Characterizing Injury-Related Fear in Patients after Anterior Cruciate Ligament Reconstruction

About This Grant

Injury-related fear after anterior cruciate ligament (ACL) injury significantly contributes to decreased return to sport, decreased physical activity engagement, and increased secondary ACL injury in previously high functioning, physically active individuals. Injury-related fear is also associated with poor jump-landing movement patterns and worse self-reported knee function in patients after ACL reconstruction (ACLR). While injury-related fear can be modified using psychological interventions, we have not comprehensively characterized how, when, and what types of injury-related fears (e.g., fear of movement, reinjury, avoidance) impede recovery. Furthermore, there is limited evidence regarding patient perceptions of injury-related fear and their perceived consequences on recovery outcomes. Failure to identify what types and when these fears are present throughout ACLR rehabilitation, and how patients perceive these fears to impact their recovery, will significantly inhibit our ability to effectively intervene with robust and effective psychological interventions aimed to mitigate secondary ACL injury risk. We hypothesize that patients follow three separate trajectories, including favorable (i.e., decreases in fear that are maintained), unfavorable (i.e., unresolved fear at clearance for return for activity), and variable trajectories (i.e., decreases in fear likely due to direct intervention prior to return to activity). Identifying these trajectories will enhance intervention effectiveness for future clinical trials using psychological interventions to mitigate secondary ACL injury risk and improve long-term knee joint health. Consequently, there is a critical need for high-quality longitudinal studies to characterize injury-related fear, both quantitatively and qualitatively, in patients after ACLR. Therefore, the objective of this study is to characterize injury-related fear in patients post-ACLR. A total of 50 patients will complete surveys to assess injury-related fear at important clinical timepoints, including pre-operatively, and at 2-, 4-, 6-, and 9-months post-ACLR. A subset of 15 patients at 9- months post-ACLR will complete semi-structured interviews to identify patient perceived impacts of injury-related fear on recovery outcomes and discuss interventions that could be used to reduce injury-related fear after ACLR. The central hypothesis is that multiple trajectories will exist for injury-related fears (i.e., fear of movement, fear of reinjury, and fear-avoidance beliefs) which will be supported qualitatively through patient interviews. The findings from this proposal will address a gap in knowledge by providing a clear understanding of how injury- related fear changes over time in patients after ACLR. This proposal will also position an aspiring independent clinician scientist with pertinent data that is needed to support future NIH grant applications and the trajectory of her independent research career.