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  • 1.
    Arumugam, Ashokan
    et al.
    Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
    Björklund, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi. Centre for Musculoskeletal Research, Department of Occupational Health Sciences and Psychology, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden.
    Mikko, Sanna
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Häger, Charlotte K.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Effects of neuromuscular training on knee proprioception in individuals with anterior cruciate ligament injury: A systematic review and GRADE evidence synthesis2021Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 11, nr 5, artikkel-id e049226Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Objective: To systematically review and summarise the evidence for the effects of neuromuscular training compared with any other therapy (conventional training/sham) on knee proprioception following anterior cruciate ligament (ACL) injury.

    Design: Systematic Review.

    Data sources: PubMed, CINAHL, SPORTDiscus, AMED, Scopus and Physical Education Index were searched from inception to February 2020.

    Eligibility criteria: Randomised controlled trials (RCTs) and controlled clinical trials investigating the effects of neuromuscular training on knee-specific proprioception tests following a unilateral ACL injury were included.

    Data extraction and synthesis: Two reviewers independently screened and extracted data and assessed risk of bias of the eligible studies using the Cochrane risk of bias 2 tool. Overall certainty in evidence was determined using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool.

    Results: Of 2706 articles retrieved, only 9 RCTs, comprising 327 individuals with an ACL reconstruction (ACLR), met the inclusion criteria. Neuromuscular training interventions varied across studies: whole body vibration therapy, Nintendo-Wii-Fit training, balance training, sport-specific exercises, backward walking, etc. Outcome measures included joint position sense (JPS; n=7), thresholds to detect passive motion (TTDPM; n=3) or quadriceps force control (QFC; n=1). Overall, between-group mean differences indicated inconsistent findings with an increase or decrease of errors associated with JPS by ≤2°, TTDPM by ≤1.5° and QFC by ≤6 Nm in the ACLR knee following neuromuscular training. Owing to serious concerns with three or more GRADE domains (risk of bias, inconsistency, indirectness or imprecision associated with the findings) for each outcome of interest across studies, the certainty of evidence was very low.

    Conclusions: The heterogeneity of interventions, methodological limitations, inconsistency of effects (on JPS/TTDPM/QFC) preclude recommendation of one optimal neuromuscular training intervention for improving proprioception following ACL injury in clinical practice. There is a need for methodologically robust RCTs with homogenous populations with ACL injury (managed conservatively or with reconstruction), novel/well-designed neuromuscular training and valid proprioception assessments, which also seem to be lacking.

    PROSPERO registration number CRD42018107349.

    Fulltekst (pdf)
    fulltext
  • 2.
    Mikko, Sanna
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Effekter av neuromuskulär rehabiliteringsträning på knäproprioception hos individer med främre korsbandsskada – en narrativ översikt2018Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Introduktion: Neuromuskulär träning kan potentiellt stimulera proprioception hos individer med främre korsbandsskada. Fram till idag finns det ingen litteraturöversikt tillgänglig som summerar effekterna av neuromusculär rehabilitering på proprioceptionen i knät hos individer med främre korsbandsskada.

     

    Syften: 1) att utvärdera effekten av neuromuskulära rehabiliteringsprogram jämfört med en kontrollintervention, utvärderat med knä-specfika proprioceptionstester hos individer med främre korsbandsskada, med eller utan rekonstruktion och 2) att summera neuromuskulära träningsprogram som fokuserar på att förbättra proprioception i knät.

     

    Metod: Sju databaser användes för sökning från dataabasernas start fram till Oktober 2018. Artiklar som nkluderades var: Randomized- eller Controlled clinical trials; utvärderar effekterna av neuromuskulär rehabiliteringsprogram; utvärderat med knä-specifika proprioceptionstester; före och efter interventionsperioden; hos patienter med främre korsbandsskada. 

     

    Resultat: Totalt åtta studier inkluderades. Sex studier använde joint position sense (JPS) och två threshold to detection of passive motion (TTDPM) för att utvärdera proprioception i knät. Två studier visade statistiskt signifikant skillnad på proprioception mellan experiment- och kontrollgrupp. Intervention av träningsövningar i de neuromusculära träningsprogrammen var: whole body vibration therapy (WBVT), övningar på balansbräda, vattenträning, styrketräning och plyometrisk- ”agility drills”- och grenspecifika övningar.

     

    Slutsats: De flesta neuromuskulära rehabiliteringsprogrammen visade ingen statistiskt signifikant skillnad på proprioception, förutom WBVT och övningar på balansbräda som visade sig förbättra proprioception i knät efter främre korsbandsskada. De inkluderade artiklarnas studiedesign, validitet och sensitivitet av de knä-specifika proprioceptionstesterna kan ha bidragit till resultaten. En definitiv konklusion är svårt att ge med tanke på avsaknad av analys för bedömningsbias samt få inkluderade artiklar. Fortsatt forskning inom området behövs.

     

     

     

  • 3.
    Mikko, Sanna
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Navigating through a new era of digital and technological tools in ACL injury rehabilitation – a focus group study with physiotherapists2023Independent thesis Advanced level (degree of Master (Two Years)), 20 poäng / 30 hpOppgave
    Abstract [en]

    Introduction: An anterior cruciate ligament (ACL) injury often leads to long-lasting physical and psychological impairments that traditional rehabilitation has difficulty restoring. Technological development, including digital health tools, has led to new models of rehabilitation. Physiotherapists (PTs) have a leading role in ACL rehabilitation and may have ideas on how rehabilitation can be further improved using novel technology.

    Aim: The aim of the study was to explore how PT with experiences in ACL rehabilitation perceive opportunities, challenges, and hold visions for how the rehabilitation can be improved, particularly with the use of technology.

    Methods: A qualitative approach was implemented. Four focus group discussion sessions were held digitally with a total of 12 PTs. Thematic data analysis was applied.

    Results: The analysis generated five themes describing challenges and suggestions for future development in ACL injury rehabilitation. Technological and digital tools were proposed to improve functional assessment, feedback, and remote tracking and communication. Still, the PTs expressed a lack of knowledge of available technological solutions and how they may be applied in the clinic. Constraints and worries were considered regarding implementations. However, they conveyed a curiosity about how technology could develop rehabilitation. A need to improve the psychological aspects of the injury and the therapeutic alliance were also discussed but not necessarily with a link to technology.

    Conclusions: Emphasis might be placed on facilitating the implementation of digital and technological tools into the clinic. Technological and digital tools need to be user-friendly, cost-effective, and provide evidence for superior care. A biopsychosocial approach including evaluation and treatment targeting the nervous-, psychological, and musculoskeletal system were requested to improve ACL injury rehabilitation.

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