Abstract:
This guideline was developed to inform clinical practice on rehabilitation after anterior cruciate ligament reconstruction (ACLR) and was performed in accordance with the Appraisal of Guidelines for REsearch & Evaluation II (AGREE II) instrument and used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. A Guideline Development Group systematically searched and reviewed evidence using randomised clinical trials and systematic reviews to evaluate the effectiveness of rehabilitation interventions and guide clinicians and patients on the content of the optimal rehabilitation protocol after ACLR.The guideline targets patients during rehabilitation after ACLR and investigates the effectiveness of the available interventions to the physiotherapist, alone or in combination (eg, exercise, modalities, objective progression criteria). Exercise interventions should be considered the mainstay of ACLR rehabilitation. However, there is little evidence on the dose-response relationship between volume and/or intensity of exercise and outcomes. Physical therapy modalities can be helpful as an adjunct in the early phase of rehabilitation when pain, swelling and limitations in range of motion are present. Adding modalities in the early phase may allow earlier pain-free commencement of exercise rehabilitation. Return to running and return to training/activity are key milestones for rehabilitation after ACLR. However, there is no evidence on which progression or discharge criteria should be used.While there is a very low level of certainty for most components of rehabilitation, most of the recommendations provided in this guideline were agreed to by expert clinicians. This guideline also highlights several new elements of ACLR management not reported previously.
摘要:
本指南旨在为前交叉韧带重建(ACLR)后的康复临床实践提供信息,并根据评估和评估指南II(AGREEII)工具进行评估,并使用建议分级。评估,开发和评估(等级)方法。一个指南开发小组使用随机临床试验和系统评价来系统地搜索和审查证据,以评估康复干预措施的有效性,并指导临床医生和患者在ACLR后最佳康复方案的内容。该指南针对ACLR后康复期间的患者,并调查了物理治疗师可用干预措施的有效性,单独或组合(例如,锻炼,模态,客观进展标准)。运动干预应被视为ACLR康复的支柱。然而,关于运动量和/或强度与结局之间的剂量-反应关系的证据很少.物理治疗方式可以作为辅助在早期阶段的康复时疼痛,肿胀和运动范围的限制是存在的。在早期阶段添加方式可以允许更早地无痛地开始运动康复。恢复跑步和恢复训练/活动是ACLR后康复的关键里程碑。然而,没有证据表明应使用哪种进展或出院标准.虽然康复的大多数组成部分的确定性非常低,本指南中提供的大部分建议得到了临床专家的同意.该指南还强调了以前未报告的ACLR管理的几个新要素。