A conceptual framework to improve the reporting quality of strength training exercise descriptors in anterior cruciate ligament reconstruction rehabilitation programs

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Vlok, Arnold
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University of the Free State
𝗜𝗻𝘁𝗿𝗼𝗱𝘂𝗰𝘁𝗶𝗼𝗻 Muscle weakness after anterior cruciate ligament reconstruction (ACLR) is persistent and associated with abnormal biomechanics, poor knee function, new knee injury and development of osteoarthritis. The proposed drivers of persistent muscle weakness after ACLR are changes in muscle morphology, atrophy-inducing cytokines in the knee joint, and neurological alterations on a cortical and spinal level. The most accessible approach to target muscle weakness is various types of strength training exercises. However, another explanation for persistent weakness after ACLR rehabilitation could be that programs are not following the best practice for strength training. Failure to improve muscle strength after ACLR could be caused by faulty programming of exercise descriptors (e.g., exercise type, frequency, load). 𝐀𝐢𝐦 The main aim of this study was to develop a conceptual framework to improve the reporting quality of strength training exercise descriptors in ACLR rehabilitation programs. 𝗠𝗲𝘁𝗵𝗼𝗱𝗼𝗹𝗼𝗴𝘆 The study was conducted in three stages, including a Scoping Review, focussing on which strength training exercise descriptors are reported in ACLR research after ACLR surgery, and comparing the current standards of reporting ACLR strength training exercise descriptors to international best practice strength training guidelines. The modified e-Delphi survey was utilised to formulate a conceptual rehabilitation framework for ACLR. The last stage included validating the preliminary ACLR conceptual framework that included a core outcome set (COS) of strength training exercise descriptors for reporting after ACLR. 𝗥𝗲𝘀𝘂𝗹𝘁𝘀 𝗮𝗻𝗱 𝗱𝗶𝘀𝗰𝘂𝘀𝘀𝗶𝗼𝗻 We extracted data on 117 exercises from 41 studies. A median of seven of the 19 possible exercise descriptors were reported (range 3-16). Reporting of specific exercise descriptors varied across studies from 93% (name of the strength training exercise) to 5% (exercise aim). On average, 46%, 35%, and 43% of the exercise descriptors included in the ACSM, CERT, and Toigo and Boutellier guidelines were reported, respectively. The e-Delphi results from 27 ACLR experts regarding the 21-exercise descriptor definition was 100% consensus agreement (>80% agreement), also 100% consensus agreement on a COS of strength training exercise descriptors (). However, very low consensus agreement on exercise dosages prescribed in ACLR strengthening programs. The validation meeting consisted of four panellists that validated the preliminary ACLR conceptual framework and proposed to re-organise the 13 COS of exercise descriptors into levels of importance regarding the frequency of reporting. 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻 The proposed ACLR conceptual framework for researchers and clinicians provided a platform for the reporting of strength training rehabilitation after ACLR. Improving the reporting quality of strength training exercise descriptors, definitions, and exercise dosages for ACLR rehabilitation programs can aid in the transfer of ACLR rehabilitation research towards private practice. Therefore, enabling clinicians to implement evidence-based strength training exercise configurations.
Thesis (Ph.D. (Human Movement Studies))--University of the Free State, 2023