Physical Therapy Outcomes Following Anterior Cruciate Ligament
Reconstruction and Rehabilitation

Tammy Reis, M.P.T., Kevin Axtman, P.T., L.A.T.C., Renee Mabey, Ph.D., P.T.

ABSTRACT

This study analyzes physical therapy outcomes for patients with anterior cruciate ligament (ACL) reconstruction and rehabilitation. Data was collected from 31 patients at St. Alexius Medical Center’s Institute of Sports Medicine at 5, 10 or 12, 24, and 52 weeks post patellar tendon graft. Data included measurements of knee range of motion; ACL laxity; quadriceps and hamstrings strength and work; and functional performance.
Satisfactory outcomes were found for knee range of motion and ACL laxity. Isokinetic data for strength and work showed deficits, but outcomes met protocol goals. Subjective ratings of function were high, and objective functional hopping scores indicated stability, coordination, and proprioception in the surgical extremity.
This study identifies expected outcomes for patients with ACL reconstruction. The results will be useful relative to individual patient care decisions and as evidence of clinical effectiveness. The results be also be useful to other facilities providing care, and the physical therapy profession in general, as accountability for practice is paramount.

PURPOSE

Burnout is a syndrome of emotional and physical exhaustion often accompanied by feelings of extreme cynicism. It is evidenced in the workplace as increased absenteeism, job turnover, and withdrawal behaviors. Burnout frequently occurs in individuals who work with others, including those in educational settings. While burnout in the field of education has been studied previously, faculty burnout within physical therapy has not been addressed. This study surveyed physical therapy faculty members to determine their degree of burnout. Demographic factors associated with faculty burnout were investigated.

METHOD

Following ACL reconstruction with a patellar tendon graft, patients voluntarily participated in data collection procedures during their rehabilitation at the Institute.
Data collection forms were completed by physical therapists at the Institute of Sports Medicine (September 1995 to June 1997), as part of routine patient care. Rehabilitation procedures used an accelerated ACL protocol designed by the Institute.
Measurements were gathered at 5, 10 or 12, 24, and 52 weeks post surgery. Knee range of motion was measured using a standard goniometer. Graft anterior laxity was determined using the KT-1000 for 20 and 30 pounds of force. The Cybex 6000 was used to test quadriceps and hamstring peak torque and total work at 60, 180, and 300°/s; quadriceps peak torque as a percentage of body weight at 60°/s; and hamstrings to quadriceps ratio at 60°/s. Satisfaction with function during transfers, ambulation and daily activities was determined using a patient rating scale. Objective functional testing was performed using a four-square hop test.

Figure 1. Maslach Burnout Inventory: Sample Items

Emotional Exhaustion:
I feel emotionally drained from my work.
I feel like I’m at the end of my rope.

Depersonalization:
I feel I treat some students as if they were impersonal objects.
I worry that this job is hardening me emotionally.

Personal Accomplishment:
I feel very energetic.
I can easily create a relaxed atmosphere with my students.

RESULTS

31 SUBJECTS: 19 males, 12 females ages 14 - 45 years; mean age = 25 (± 9.4) years

CLINICAL MEASUREMENTS:

ROM: Figure 1
ACL Laxity: Figure 2
Isokinetic Data: Figures 3 - 5
Function: Figures 6 - 7
Patient Profile at 12 weeks: Figure 8

Table 2: Factors Predicting Maslach Burnout Inventory Scores

Emotional Exhaustion: Number of Hours Worked each Week +

Personal Accomplishment: Number of Courses Taught per Year +

 

CONCLUSION

For the Patient: Overall satisfactory outcomes found in majority of clinical parameters analyzed.

Further Implications for the Study:
1. Improved patient care, in general.
2. Evidence of clinical effectiveness of treatment.
3. Accountability for St. Alexius Medical Center.
4. Accountability for the Physical Therapy profession.
5. Usefulness for other clinics or professions beginning outcomes measurement, as this study may be used as a template for data collection and analysis.