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Psychological, Social and Contextual Factors Always Influence Rehabilitation

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The purpose of this study was to explore the role of psychological, social, and contextual factors across the recovery stages (ie, acute, rehabilitation, or return to sport (RTS)) following a traumatic time-loss sport-related knee injury. Improved physical outcomes are not always associated with a return to physical activity, long-term satisfaction, or favorable health-related quality of life (HRQoL), suggesting that additional ‘non-physical factors’ may mediate recovery.

These non-physical factors likely encompass a broad range of psychological, social, and contextual domains. Psychological factors that influence recovery from a traumatic, time-loss, sport-related knee injury include cognitive (eg, perceptions), behavioral (eg, adherence), and affective (eg, moods) responses associated with an individual’s experience of the injury, rehabilitation, surgery, and RTS.

Four themes were identified within the psychological domain: barriers to progress, active coping, independence, and recovery expectations. Consistent with previous research, fear is common in this population and consistently reported as a barrier for RTS. However, other barriers such as frustration, anxiety, lack of confidence, motivation, or psychological readiness for RTS are also important.

Tailoring recovery to the individual is essential for patient-centered care. Understanding personal goals, values, and definitions of success are important as they influence recovery expectations. Cookie-cutter approaches (protocols, even algorithms blindly adhered to are simply fancy cookie-cutters) will always be inferior.

All exercise programs and rehabilitation need to be personalized. If you are a patient and your PT is not considering the psychological domains of your recovery, I suggest you look for a new PT.


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