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Addressing fear-related barriers in ACL rehabilitation: Sports physiotherapists' experiences and needs
Inge E P M van Haren1, Anne Tankink2, Robert E H van Cingel3
1Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, P.O. Box 6960, 6503 GL, Nijmegen, the Netherlands; Radboud university Medical Center, Science Department IQ Health, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
Background:
During rehabilitation following anterior cruciate ligament (ACL) reconstruction, increased attention is given to addressing psychological factors, such as fear. Fear can hinder the rehabilitation process and return to sport after rehabilitation.
Objective:
This study aimed to explore sports physiotherapists' experiences and needs in assessing and managing fear-related barriers in patients undergoing rehabilitation following ACL reconstruction.
Design:
A qualitative study.
Method:
Semi-structured interviews were performed among sports physiotherapists experienced in treating athletes during ACL rehabilitation following ACL reconstruction. Inclusion continued until data saturation. Inductive thematic analysis was used. Relevant phrases from each interview were iteratively coded and clustered into categories and themes.
Results:
Fourteen sports physiotherapists were interviewed. Three themes emerged: (I) fear is normal during rehabilitation, (II) handling fear, and (III) psychosocial education. The impact of fear-related barriers during ACL rehabilitation varied and was linked to causes including personal stressors or confidence. Participants used tailored assessment and management strategies based on personal or athlete-specific factors alongside clinical guidelines. Collaboration with other professionals, such as (sport) psychologists, was sometimes limited by logistical and financial barriers or stigma. Sports physiotherapists expressed a need for additional education in the psychosocial domain.
Conclusions:
Sports physiotherapists recognise fear as a normal part of rehabilitation, but face challenges in managing excessive fear. Strategies to address and handle fear are highly individualised, based on experience and athlete-specific needs. Further research should focus on developing training programmes for physiotherapists that address both psychological and physical aspects of rehabilitation, updating ACL guidelines accordingly, and facilitating interdisciplinary collaboration.
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