Abstract：
OBJECTIVE: We aimed to develop a consensus-based rehabilitation guideline specifically designed to reduce apprehension following arthroscopic Bankart repair after traumatic anterior shoulder dislocation. DESIGN: Delphi-based consensus. METHOD: A comprehensive list of interventions for potential inclusion in a postoperative rehabilitation guideline was developed. American and European physiotherapists and orthopedic surgeons were invited to participate in a Delphi panel, engaging in 3 survey rounds. The health professionals were surveyed about their level of agreement on both initially listed and newly suggested interventions. Consensus was established when a \"critical-to-include\" rating was given in ≥70% of all responses. Ten former patients were consulted to identify the intervention during standard care rehabilitation that had the most impact on reducing postoperative apprehension following ABR. Any interventions not initially listed in the first round were added to the second survey round of the Delphi process. RESULTS: Forty-four health professionals reached consensus on a set of 27 interventions for managing apprehension after arthroscopic Bankart repair. New interventions included gradual exposure to shoulder positions eliciting apprehension, training in anterior stability-provoking positions, and education addressing the impact of psychosocial factors. Former patients identified specific interventions that were effective in reducing postoperative apprehension following ABR. These interventions encompassed medicine ball throws, active-assisted wall slides, and kinetic chain exercises in anterior stability-provoking positions. CONCLUSION: Our Delphi process informed expert recommendations for various interventions aimed at addressing apprehension associated with ABR. The recommendations were the foundation for developing a rehabilitation guideline (REGUIDE). The REGUIDE integrates principles from cognitive-behavioral therapy to improve rehabilitation and mitigate apprehension. J Orthop Sports Phys Ther 2024;54(5):1-13. Epub 20 March 2024. doi:10.2519/jospt.2024.12106.
摘要：
目的：我们旨在制定一项基于共识的康复指南，旨在减少创伤性肩关节前脱位后关节镜Bankart修复后的忧虑。设计：基于德尔菲的共识。方法：制定了可能纳入术后康复指南的综合干预措施清单。美国和欧洲的物理治疗师和骨科医生被邀请参加德尔福小组，参与3轮调查。对卫生专业人员进行了调查，了解他们对最初列出的干预措施和新建议的干预措施的协议水平。当所有回答中≥70%的人给出“包括关键”评级时，就建立了共识。咨询了十名以前的患者，以确定在标准护理康复期间对减少ABR术后忧虑影响最大的干预措施。最初未在第一轮中列出的任何干预措施都被添加到德尔菲过程的第二轮调查中。结果：44名卫生专业人员就一组27种干预措施达成共识，以管理关节镜Bankart修复后的忧虑。新的干预措施包括逐渐暴露于引起忧虑的肩膀姿势，在前稳定位置训练，和解决社会心理因素影响的教育。前患者确定了可有效减少ABR术后忧虑的特定干预措施。这些干预措施包括药物投掷，主动辅助墙幻灯片，和前稳定位置的动力链练习。结论：我们的德尔菲过程为旨在解决与ABR相关的忧虑的各种干预措施提供了专家建议。这些建议是制定康复指南（REGUIDE）的基础。REGUIDE整合了认知行为疗法的原则，以改善康复和减轻忧虑。J正交运动物理学号2024；54(5)：1-13。Epub2024年3月20日。doi:10.2519/jospt.2024.12106。
