BEYOND EXERCISE: THE EFFECT OF ADDING ERGOTHERAPY METHODS TO PHYSICAL THERAPY ON FUNCTIONAL OUTCOMES AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Öz

OBJECTIVE: The aim of this study is to investigate the effects of adding ergotherapy to standard physiotherapy after anterior cruciate ligament reconstruction (ACLR) improves functional outcomes, time to return to sport, and movement quality.
MATERIAL AND METHODS: Fifty-four patients aged 18–45 who underwent ACLR with quadrupled hamstring autograft were included: Group 1 received physiotherapy alone (n=31) and Group 2 received physiotherapy plus ergotherapy (n=23). Outcomes were assessed at postoperative week 2 and month 6 using the Lower Extremity Functional Scale (LEFS), Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI), Knee injury and Osteoarthritis Outcome Score (KOOS), Knee Outcome Survey–Sports Activities Scale (KOS-SAS), and Knee Outcome Survey–Activities of Daily Living Scale (KOS-ADLS). OT interventions were individualized using the Canadian Occupational Performance Measure (COPM). Analyses were performed in SPSS v24; a priori calculation (two-tailed t-test; assumed d≈0.88; α=0.05; power=0.80) indicated ≥21 participants/arm. Nonparametric tests (Mann–Whitney U, Wilcoxon, Spearman) were used; post-hoc effect size was large (d=3.27; >90% power).
RESULTS: Compared with Group 1, Group 2 returned to sport sooner (8.5 vs 11.8 months) and showed higher scores on LEFS (66 vs 48), KOOS (81 vs 71), KOS-SAS (87 vs 69), and KOS-ADLS (74 vs 59). Psychological readiness and ACL-RSI (76 vs 68) was superior in the ergotherapy group.
CONCLUSIONS: Integrating ergotherapy into postoperative rehabilitation after ACLR accelerated functional recovery, shortened return-to-sport time, and enhanced psychological readiness; this multidisciplinary approach is recommended for clinical practice.

Anahtar Kelimeler

• Anterior cruciate ligament reconstruction
• Rehabilitation
• Ergotherapy
• Return to sport.

Proje Numarası

FSMEAH-KAEK 2020/48

EGZERSİZİN ÖTESİNDE: ÖN ÇAPRAZ BAĞ REKONSTRÜKSİYONU SONRASI FİZİK TEDAVİYE ERGOTERAPİ YÖNTEMLERİNİN EKLENMESİNİN FONKSİYONEL SONUÇLARA ETKİSİ

Öz

AMAÇ: Bu çalışmanın amacı, ön çapraz bağ rekonstrüksiyonu (ÖÇB-R) sonrası standart fizik tedavi ve rehabilitasyon programına ergoterapi yöntemlerinin eklenmesinin fonksiyonel sonuçlar, spora dönüş süresi ve hareket kalitesi üzerindeki etkilerini araştırmaktır.
GEREÇ VE YÖNTEM: Çalışmaya, 18-45 yaş aralığında, dörtlü hamstring otogrefti ile ÖÇB-R geçiren 54 hasta dahil edildi. Hastalar, sadece fizik tedavi alan Grup 1 (n=31) ve fizik tedaviye ek olarak ergoterapi alan Grup 2 (n=23) olarak ikiye ayrıldı. Değerlendirmeler, ameliyat sonrası 2. hafta ve 6. ayda Alt Ekstremite Fonksiyonel Skalası (LEFS), Ön Çapraz Bağ Yaralanması Sonrası Spora Dönüş Anketi (ACL-RSI), Diz Yaralanması ve Osteoartrit Sonuç Skoru (KOOS), Diz Sonuç Anketi – Spor Aktiviteleri Ölçeği (KOS-SAS) ve Günlük Yaşam Aktiviteleri Ölçeği (KOS-ADLS) ölçekleri kullanılarak yapıldı. Ergoterapi grubunda, Kanada İş Performans Ölçümü (COPM) ile bireyselleştirilmiş yöntemler uygulandı. SPSS v24 ile analiz edilen verilerde, Çalışma öncesi (d≈0,88, α=0,05, güç=0,80) örneklem büyüklüğü ≥21/kol hesaplandı; nonparametrik testler (Mann–Whitney U, Wilcoxon, Spearman) kullanıldı ve nihai etki d=3,27 (>%90 güç) bulundu.
BULGULAR: Grup 2'de spora dönüş süresi ortalama 8,5 ay ile Grup 1'e (11,8 ay) göre anlamlı derecede kısa bulundu. Grup 2, Grup 1’e kıyasla LEFS 66’ e 48, KOOS 81’e 71, KOS-SAS 87’ye 69 KOS-ADLS 74’e 59 değerleriyle daha yüksekti. Ergoterapi grubunda ACL-RSI (76- 68), skorları da daha yüksekti, psikolojik hazırlığın olumlu etkisi saptandı.
SONUÇ: ÖÇB-R sonrası rehabilitasyona ergoterapi yöntemlerinin eklenmesi, fonksiyonel iyileşmeyi hızlandırmış, spora dönüş süresini kısaltmış ve hastaların psikolojik hazırlığını artırmıştır. Bu multidisipliner yaklaşımın, klinik uygulamalarda önerilen bir yöntem olmasını savunuyoruz.

Anahtar Kelimeler

• Ön çapraz bağ rekonstrüksiyonu
• Rehabilitasyon
• Ergoterapi
• Spora dönüş.

Destekleyen Kurum

Sağlık Bilimleri Üniversitesi Fatih Sultan Mehmet Eğitim ve Araştırma Hastanesi Klinik Araştırmalar Etik Kurulu

Proje Numarası

FSMEAH-KAEK 2020/48

Etik Beyan

Çalışmanın tüm süreçlerinin araştırma ve yayın etiğine uygun olduğunu, etik kurallara ve bilimsel atıf gösterme ilkelerine uyduğumu beyan ederiz

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