily responsible for their rehabilitative care. METHODS: We completed a cross-sectional, qualitative study in which adolescent patients who had recently completed physical rehabilitation after ACLR (N=9, age=15.7±1.6, months since surgery=5.9±1.9), one of their parents (N=9), and their PT (N=9, years of experience=14.9±8.4) completed semi-structured interviews. The interview scripts for patients, parents, and PTs intentionally addressed the same topics, with only minor modifications in wording as appropriate for each role. All interviews were recorded, transcribed verbatim, and analyzed using a hybrid of deductive/inductive coding by trained members of the study team. RESULTS: Our findings indicate that parents and PTs tend to underestimate the psychological trauma and social isolation experienced by patients throughout rehabilitation (Figure 1). Additionally, patients and parents indicated that a pre-operative lack of information about the rehabilitation process hindered their ability to ask informed questions or seek additional information from the PT and surgeon after surgery. Parents and patients consistently described a need for enhanced access to medical providers and regularly updated digital educational resources to improve their knowledge of the ACLR procedure, the rehabilitation timeline, and the resources available to them (e.g., mental health support) in order to overcome these barriers. CONCLUSION: Participants from all stakeholder groups reported that orthopedic surgeons and other members of the healthcare team may consider being more consistent when setting expectations, physical restrictions, and recovery timelines. All stakeholder groups agreed that increased frequency of communication between the members of the healthcare team would be beneficial in ensuring that patients are meeting progress expectations and all members of the healthcare team have a shared understanding of the patients’ needs and desires.