Composite psychosocial risk based on the fear avoidance model in patients undergoing anterior cruciate ligament reconstruction: Cluster-based analysis.
Rogelio A Coronado, Jordan A Bley, Laura J Huston and 11 others
PMID 34116406WHAT IT FOUND
Patients with moderate-to-high preoperative fear-avoidance risk reported poorer knee function and quality of life during follow-up.
They were less likely to report returning to sport at the same level without pain, though this result was not clear. Screening may identify risk.
Key findings
01Two preoperative fear-avoidance subgroups were identified, and 24% of patients were in the moderate-to-high risk group.
02The moderate-to-high risk group had 70% lower odds of returning to sport at 12 months and lower knee function at 6 and 12 months.
03Preoperative expectation was associated with lower knee function at 6 months, but not with return to sport or sports participation at 6 or 12 months.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Small sample; 54 patients were enrolled, and complete-case analysis included 50 patients at 6 months and 51 patients at 12 months. Single surgeon and single academic center; all patients had the same graft type and a prescribed physical therapy protocol, so results may not generalize to other settings. Physical therapy compliance and rehabilitation details were not documented, so rehab factors could confound outcomes. All outcomes were patient-reported; no objective physical function or performance measures were used. Most patients had high preoperative activity and high expectation for surgical success, which may limit generalizability and make expectation results hard to interpret. The study was observational and the authors called the findings preliminary, so it cannot show that fear-avoidance risk or expectation caused poorer recovery. The return-to-sport association at 6 months was not statistically significant, and the 12-month association was marginal. Subgroup membership and fear-avoidance scores were not tracked over time.
Declared interests
No conflicts of interest were declared.
The easy way to misread this
Do not conclude that screening or treating fear-avoidance risk will improve return to sport. This was an observational cohort, not a treatment trial, and the 6-month return-to-sport association was not statistically significant.