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. 2021 Jul:50:217-225.
doi: 10.1016/j.ptsp.2021.05.012. Epub 2021 Jun 2.

Composite psychosocial risk based on the fear avoidance model in patients undergoing anterior cruciate ligament reconstruction: Cluster-based analysis

Rogelio A Coronado  1 , Jordan A Bley  2 , Laura J Huston  3 , Jacquelyn S Pennings  3 , Hiral Master  2 , Emily K Reinke  4 , Mackenzie L Bird  2 , Erica A Scaramuzza  2 , Christine M Haug  2 , Shannon L Mathis  5 , Susan W Vanston  2 , Charles L Cox  2 , Kurt P Spindler  6 , Kristin R Archer  7
Affiliations

Composite psychosocial risk based on the fear avoidance model in patients undergoing anterior cruciate ligament reconstruction: Cluster-based analysis

Rogelio A Coronado et al. Phys Ther Sport. 2021 Jul.

Abstract

Objectives: To examine associations between preoperative fear-avoidance model (FAM) risk subgroup status and patient expectation of surgical success with postoperative outcomes at 6 and 12 months after anterior cruciate ligament reconstruction (ACLR).

Design: Cohort study.

Setting: Academic medical center.

Participants: 54 patients (25 females) undergoing unilateral ACLR.

Main outcome measures: Cluster analysis distinguished FAM risk subgroups based on preoperative fear of movement/reinjury, self-efficacy, and pain catastrophizing. Preoperative expectation for surgical success was assessed with a numeric rating scale. Six and 12-month outcomes included Subjective Patient Outcomes for Return to Sport, Knee Injury and Osteoarthritis Outcome Score (KOOS) sports/recreation and quality of life, and International Knee Documentation Committee (IKDC) Subjective Knee Form.

Results: Thirteen (24%) patients were "moderate-to-high FAM risk." Moderate-to-high FAM risk patients had lower odds of return to sport at 12 months (OR = 0.3, p = .05) and lower KOOS sports/recreation at 6 months (st. beta = -0.27, p = .05), KOOS quality of life at 12 months (st. beta = -0.42, p = .007), and IKDC at 6 (st. beta = -0.29, p = .04) and 12 months (st. beta = -0.47, p = .001). Higher expectation was associated with lower 6-month IKDC (st. beta = -0.36, p = .008) and 12-month KOOS quality of life (st. beta = -0.29, p = .05).

Conclusions: Preoperative FAM risk influences patient-reported outcomes and return to sport at 6 and 12 months.

Keywords: Knee injuries; Patient expectations; Psychological adaptation; Return to sport.

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Conflict of interest statement

Declaration of competing interest The authors acknowledge that this manuscript has not been previously published nor under consideration for publication elsewhere. If accepted, the manuscript will not be published elsewhere. All authors have approved the final version of this manuscript.

Figures

Figure 1.
Figure 1.
Return to sport at 6 (n =50) and 12 months (n = 51) by preoperative FAM risk subgroup.
Figure 2.
Figure 2.
Unadjusted scores for Knee Injury and Osteoarthritis Outcome Score (KOOS) Sports and Recreation and Quality of Life subscales and International Knee Documentation Committee (IKDC) by preoperative FAM risk subgroup. Mean scores are marked, with error bars representing 95% confidence intervals.
See this image and copyright information in PMC

References

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