An Investigation of Patient Progression Through Rehabilitation with the Step-Up-and-Over Test
The goal of surgery for patients undergoing anterior cruciate ligament reconstruction (ACLR) and subsequent rehabilitation is the restoration of normal knee function (van Grinsven et al., 2010). Having procedures that accurately assess and quantify recovery are crucial to ensure that physicians if patients are regaining knee function. However, there is no standardized, objective assessment of a patient’s improvement as they progress through the stages of rehabilitation. Currently, maximal effort testing is used to evaluate knee function to determine a patient’s readiness to return to unrestricted physical activity but, these tests place a high demand on the knee joint, which is contraindicated in early rehabilitation (Cascio et al., 2004) and may confound the patient’s results due to fear of re-injury. The step-up-and-over (SUAO) test is an objective, submaximal effort test that quantifies performance (van Grinsven et al., 2010) and, therefore, can be used to evaluate knee function throughout rehabilitation to gauge the patient’s progression. Two studies were completed for this thesis. In the first study, 12 ACL-reconstructed individuals completed the SUAO test at each physiotherapy clinic visit until they were cleared to return to unrestricted physical activity by their physician or physiotherapist. They also completed the ACL-QoL, a questionnaire measuring the patient’s subjective knee function. In the second study, these 12 ACL-reconstructed patients completed a fear of re-injury questionnaire once a month and their pain was measured on each testing day to evaluate whether these two variables affected the results obtained from the SUAO test. Results showed that the ACL-QoL was not related to the variables measured using the SUAO test and that the SUAO test was able to track an individual’s progression through rehabilitation. Results also showed that fear of re-injury did not affect the performance on each testing day but pain did. Together, these results indicate that the SUAO test is a clinically viable option to track an individual’s progression through rehabilitation without having fear of re-injury affect the results and that pain may affect performance of the SUAO test.
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