Joseph H. Sklar

Pain and negative mood during rehabilitation after anterior cruciate ligament reconstruction: a daily process analysis

Daily diary methods were used to examine changes in pain and negative mood over the first 6 weeks of rehabilitation after surgical reconstruction of the anterior cruciate ligament (ACL). Participants (58 men and 33 women) completed measures of personal factors (i.e., age, athletic identity, neuroticism, optimism) before surgery and indices of daily pain, negative mood, and stress for 42 days after surgery. Multilevel modeling revealed that, as would be expected, daily pain ratings decreased significantly over the course of the study and that the rate of decline in pain ratings decreased over time. Age and daily negative mood were positively associated with daily pain ratings. Daily negative mood also decreased significantly over the course of the study and was positively associated with neuroticism, daily pain, and daily stress. Athletic identity and optimism interacted with time since surgery in predicting daily negative mood such that participants with high levels of athletic identity and low levels of optimism reported greater decreases in daily negative mood over time. Overall, the findings reveal a pattern of improved psychological functioning over the early stages of post‐operative ACL rehabilitation.

Rehabilitation adherence and anterior cruciate ligament reconstruction outcome

This study examined the relationship between adherence to postoperative physical therapy and outcome after surgical reconstruction of the anterior cruciate ligament (ACL) of the knee in a sample of 72 men and 36 women. Indices of adherence were obtained during the first 6 weeks of postsurgical rehabilitation. Outcome measures were administered before surgery and approximately 6 months after surgery. Results of a canonical correlation analysis indicated a statistically significant association between the adherence variables and the outcome variables (r = 0.56, p < 0.05). Greater attendance at rehabilitation sessions and more favourable practitioner ratings of adherence during rehabilitation sessions were associated with fewer self-reported knee symptoms and greater knee laxity. The findings highlight the complex nature of the adherence – outcome relationship.

Prevalence of psychological distress among patients at a physical therapy clinic specializing in sports medicine

To assess the frequency with which patients at an orthopedic physical therapy clinic specializing in sports medicine experience clinically meaningful psychological distress, 200 consecutive patients were administered a standardized measure of psychopathology. Patients varied in terms of diagnosis, stage of rehabilitation, and level of athletic involvement. The physical therapist and athletic trainer responsible for the rehabilitation of a patient rated a patients behavior during rehabilitation sessions. Approximately 19% of patients reported a clinical level of psychological distress. Most patients demonstrated few overt signs of a maladaptive psychological response to injury. The physical therapist or athletic trainer rating was not significantly correlated with a patients self‐reported psychological distress. It was concluded that psychological distress occurs infrequently among patients at a sports medicine clinic, but with sufficient regularity to warrant concern.

Attributions for recovery and adherence to rehabilitation following anterior cruciate ligament reconstruction: A prospective analysis

Abstract The relationship between causal attributions for recovery and adherence was examined in a sample of 80 individuals (25 females and 55 males) undergoing rehabilitation following anterior cruciate ligament reconstruction. Participants estimated their speed of recovery and then rated their open-ended attributions for recovery on the Revised Causal Dimension Scale (McAuley, Duncan and Russell, 1992). Adherence was assessed in terms of attendance at rehabilitation sessions and practitioner ratings for the remainder of the rehabilitation period. Participants who perceived themselves as recovering rapidly attributed their recovery to more stable and personally controllable factors than participants who perceived themselves as recovering slowly. Causal dimension ratings predicted attendance at rehabilitation sessions, but not practitioner ratings of adherence. The results, which further demonstrate the relevance of causal attributions to health behavior, are compared with previous cross-sectional findings.