Susanne Beischer - Academia.edu (original) (raw)

Papers by Susanne Beischer

Research paper thumbnail of Greater self-efficacy, psychological readiness and return to sport amongst paediatric patients compared with adolescents and young adults, 8 and 12 months after ACL reconstruction

Knee Surgery, Sports Traumatology, Arthroscopy

Purpose The purpose of this study was to evaluate differences in rehabilitation-specific outcomes... more Purpose The purpose of this study was to evaluate differences in rehabilitation-specific outcomes between paediatric patients, adolescents and young adults within the first 2 years after anterior cruciate ligament (ACL) reconstruction. A further aim was to determine whether patient age was associated with an increased risk of not achieving symmetrical muscle function within the first 2 years after ACL reconstruction. Methods The patient data in the present study were extracted from the rehabilitation outcome registry, Project ACL. Patients aged 11–25 years registered for primary ACL reconstruction with a hamstring tendon autograft between April 1, 2013 and November 23, 2020 were included. A total of 691 patients met the inclusion criteria and were included in the study; 41 paediatric patients (females 11–13, males 11–15 years), 347 adolescents (females 14–19, males 16–19 years) and 303 young adults (females 20–25, males 20–25 years). Results The comparison between groups revealed th...

Research paper thumbnail of Hop tests and psychological PROs provide a demanding and clinician-friendly RTS assessment of patients after ACL reconstruction, a registry study

BMC sports science, medicine & rehabilitation, May 13, 2020

Background: There is growing interest in assessing psychological well-being in patients after ant... more Background: There is growing interest in assessing psychological well-being in patients after anterior cruciate ligament (ACL) reconstruction. It is unknown whether an assessment of psychological outcome in addition to tests of muscle function can facilitate decisions on return to sport (RTS). Therefore, the aim of this study was to evaluate passing rates in different physical RTS test batteries, with and without the inclusion of psychological outcome measures 1 year after ACL reconstruction. Method: In this cross-sectional cohort study a total of 320 patients (51% men) aged 18-65 years were included 1 year after ACL reconstruction. Passing rates on different muscle function (MF) test batteries (with results presented as Limb Symmetry Index (LSI)), consisting of knee extension and flexion strength tests, 3 hop tests, and 2 psychological patient-reported outcomes (PROs); Quality of Life subscale from the Knee injury and Osteoarthritis Outcome Score (KOOS QoL) and ACL Return to Sport after Injury (ACL-RSI), were evaluated 1 year after ACL reconstruction. Muscle function test batteries comprised: 2 MF tests (vertical hop and hop for distance; pass = 90% LSI); 2 MF tests and 2 PRO (pass = 90% LSI, 62.5 points on KOOS QoL and 76.6 points on ACL-RSI), 5 MF tests (2 strength and 3 hop tests, pass = 90% LSI), and 5 MF tests and 2 PRO (pass = 90% LSI, 62.5 points on KOOS QoL and 76.6 points on ACL-RSI). Results: Passing rates in the different test batteries were 47% for 2 MF tests, 19% for 2 MF tests and 2 PROs, 29% for 5 MF tests and 13% for 5 MF tests and 2 PROs. The use of psychological PROs together with tests of muscle function gave the lowest passing rate (13%). There was a very strong correlation between passing 2 hop tests and 2 PROs and passing 5 MF tests (rφ = 0.41) as well as passing 5 MF tests and 2 PROs (rφ = 0.79). Conclusion: The use of hop tests together with psychological PROs provides a clinician-friendly RTS test battery for assessment 1 year after ACL reconstruction as the passing rate was 19% when using 2 hop-tests combined with 2 PROs, compared with 29% when using 5 tests of MF requiring advanced testing equipment.

Research paper thumbnail of No major difference in perceived quality of care in patients with hip or knee osteoarthritis assessed in a physical therapy-led triage compared with standard care: a randomized controlled trial

BMC Musculoskeletal Disorders, Jun 29, 2023

Background Physical therapy-led orthopedic triage is a care model used to optimize pathways for p... more Background Physical therapy-led orthopedic triage is a care model used to optimize pathways for patients with hip or knee osteoarthritis. However, scientific evidence of the effectiveness of this model of care is still limited and only a few studies report patients' perception of it. The aim of this study was to compare patients' perceived quality of care after physical therapy-led triage with standard practice in a secondary care setting for patients with primary hip or knee osteoarthritis. Methods In this randomized study, patients with hip or knee osteoarthritis referred for an orthopedic consultation received either physical therapy-led triage (n = 344) or a standard care assessment by an orthopedic surgeon (n = 294). To evaluate the patients' perceived quality of care, a short version of the Quality from the Patient' s Perspective (QPP) questionnaire was sent to the patients within a week after their assessment. The primary outcome was the statement "I received the best examination and treatment" on QPP. Results A total of 348 patients (70%, physical therapy-led triage: n = 249, standard care: n = 199) answered the questionnaire. No significant difference was found in the primary outcome between the groups (p = 0.6). Participants in the triage group perceived themselves to have received significantly better information about how to take care of their osteoarthritis (p = 0.017) compared with the standard care group. The standard care group reported that they participated in the decision-making process to a greater extent (p = 0.005), that their expectations were met to a greater degree (p = 0.013), and that their care depended more on their need for care rather than the caregivers' routines (0.007). Conclusion Both groups report high perceived quality of care. Significant differences were found in four of 14 questions, one in favor of the physical therapist and three in favor of the standard care group. The findings of this

Research paper thumbnail of Generalized joint hypermobility does not influence clinical outcomes following isolated MPFL reconstruction for patellofemoral instability

Knee Surgery, Sports Traumatology, Arthroscopy, 2019

Purpose Generalized joint hypermobility (GJH) has frequently been described as a risk factor for ... more Purpose Generalized joint hypermobility (GJH) has frequently been described as a risk factor for patellofemoral instability; however, only a few primary research studies have demonstrated any evidence of a relationship. The primary purpose of this study was to determine if isolated proximal soft tissue stabilization for patellofemoral instability is as successful in patients with GJH compared those without, as measured by disease-specific quality-of-life (QOL), symptom scores and functional outcomes. The secondary purpose was to determine if clinical and patient-reported outcomes were influenced by patient demographic factors in the presence of joint hypermobility. Methods Between 2009 and 2014, data were collected on 174/193 knees (92% follow-up) following an isolated medial patellofemoral ligament reconstruction (MPFL-R). Patients with a Beighton score of 4 or greater were classified as positive for GJH, and any score of 3 or less was classified as negative. Pre-and post-operative Banff Patella Instability Instrument (BPII) scores were compared using a two-sample t test to determine the influence of GJH on QOL. The relationship between the Beighton score, and demographic and clinical factors was explored using correlational analysis. Functional testing including balance and single-leg hop testing was conducted 1 and 2 years post-operatively. Limb symmetry and mean limb-to-limb performance differences were calculated. Results In this cohort of isolated MPFL reconstructions, 55.1% had a positive Beighton score. There were seven surgical failures (3.6%). There was no evidence of a relationship between a positive Beighton score and pre-operative BPII scores, post-operative BPII scores or post-operative symptom scores. GJH did not correlate significantly with any post-operative functional testing measures. A positive Beighton score was inversely related to patient age and more prevalent in females. Conclusions This study determined that the presence of GJH did not influence disease-specific quality of life, physical symptom score or functional outcomes following MPFL reconstruction. Level of evidence III.

Research paper thumbnail of Only 10% of Patients With a Concomitant MCL Injury Return to Their Preinjury Level of Sport 1 Year After ACL Reconstruction: A Matched Comparison With Isolated ACL Reconstruction

Sports Health: A Multidisciplinary Approach

Background: There is a need for an increased understanding of the way a concomitant medial collat... more Background: There is a need for an increased understanding of the way a concomitant medial collateral ligament (MCL) injury may influence outcome after anterior cruciate ligament (ACL) reconstruction. Hypothesis: Patients with a concomitant MCL injury would have inferior clinical outcomes compared with a matched cohort of patients undergoing ACL reconstruction without an MCL injury. Study Design: Matched registry-based cohort study; case-control. Level of Evidence: Level 3. Methods: Data from the Swedish National Knee Ligament Registry and a local rehabilitation outcome registry were utilized. Patients who had undergone a primary ACL reconstruction with a concomitant nonsurgically treated MCL injury (ACL + MCL group) were matched with patients who had undergone an ACL reconstruction without an MCL injury (ACL group), in a 1:3 ratio. The primary outcome was return to knee-strenuous sport, defined as a Tegner activity scale ≥6, at the 1-year follow-up. In addition, return to preinjury...

Research paper thumbnail of No major difference in perceived quality of care in patients with hip or knee osteoarthritis assessed in a physical therapy-led triage compared with standard care: a randomized controlled trial

Background: Physical therapy-led orthopedic triage is a care model used to optimize pathways for ... more Background: Physical therapy-led orthopedic triage is a care model used to optimize pathways for patients with hip or knee osteoarthritis. However, scientific evidence of the effectiveness of this model of care is still limited and only a few studies report patients’ perception of it. The aim of this study was to compare patients’ perceived quality of care after physical therapy-led triage with standard practice in a secondary care setting for patients with primary hip or knee osteoarthritis. Methods: In this randomized study, patients with hip or knee osteoarthritis referred for an orthopedic consultation received either physical therapy-led triage (n=344) or a standard care assessment by an orthopedic surgeon (n=294). To evaluate the patients’ perceived quality of care, a short version of the Quality from the Patient’s Perspective questionnaire was sent to the patients within a week after their assessment. The primary outcome was the statement “I received the best examination and ...

Research paper thumbnail of Concomitant injuries may not reduce the likelihood of achieving symmetrical muscle function one year after anterior cruciate ligament reconstruction: a prospective observational study based on 263 patients

Knee Surgery, Sports Traumatology, Arthroscopy, 2018

Purpose A better understanding of patient characteristics and the way common concomitant injuries... more Purpose A better understanding of patient characteristics and the way common concomitant injuries affect the recovery of muscle function after surgery should help providers to treat patients with anterior cruciate ligament (ACL) injuries. The aim of this study was to determine whether patient characteristics, concomitant injuries and graft choice at ACL reconstruction were associated with symmetrical knee muscle function at one year. The hypothesis was that the presence of concomitant injuries would negatively influence the opportunity to achieve symmetrical knee function at the one-year follow-up. Methods Data was extracted from the Swedish National Knee Ligament Register and a rehabilitation outcome register between August 2012 and December 2016. The patients had been evaluated with a battery of tests comprising knee extension and flexion strength, vertical jump, hop for distance and the side-hop test one year after ACL reconstruction. Univariable and multivariable logistic regression analyses were performed with achieving a limb symmetry index (LSI) of ≥ 90% in all tests of muscle function as primary outcome. Results A total of 263 patients with a mean age of 26.7 ± 10.3 years were included in the study (47% females). No patient demographic or intra-operative predictors were found to be significant when attempting to predict the achievement of a symmetrical muscle function. Lateral meniscus injury and a patellar tendon autograft reduced the odds of achieving an LSI of ≥ 90% in knee extension strength, OR = 0.49 [(95% CI 0.25-0.97), p = 0.039] and OR = 0.30 [(95% CI 0.14-0.67), p = 0.0033] respectively. In addition, reduced odds of recovering knee extension strength were found in older patients, OR = 0.76 [(95% CI 0.60-0.98), p = 0.034]. A higher pre-injury level of physical activity increased the odds of recovering knee flexion strength, OR = 1.14 [(95% CI 1.01-1.29), p = 0.037]. Conclusion Intra-operatively identified concomitant injuries or graft choice did not affect the likelihood of recovering symmetrical performance in five different tests of muscle function one year after ACL reconstruction. However, fewer than one in four patients achieved an LSI of ≥ 90% in all tests. Level of evidence Prospective observational study: Level 2.

Research paper thumbnail of Patients that maintain their pre-injury level of physical activity 3–5 years after ACL reconstruction are, 18 months after surgery, characterised by higher levels of readiness to return to sport

Knee Surgery, Sports Traumatology, Arthroscopy

Purpose To characterise patients who had returned to their pre-injury physical activity (PA) or h... more Purpose To characterise patients who had returned to their pre-injury physical activity (PA) or higher at 18 months and maintained that level of PA 3–5 years after the primary ACL reconstruction and to describe the level, frequency, and type of PA participation during the first 5 years after ACL reconstruction Method Data, from follow-ups at 18 months and 3–5 years after an ACL reconstruction, were extracted from a rehabilitation-specific register. Patients, 15–65 years of age, were included. The data comprised patient-reported outcomes and the results from two questions with respect to the level, frequency, and type of PA. Comparisons were made between patients who had and had not maintained their pre-injury level of PA at the follow-up 3–5 years after an ACL reconstruction. Results A total of 272 patients met the inclusion criteria. The mean follow-up time was 3.8 years (min–max: 2.9–5.1) after the ACL reconstruction. Of patients who had returned to their pre-injury or a higher l...

Research paper thumbnail of Persistent knee flexor strength deficits identified through the NordBord eccentric test compared with “gold standard” isokinetic concentric testing during the first year after anterior cruciate ligament reconstruction with a hamstring tendon autograft

Physical Therapy in Sport, 2022

Research paper thumbnail of Validation of an 18-item version of the Swedish Knee Self-Efficacy Scale for patients after ACL injury and ACL reconstruction

Journal of Experimental Orthopaedics, 2021

Purpose To evaluate the measurement properties of a new version of the Swedish Knee Self-Efficacy... more Purpose To evaluate the measurement properties of a new version of the Swedish Knee Self-Efficacy Scale (K-SES) in samples of individuals with an anterior cruciate ligament (ACL) injury and after ACL reconstruction. A secondary aim was to translate the new version of K-SES into English in order to prepare for future complete cross-cultural adaptation. Methods The reliability, structural validity, internal consistency and construct validity of the new, 18-item version of the K-SES (K-SES18) were assessed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist for evaluating methodological quality. The Swedish version of the K-SES18 was translated to English using recommended guidelines. Results The test-retest reliability for the K-SES18 subscale present and the K-SES18 subscale future showed an Interclass Correlation Coefficient (ICC) = 0.92. In addition, the K-SES18 had a Cronbach’s α ranging from 0.93 to 0.96 for the K-SES1...

Research paper thumbnail of Factors Affecting the Achievement of a Patient-Acceptable Symptom State 1 Year After Anterior Cruciate Ligament Reconstruction: A Cohort Study of 343 Patients From 2 Registries

Orthopaedic Journal of Sports Medicine, 2018

Background: There is insufficient knowledge regarding the influence of concomitant injuries on th... more Background: There is insufficient knowledge regarding the influence of concomitant injuries on the recovery of short-term subjective knee function after anterior cruciate ligament (ACL) reconstruction. Purpose: To determine whether patient characteristics, concomitant injuries, and graft choice during ACL reconstruction can predict which patients achieve acceptable knee function 1 year after reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: Data from 1 physical therapist–specific and 1 surgeon-specific register were used. Patients who had completed the Knee injury and Osteoarthritis Outcome Score (KOOS) at 1-year follow-up were included. Additional intraoperative information was extracted from a database. The primary outcome was achieving a patient-acceptable symptom state (PASS) for each subscale of the KOOS. Univariable and multivariable logistic regression models were used, with patient sex, age, and preinjury level of physical activity as covariate...

Research paper thumbnail of How Is Psychological Outcome Related to Knee Function and Return to Sport Among Adolescent Athletes After Anterior Cruciate Ligament Reconstruction?

The American Journal of Sports Medicine, 2019

Background: Adult patients who succeed in returning to their preinjury levels of sport after ante... more Background: Adult patients who succeed in returning to their preinjury levels of sport after anterior cruciate ligament (ACL) reconstruction have been characterized by a more positive psychological response. It is not known whether this relationship is valid for adolescent athletes. Purpose: To investigate psychological readiness to return to sport, knee-related self-efficacy, and motivation among adolescent (15-20 years old) and adult (21-30 years old) athletes after ACL reconstruction. A further aim was to compare athletes (15-30 years old) who had recovered their muscle function and returned to sport with athletes who had not. Study Design: Case-control study; Level of evidence, 3. Methods: Data were extracted from a rehabilitation-specific register 8 and 12 months after ACL reconstruction. Athletes previously involved in knee-strenuous sport who had undergone primary ACL reconstruction were included. Data comprised psychological patient-reported outcomes and results from 5 tests...

Research paper thumbnail of Low 1-Year Return-to-Sport Rate After Anterior Cruciate Ligament Reconstruction Regardless of Patient and Surgical Factors: A Prospective Cohort Study of 272 Patients

The American Journal of Sports Medicine, 2018

Background: There is insufficient knowledge about the way that concomitant injuries affect the sh... more Background: There is insufficient knowledge about the way that concomitant injuries affect the short-term likelihood of a return to a knee-strenuous sport after anterior cruciate ligament (ACL) reconstruction. Hypotheses/Purpose: The purpose was to study whether patient characteristics, concomitant injuries, and graft choice at primary ACL reconstruction can predict return to sport (RTS) 1 year after surgery. The hypotheses were that younger age at the time of ACL reconstruction would positively affect RTS, while the presence of concomitant injuries would negatively affect RTS 1 year after surgery. Study Design: Case-control study; Level of evidence, 3. Methods: Data were extracted from a rehabilitation-specific register and the Swedish National Knee Ligament Register. Twelve months after surgery, all patients were evaluated for RTS via the Tegner Activity Scale. The primary outcome was a return to knee-strenuous sport, defined as a Tegner Activity Scale ≥6. Univariable and multivar...

Research paper thumbnail of Young athletes return too early to knee-strenuous sport, without acceptable knee function after anterior cruciate ligament reconstruction

Knee Surgery, Sports Traumatology, Arthroscopy, 2017

Research paper thumbnail of Lower Extremity Injuries in Young Floorball Players: A Prospective Study on Overuse Injuries

The Open Sports Sciences Journal, 2016

Background: Overuse injuries in sports seem to be 1.5 to 2.5 times more common than traumatic inj... more Background: Overuse injuries in sports seem to be 1.5 to 2.5 times more common than traumatic injuries in the lower extremity (LE) in children and adolescents. Floorball is the most popular indoor sport in Sweden and is associated with many potential risks of injuries. However, to our knowledge, no previous studies have examined the appearance of injury in young floorball players. Objective: The aim of the present study was to investigate the occurrence of overuse injuries in LE in floorball players aged 15 or younger, with respect to frequency, location, and consequence of injury. Method: Fifty-seven players, from 9 different teams, participated (mean age 11±2 years). A modified version of Oslo Sports Trauma Research Center Overuse Injury Questionnaire was submitted every fourth week during five months in order to record overuse injuries in LE. An online survey software was used to send out the questionnaires. Results: A of 42 overuse injuries in 42% (24/57) of the cohort were foun...

Research paper thumbnail of Return to knee-strenuous sport after anterior cruciate ligament reconstruction: a report from a rehabilitation outcome registry of patient characteristics

Knee Surgery, Sports Traumatology, Arthroscopy, 2016

Research paper thumbnail of Knee strength, hop performance and self-efficacy at 4 months are associated with symmetrical knee muscle function in young athletes 1 year after an anterior cruciate ligament reconstruction

BMJ Open Sport & Exercise Medicine, 2019

ObjectivesWe investigated whether patient demographics, 4-month patient-reported outcomes (PRO) a... more ObjectivesWe investigated whether patient demographics, 4-month patient-reported outcomes (PRO) and muscle function predicted young athletes regaining symmetrical muscle function in five tests of muscle function 1 year after ACL reconstruction.MethodsWe extracted data on patient demographics, PROs and the results of five tests of muscle function from a rehabilitation-specific register. Athletes were 15–30 years of age, involved in knee-strenuous sport and had undergone a primary ACL reconstruction. The primary outcome was achieving a Limb Symmetry Index of ≥90% for the battery of tests 1 year after ACL reconstruction. Patient demographics, muscle-function data and results for PROs at the 4-month follow-up were analysed.ResultsIn all, 237 athletes (59% female; mean age 22±4 years) were included in the study. One year after ACL reconstruction, 26% (62/237) of the included athletes had achieved symmetrical muscle function. Univariable analysis showed that symmetrical muscle function wa...

Research paper thumbnail of Patience you must have, my young athlete - Rehabilitation specific outcomes after anterior cruciate ligament reconstruction

An anterior cruciate ligament (ACL) injury is one of the most common knee-related injuries, usual... more An anterior cruciate ligament (ACL) injury is one of the most common knee-related injuries, usually occurring in younger individuals during sports participation. Moreover, almost 1 in 4 of younger athletes sustain a subsequent ACL injury once they return to sport (RTS). Few previous studies have, however, focused on outcomes in adolescent athletes (15-20 years of age) after a primary ACL reconstruction. The overall aim of this thesis was to describe outcomes after a primary ACL reconstruction in terms of muscle function, RTS, concomitant injuries, subsequent ACL injury, psychological aspects and symptoms related to knee function in adolescent athletes, aged 15 to 20 years, and in adult athletes, aged 21 to 30 years. This thesis comprises 5 studies, all based on data from a rehabilitation outcome register, Project ACL. The primary statistical methods used were comparative analyses between adolescents and adult athletes as well as uniand multivariable analyses with different binary de...

Research paper thumbnail of Greater psychological readiness to return to sport, as well as greater present and future knee-related self-efficacy can increase the risk for an ACL re-rupture: a matched cohort study

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Research paper thumbnail of Recovery of preoperative absolute knee extension and flexion strength after ACL reconstruction

BackgroundThe recovery of muscle function after an Anterior Cruciate Ligament (ACL) reconstructio... more BackgroundThe recovery of muscle function after an Anterior Cruciate Ligament (ACL) reconstruction is most commonly reported as limb-to-limb differences using the Limb Symmetry Index (LSI), which is not free from limitations. The purpose of this study was to compare the proportion of patients who recover their Preoperative Absolute Muscle Strength (PAMS) 8 and 12 months after ACL reconstruction with the proportion of patients who recover their symmetrical knee strength. A secondary aim was to assess the relationship between psychological Patient-Reported Outcomes (PROs) and recovering PAMS at 8 and 12 months after ACL reconstruction and rehabilitation.MethodPreoperative, 8- and 12-month results from quadriceps and hamstring strength tests and PROs for 117 patients were extracted from a rehabilitation registry. Individual preoperative peak torques from strength tests were compared with results from the 8- and 12-month follow-ups respectively. Patients were defined as having recovered...

Research paper thumbnail of Greater self-efficacy, psychological readiness and return to sport amongst paediatric patients compared with adolescents and young adults, 8 and 12 months after ACL reconstruction

Knee Surgery, Sports Traumatology, Arthroscopy

Purpose The purpose of this study was to evaluate differences in rehabilitation-specific outcomes... more Purpose The purpose of this study was to evaluate differences in rehabilitation-specific outcomes between paediatric patients, adolescents and young adults within the first 2 years after anterior cruciate ligament (ACL) reconstruction. A further aim was to determine whether patient age was associated with an increased risk of not achieving symmetrical muscle function within the first 2 years after ACL reconstruction. Methods The patient data in the present study were extracted from the rehabilitation outcome registry, Project ACL. Patients aged 11–25 years registered for primary ACL reconstruction with a hamstring tendon autograft between April 1, 2013 and November 23, 2020 were included. A total of 691 patients met the inclusion criteria and were included in the study; 41 paediatric patients (females 11–13, males 11–15 years), 347 adolescents (females 14–19, males 16–19 years) and 303 young adults (females 20–25, males 20–25 years). Results The comparison between groups revealed th...

Research paper thumbnail of Hop tests and psychological PROs provide a demanding and clinician-friendly RTS assessment of patients after ACL reconstruction, a registry study

BMC sports science, medicine & rehabilitation, May 13, 2020

Background: There is growing interest in assessing psychological well-being in patients after ant... more Background: There is growing interest in assessing psychological well-being in patients after anterior cruciate ligament (ACL) reconstruction. It is unknown whether an assessment of psychological outcome in addition to tests of muscle function can facilitate decisions on return to sport (RTS). Therefore, the aim of this study was to evaluate passing rates in different physical RTS test batteries, with and without the inclusion of psychological outcome measures 1 year after ACL reconstruction. Method: In this cross-sectional cohort study a total of 320 patients (51% men) aged 18-65 years were included 1 year after ACL reconstruction. Passing rates on different muscle function (MF) test batteries (with results presented as Limb Symmetry Index (LSI)), consisting of knee extension and flexion strength tests, 3 hop tests, and 2 psychological patient-reported outcomes (PROs); Quality of Life subscale from the Knee injury and Osteoarthritis Outcome Score (KOOS QoL) and ACL Return to Sport after Injury (ACL-RSI), were evaluated 1 year after ACL reconstruction. Muscle function test batteries comprised: 2 MF tests (vertical hop and hop for distance; pass = 90% LSI); 2 MF tests and 2 PRO (pass = 90% LSI, 62.5 points on KOOS QoL and 76.6 points on ACL-RSI), 5 MF tests (2 strength and 3 hop tests, pass = 90% LSI), and 5 MF tests and 2 PRO (pass = 90% LSI, 62.5 points on KOOS QoL and 76.6 points on ACL-RSI). Results: Passing rates in the different test batteries were 47% for 2 MF tests, 19% for 2 MF tests and 2 PROs, 29% for 5 MF tests and 13% for 5 MF tests and 2 PROs. The use of psychological PROs together with tests of muscle function gave the lowest passing rate (13%). There was a very strong correlation between passing 2 hop tests and 2 PROs and passing 5 MF tests (rφ = 0.41) as well as passing 5 MF tests and 2 PROs (rφ = 0.79). Conclusion: The use of hop tests together with psychological PROs provides a clinician-friendly RTS test battery for assessment 1 year after ACL reconstruction as the passing rate was 19% when using 2 hop-tests combined with 2 PROs, compared with 29% when using 5 tests of MF requiring advanced testing equipment.

Research paper thumbnail of No major difference in perceived quality of care in patients with hip or knee osteoarthritis assessed in a physical therapy-led triage compared with standard care: a randomized controlled trial

BMC Musculoskeletal Disorders, Jun 29, 2023

Background Physical therapy-led orthopedic triage is a care model used to optimize pathways for p... more Background Physical therapy-led orthopedic triage is a care model used to optimize pathways for patients with hip or knee osteoarthritis. However, scientific evidence of the effectiveness of this model of care is still limited and only a few studies report patients' perception of it. The aim of this study was to compare patients' perceived quality of care after physical therapy-led triage with standard practice in a secondary care setting for patients with primary hip or knee osteoarthritis. Methods In this randomized study, patients with hip or knee osteoarthritis referred for an orthopedic consultation received either physical therapy-led triage (n = 344) or a standard care assessment by an orthopedic surgeon (n = 294). To evaluate the patients' perceived quality of care, a short version of the Quality from the Patient' s Perspective (QPP) questionnaire was sent to the patients within a week after their assessment. The primary outcome was the statement "I received the best examination and treatment" on QPP. Results A total of 348 patients (70%, physical therapy-led triage: n = 249, standard care: n = 199) answered the questionnaire. No significant difference was found in the primary outcome between the groups (p = 0.6). Participants in the triage group perceived themselves to have received significantly better information about how to take care of their osteoarthritis (p = 0.017) compared with the standard care group. The standard care group reported that they participated in the decision-making process to a greater extent (p = 0.005), that their expectations were met to a greater degree (p = 0.013), and that their care depended more on their need for care rather than the caregivers' routines (0.007). Conclusion Both groups report high perceived quality of care. Significant differences were found in four of 14 questions, one in favor of the physical therapist and three in favor of the standard care group. The findings of this

Research paper thumbnail of Generalized joint hypermobility does not influence clinical outcomes following isolated MPFL reconstruction for patellofemoral instability

Knee Surgery, Sports Traumatology, Arthroscopy, 2019

Purpose Generalized joint hypermobility (GJH) has frequently been described as a risk factor for ... more Purpose Generalized joint hypermobility (GJH) has frequently been described as a risk factor for patellofemoral instability; however, only a few primary research studies have demonstrated any evidence of a relationship. The primary purpose of this study was to determine if isolated proximal soft tissue stabilization for patellofemoral instability is as successful in patients with GJH compared those without, as measured by disease-specific quality-of-life (QOL), symptom scores and functional outcomes. The secondary purpose was to determine if clinical and patient-reported outcomes were influenced by patient demographic factors in the presence of joint hypermobility. Methods Between 2009 and 2014, data were collected on 174/193 knees (92% follow-up) following an isolated medial patellofemoral ligament reconstruction (MPFL-R). Patients with a Beighton score of 4 or greater were classified as positive for GJH, and any score of 3 or less was classified as negative. Pre-and post-operative Banff Patella Instability Instrument (BPII) scores were compared using a two-sample t test to determine the influence of GJH on QOL. The relationship between the Beighton score, and demographic and clinical factors was explored using correlational analysis. Functional testing including balance and single-leg hop testing was conducted 1 and 2 years post-operatively. Limb symmetry and mean limb-to-limb performance differences were calculated. Results In this cohort of isolated MPFL reconstructions, 55.1% had a positive Beighton score. There were seven surgical failures (3.6%). There was no evidence of a relationship between a positive Beighton score and pre-operative BPII scores, post-operative BPII scores or post-operative symptom scores. GJH did not correlate significantly with any post-operative functional testing measures. A positive Beighton score was inversely related to patient age and more prevalent in females. Conclusions This study determined that the presence of GJH did not influence disease-specific quality of life, physical symptom score or functional outcomes following MPFL reconstruction. Level of evidence III.

Research paper thumbnail of Only 10% of Patients With a Concomitant MCL Injury Return to Their Preinjury Level of Sport 1 Year After ACL Reconstruction: A Matched Comparison With Isolated ACL Reconstruction

Sports Health: A Multidisciplinary Approach

Background: There is a need for an increased understanding of the way a concomitant medial collat... more Background: There is a need for an increased understanding of the way a concomitant medial collateral ligament (MCL) injury may influence outcome after anterior cruciate ligament (ACL) reconstruction. Hypothesis: Patients with a concomitant MCL injury would have inferior clinical outcomes compared with a matched cohort of patients undergoing ACL reconstruction without an MCL injury. Study Design: Matched registry-based cohort study; case-control. Level of Evidence: Level 3. Methods: Data from the Swedish National Knee Ligament Registry and a local rehabilitation outcome registry were utilized. Patients who had undergone a primary ACL reconstruction with a concomitant nonsurgically treated MCL injury (ACL + MCL group) were matched with patients who had undergone an ACL reconstruction without an MCL injury (ACL group), in a 1:3 ratio. The primary outcome was return to knee-strenuous sport, defined as a Tegner activity scale ≥6, at the 1-year follow-up. In addition, return to preinjury...

Research paper thumbnail of No major difference in perceived quality of care in patients with hip or knee osteoarthritis assessed in a physical therapy-led triage compared with standard care: a randomized controlled trial

Background: Physical therapy-led orthopedic triage is a care model used to optimize pathways for ... more Background: Physical therapy-led orthopedic triage is a care model used to optimize pathways for patients with hip or knee osteoarthritis. However, scientific evidence of the effectiveness of this model of care is still limited and only a few studies report patients’ perception of it. The aim of this study was to compare patients’ perceived quality of care after physical therapy-led triage with standard practice in a secondary care setting for patients with primary hip or knee osteoarthritis. Methods: In this randomized study, patients with hip or knee osteoarthritis referred for an orthopedic consultation received either physical therapy-led triage (n=344) or a standard care assessment by an orthopedic surgeon (n=294). To evaluate the patients’ perceived quality of care, a short version of the Quality from the Patient’s Perspective questionnaire was sent to the patients within a week after their assessment. The primary outcome was the statement “I received the best examination and ...

Research paper thumbnail of Concomitant injuries may not reduce the likelihood of achieving symmetrical muscle function one year after anterior cruciate ligament reconstruction: a prospective observational study based on 263 patients

Knee Surgery, Sports Traumatology, Arthroscopy, 2018

Purpose A better understanding of patient characteristics and the way common concomitant injuries... more Purpose A better understanding of patient characteristics and the way common concomitant injuries affect the recovery of muscle function after surgery should help providers to treat patients with anterior cruciate ligament (ACL) injuries. The aim of this study was to determine whether patient characteristics, concomitant injuries and graft choice at ACL reconstruction were associated with symmetrical knee muscle function at one year. The hypothesis was that the presence of concomitant injuries would negatively influence the opportunity to achieve symmetrical knee function at the one-year follow-up. Methods Data was extracted from the Swedish National Knee Ligament Register and a rehabilitation outcome register between August 2012 and December 2016. The patients had been evaluated with a battery of tests comprising knee extension and flexion strength, vertical jump, hop for distance and the side-hop test one year after ACL reconstruction. Univariable and multivariable logistic regression analyses were performed with achieving a limb symmetry index (LSI) of ≥ 90% in all tests of muscle function as primary outcome. Results A total of 263 patients with a mean age of 26.7 ± 10.3 years were included in the study (47% females). No patient demographic or intra-operative predictors were found to be significant when attempting to predict the achievement of a symmetrical muscle function. Lateral meniscus injury and a patellar tendon autograft reduced the odds of achieving an LSI of ≥ 90% in knee extension strength, OR = 0.49 [(95% CI 0.25-0.97), p = 0.039] and OR = 0.30 [(95% CI 0.14-0.67), p = 0.0033] respectively. In addition, reduced odds of recovering knee extension strength were found in older patients, OR = 0.76 [(95% CI 0.60-0.98), p = 0.034]. A higher pre-injury level of physical activity increased the odds of recovering knee flexion strength, OR = 1.14 [(95% CI 1.01-1.29), p = 0.037]. Conclusion Intra-operatively identified concomitant injuries or graft choice did not affect the likelihood of recovering symmetrical performance in five different tests of muscle function one year after ACL reconstruction. However, fewer than one in four patients achieved an LSI of ≥ 90% in all tests. Level of evidence Prospective observational study: Level 2.

Research paper thumbnail of Patients that maintain their pre-injury level of physical activity 3–5 years after ACL reconstruction are, 18 months after surgery, characterised by higher levels of readiness to return to sport

Knee Surgery, Sports Traumatology, Arthroscopy

Purpose To characterise patients who had returned to their pre-injury physical activity (PA) or h... more Purpose To characterise patients who had returned to their pre-injury physical activity (PA) or higher at 18 months and maintained that level of PA 3–5 years after the primary ACL reconstruction and to describe the level, frequency, and type of PA participation during the first 5 years after ACL reconstruction Method Data, from follow-ups at 18 months and 3–5 years after an ACL reconstruction, were extracted from a rehabilitation-specific register. Patients, 15–65 years of age, were included. The data comprised patient-reported outcomes and the results from two questions with respect to the level, frequency, and type of PA. Comparisons were made between patients who had and had not maintained their pre-injury level of PA at the follow-up 3–5 years after an ACL reconstruction. Results A total of 272 patients met the inclusion criteria. The mean follow-up time was 3.8 years (min–max: 2.9–5.1) after the ACL reconstruction. Of patients who had returned to their pre-injury or a higher l...

Research paper thumbnail of Persistent knee flexor strength deficits identified through the NordBord eccentric test compared with “gold standard” isokinetic concentric testing during the first year after anterior cruciate ligament reconstruction with a hamstring tendon autograft

Physical Therapy in Sport, 2022

Research paper thumbnail of Validation of an 18-item version of the Swedish Knee Self-Efficacy Scale for patients after ACL injury and ACL reconstruction

Journal of Experimental Orthopaedics, 2021

Purpose To evaluate the measurement properties of a new version of the Swedish Knee Self-Efficacy... more Purpose To evaluate the measurement properties of a new version of the Swedish Knee Self-Efficacy Scale (K-SES) in samples of individuals with an anterior cruciate ligament (ACL) injury and after ACL reconstruction. A secondary aim was to translate the new version of K-SES into English in order to prepare for future complete cross-cultural adaptation. Methods The reliability, structural validity, internal consistency and construct validity of the new, 18-item version of the K-SES (K-SES18) were assessed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist for evaluating methodological quality. The Swedish version of the K-SES18 was translated to English using recommended guidelines. Results The test-retest reliability for the K-SES18 subscale present and the K-SES18 subscale future showed an Interclass Correlation Coefficient (ICC) = 0.92. In addition, the K-SES18 had a Cronbach’s α ranging from 0.93 to 0.96 for the K-SES1...

Research paper thumbnail of Factors Affecting the Achievement of a Patient-Acceptable Symptom State 1 Year After Anterior Cruciate Ligament Reconstruction: A Cohort Study of 343 Patients From 2 Registries

Orthopaedic Journal of Sports Medicine, 2018

Background: There is insufficient knowledge regarding the influence of concomitant injuries on th... more Background: There is insufficient knowledge regarding the influence of concomitant injuries on the recovery of short-term subjective knee function after anterior cruciate ligament (ACL) reconstruction. Purpose: To determine whether patient characteristics, concomitant injuries, and graft choice during ACL reconstruction can predict which patients achieve acceptable knee function 1 year after reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: Data from 1 physical therapist–specific and 1 surgeon-specific register were used. Patients who had completed the Knee injury and Osteoarthritis Outcome Score (KOOS) at 1-year follow-up were included. Additional intraoperative information was extracted from a database. The primary outcome was achieving a patient-acceptable symptom state (PASS) for each subscale of the KOOS. Univariable and multivariable logistic regression models were used, with patient sex, age, and preinjury level of physical activity as covariate...

Research paper thumbnail of How Is Psychological Outcome Related to Knee Function and Return to Sport Among Adolescent Athletes After Anterior Cruciate Ligament Reconstruction?

The American Journal of Sports Medicine, 2019

Background: Adult patients who succeed in returning to their preinjury levels of sport after ante... more Background: Adult patients who succeed in returning to their preinjury levels of sport after anterior cruciate ligament (ACL) reconstruction have been characterized by a more positive psychological response. It is not known whether this relationship is valid for adolescent athletes. Purpose: To investigate psychological readiness to return to sport, knee-related self-efficacy, and motivation among adolescent (15-20 years old) and adult (21-30 years old) athletes after ACL reconstruction. A further aim was to compare athletes (15-30 years old) who had recovered their muscle function and returned to sport with athletes who had not. Study Design: Case-control study; Level of evidence, 3. Methods: Data were extracted from a rehabilitation-specific register 8 and 12 months after ACL reconstruction. Athletes previously involved in knee-strenuous sport who had undergone primary ACL reconstruction were included. Data comprised psychological patient-reported outcomes and results from 5 tests...

Research paper thumbnail of Low 1-Year Return-to-Sport Rate After Anterior Cruciate Ligament Reconstruction Regardless of Patient and Surgical Factors: A Prospective Cohort Study of 272 Patients

The American Journal of Sports Medicine, 2018

Background: There is insufficient knowledge about the way that concomitant injuries affect the sh... more Background: There is insufficient knowledge about the way that concomitant injuries affect the short-term likelihood of a return to a knee-strenuous sport after anterior cruciate ligament (ACL) reconstruction. Hypotheses/Purpose: The purpose was to study whether patient characteristics, concomitant injuries, and graft choice at primary ACL reconstruction can predict return to sport (RTS) 1 year after surgery. The hypotheses were that younger age at the time of ACL reconstruction would positively affect RTS, while the presence of concomitant injuries would negatively affect RTS 1 year after surgery. Study Design: Case-control study; Level of evidence, 3. Methods: Data were extracted from a rehabilitation-specific register and the Swedish National Knee Ligament Register. Twelve months after surgery, all patients were evaluated for RTS via the Tegner Activity Scale. The primary outcome was a return to knee-strenuous sport, defined as a Tegner Activity Scale ≥6. Univariable and multivar...

Research paper thumbnail of Young athletes return too early to knee-strenuous sport, without acceptable knee function after anterior cruciate ligament reconstruction

Knee Surgery, Sports Traumatology, Arthroscopy, 2017

Research paper thumbnail of Lower Extremity Injuries in Young Floorball Players: A Prospective Study on Overuse Injuries

The Open Sports Sciences Journal, 2016

Background: Overuse injuries in sports seem to be 1.5 to 2.5 times more common than traumatic inj... more Background: Overuse injuries in sports seem to be 1.5 to 2.5 times more common than traumatic injuries in the lower extremity (LE) in children and adolescents. Floorball is the most popular indoor sport in Sweden and is associated with many potential risks of injuries. However, to our knowledge, no previous studies have examined the appearance of injury in young floorball players. Objective: The aim of the present study was to investigate the occurrence of overuse injuries in LE in floorball players aged 15 or younger, with respect to frequency, location, and consequence of injury. Method: Fifty-seven players, from 9 different teams, participated (mean age 11±2 years). A modified version of Oslo Sports Trauma Research Center Overuse Injury Questionnaire was submitted every fourth week during five months in order to record overuse injuries in LE. An online survey software was used to send out the questionnaires. Results: A of 42 overuse injuries in 42% (24/57) of the cohort were foun...

Research paper thumbnail of Return to knee-strenuous sport after anterior cruciate ligament reconstruction: a report from a rehabilitation outcome registry of patient characteristics

Knee Surgery, Sports Traumatology, Arthroscopy, 2016

Research paper thumbnail of Knee strength, hop performance and self-efficacy at 4 months are associated with symmetrical knee muscle function in young athletes 1 year after an anterior cruciate ligament reconstruction

BMJ Open Sport & Exercise Medicine, 2019

ObjectivesWe investigated whether patient demographics, 4-month patient-reported outcomes (PRO) a... more ObjectivesWe investigated whether patient demographics, 4-month patient-reported outcomes (PRO) and muscle function predicted young athletes regaining symmetrical muscle function in five tests of muscle function 1 year after ACL reconstruction.MethodsWe extracted data on patient demographics, PROs and the results of five tests of muscle function from a rehabilitation-specific register. Athletes were 15–30 years of age, involved in knee-strenuous sport and had undergone a primary ACL reconstruction. The primary outcome was achieving a Limb Symmetry Index of ≥90% for the battery of tests 1 year after ACL reconstruction. Patient demographics, muscle-function data and results for PROs at the 4-month follow-up were analysed.ResultsIn all, 237 athletes (59% female; mean age 22±4 years) were included in the study. One year after ACL reconstruction, 26% (62/237) of the included athletes had achieved symmetrical muscle function. Univariable analysis showed that symmetrical muscle function wa...

Research paper thumbnail of Patience you must have, my young athlete - Rehabilitation specific outcomes after anterior cruciate ligament reconstruction

An anterior cruciate ligament (ACL) injury is one of the most common knee-related injuries, usual... more An anterior cruciate ligament (ACL) injury is one of the most common knee-related injuries, usually occurring in younger individuals during sports participation. Moreover, almost 1 in 4 of younger athletes sustain a subsequent ACL injury once they return to sport (RTS). Few previous studies have, however, focused on outcomes in adolescent athletes (15-20 years of age) after a primary ACL reconstruction. The overall aim of this thesis was to describe outcomes after a primary ACL reconstruction in terms of muscle function, RTS, concomitant injuries, subsequent ACL injury, psychological aspects and symptoms related to knee function in adolescent athletes, aged 15 to 20 years, and in adult athletes, aged 21 to 30 years. This thesis comprises 5 studies, all based on data from a rehabilitation outcome register, Project ACL. The primary statistical methods used were comparative analyses between adolescents and adult athletes as well as uniand multivariable analyses with different binary de...

Research paper thumbnail of Greater psychological readiness to return to sport, as well as greater present and future knee-related self-efficacy can increase the risk for an ACL re-rupture: a matched cohort study

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Research paper thumbnail of Recovery of preoperative absolute knee extension and flexion strength after ACL reconstruction

BackgroundThe recovery of muscle function after an Anterior Cruciate Ligament (ACL) reconstructio... more BackgroundThe recovery of muscle function after an Anterior Cruciate Ligament (ACL) reconstruction is most commonly reported as limb-to-limb differences using the Limb Symmetry Index (LSI), which is not free from limitations. The purpose of this study was to compare the proportion of patients who recover their Preoperative Absolute Muscle Strength (PAMS) 8 and 12 months after ACL reconstruction with the proportion of patients who recover their symmetrical knee strength. A secondary aim was to assess the relationship between psychological Patient-Reported Outcomes (PROs) and recovering PAMS at 8 and 12 months after ACL reconstruction and rehabilitation.MethodPreoperative, 8- and 12-month results from quadriceps and hamstring strength tests and PROs for 117 patients were extracted from a rehabilitation registry. Individual preoperative peak torques from strength tests were compared with results from the 8- and 12-month follow-ups respectively. Patients were defined as having recovered...