Motor Imagery to Facilitate Sensorimotor Relearning After ACL Injury

NCT03473821 | Active Not Recruiting

• 1 other identifier: Dnr 2016/413
• Study Type: interventional
• Target: 106
• Locations: 1 country
• Sites: 1

Brief Summary

Anterior cruciate ligament injury is a common issue in sports involving cutting and jumping. Treatment may include surgical intervention followed by physical therapy, or no surgical intervention with the main treatment being physical therapy. Despite meeting physical therapist requirements for return to sport, many athletes do not return to sport. This discrepancy in the physical requirements for returning to physical activity and actually returning to the same physical activity level leads to the question of whether current rehabilitation treatments may be improved upon. One potential method is by integrating mental training into physical rehabilitation. By using mental training and increasing the meaning and relevance of rehabilitation, a person may be preparing more effectively for return to the pace and intensity common during physical activity. In this study, the investigators aim to create and evaluate a model of training which incorporates physical activity-related movement and mental training in order to more effectively prepare people for return to physical activity after anterior cruciate ligament injury. This will be measured by examining functional hop measures, as well as patient-reported outcomes.

Conditions

Anterior Cruciate Ligament Injury

Keywords

ACL Injury; Return to Sport; Mental Training; Dynamic Motor Imagery; Anterior Cruciate Ligament; Knee Injury

Outcome Measures

Primary Outcomes (2)

• Side Hop

  Change in hop performance on the injured leg from baseline to 12 weeks, expressed in number of hops completed

  12 weeks

• Anterior Cruciate Ligament Return to Sport After Injury Scale

  12 question self-reported outcome scale measuring readiness to return to sport. Scale ranges from 0-10 for each question. Scores summed from 0 (worst) - 100 (best).

  12 months

Secondary Outcomes (11)

• Test Battery to Assess Postural Orientation During Functional Tasks

  12 weeks

• Hop Test Battery

  12 weeks

• Knee Injury and Osteoarthritis Outcome Score

  12 weeks; 12 month follow-up

• Rehabilitation Outcome Satisfaction

  12 months; 12 month follow-up

• Perceived Stress Scale

  12 weeks; 12 month follow-up

Study Arms (2)

Neuromuscular Training

NO INTERVENTION

Participants in this group will undergo rehabilitation for ACL injury consisting of neuromuscular training according to care-as-usual treatment common to physical therapy professionals.

MOTIFS

EXPERIMENTAL

Participants in this group will receive an intervention that has been developed according to our new training model, known as MOTor Imagery to Facilitate Sensorimotor re-learning (MOTIFS). In this intervention, patients will receive a neuromuscular training rehabilitation program with integrated dynamic motor imagery.

Behavioral: MOTIFS

Interventions

MOTIFS BEHAVIORAL

o MOTor Imagery to Facilitate Sensorimotor re-learning (MOTIFS) is an individualized and physical activity-specific integrated model that includes aspects of both neuromuscular training, as used in rehabilitation practices, and Dynamic Motor Imagery (DMI). DMI is a form of mental training in which the participant images him-/herself performing a task from a first-person perspective in order to maximize functional equivalence to the task in question. This includes dynamic, physical movement, as well as mental imaging. The intervention provides a framework for designing individualized, physical activity-specific rehabilitation exercises for knee-injured people.

Also known as: Neuromuscular Training Plus Mental Training, Train the Brain Model

MOTIFS

Eligibility Criteria

• Age: 16 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Men and women
• Over the age of 16
• Traumatic knee injury with or without surgical intervention, and involving one or more knee structures
• Currently undergoing physical therapist-supervised rehabilitation and have reached the stage in rehabilitation which includes single-leg hop training (i.e. able to complete a side hop and a single-leg hop for distance)
• Active before the injury in recreational or competitive physical activity, with a goal of returning to physical activity

You may not qualify if:

• Any degenerative knee disorder, or other disease or disorder overriding the knee injury (e.g. spine disorder, neurological disease)
• Do not understand the languages of interest (Swedish, Danish, Norwegian), or English

Sponsors & Collaborators

• Lund University: lead

Study Sites (1)

Lund University

Lund, Skåne County, 221 00, Sweden

Location

Related Publications (23)

• Ageberg E, Thomee R, Neeter C, Silbernagel KG, Roos EM. Muscle strength and functional performance in patients with anterior cruciate ligament injury treated with training and surgical reconstruction or training only: a two to five-year followup. Arthritis Rheum. 2008 Dec 15;59(12):1773-9. doi: 10.1002/art.24066.

  PMID: 19035430 BACKGROUND

• Frobell RB, Roos EM, Roos HP, Ranstam J, Lohmander LS. A randomized trial of treatment for acute anterior cruciate ligament tears. N Engl J Med. 2010 Jul 22;363(4):331-42. doi: 10.1056/NEJMoa0907797.

  PMID: 20660401 BACKGROUND

• Ardern CL, Taylor NF, Feller JA, Webster KE. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med. 2014 Nov;48(21):1543-52. doi: 10.1136/bjsports-2013-093398. Epub 2014 Aug 25.

  PMID: 25157180 BACKGROUND

• Ardern CL, Webster KE, Taylor NF, Feller JA. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med. 2011 Jun;45(7):596-606. doi: 10.1136/bjsm.2010.076364. Epub 2011 Mar 11.

  PMID: 21398310 BACKGROUND

• Risberg MA, Grindem H, Oiestad BE. We Need to Implement Current Evidence in Early Rehabilitation Programs to Improve Long-Term Outcome After Anterior Cruciate Ligament Injury. J Orthop Sports Phys Ther. 2016 Sep;46(9):710-3. doi: 10.2519/jospt.2016.0608.

  PMID: 27581178 BACKGROUND

• Guillot A, Moschberger K, Collet C. Coupling movement with imagery as a new perspective for motor imagery practice. Behav Brain Funct. 2013 Feb 20;9:8. doi: 10.1186/1744-9081-9-8.

  PMID: 23425312 BACKGROUND

• Smith D, et al. It's All in the Mind: PETTLEP-Based Imagery and Sports Performance. J Appl Sport Psychol 2007;19:80-92.

  BACKGROUND

• Cumming J, et al. Introducing the revised applied model of deliberate imagery use for sport, dance, exercise, and rehabilitation. Movement & Sport Sciences 2013;1:69-81.

  BACKGROUND

• Grooms DR, Page SJ, Onate JA. Brain Activation for Knee Movement Measured Days Before Second Anterior Cruciate Ligament Injury: Neuroimaging in Musculoskeletal Medicine. J Athl Train. 2015 Oct;50(10):1005-10. doi: 10.4085/1062-6050-50.10.02. Epub 2015 Sep 29.

  PMID: 26509775 BACKGROUND

• Holmes PS, Collins DJ. The PETTLEP approach to motor imagery: A functional equivalence model for sport psychologists. Journal of Applied Sport Psychology 2001;13(1):60-83. doi: 10.1080/104132001753155958

  BACKGROUND

• Webster KE, Feller JA, Lambros C. Development and preliminary validation of a scale to measure the psychological impact of returning to sport following anterior cruciate ligament reconstruction surgery. Phys Ther Sport. 2008 Feb;9(1):9-15. doi: 10.1016/j.ptsp.2007.09.003. Epub 2007 Nov 5.

  PMID: 19083699 BACKGROUND

• Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985 Sep;(198):43-9.

  PMID: 4028566 BACKGROUND

• Gustavsson A, Neeter C, Thomee P, Silbernagel KG, Augustsson J, Thomee R, Karlsson J. A test battery for evaluating hop performance in patients with an ACL injury and patients who have undergone ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2006 Aug;14(8):778-88. doi: 10.1007/s00167-006-0045-6. Epub 2006 Mar 9.

  PMID: 16525796 BACKGROUND

• Nae J, Creaby MW, Cronstrom A, Ageberg E. Measurement properties of visual rating of postural orientation errors of the lower extremity - A systematic review and meta-analysis. Phys Ther Sport. 2017 Sep;27:52-64. doi: 10.1016/j.ptsp.2017.04.003. Epub 2017 Apr 18.

  PMID: 28647205 BACKGROUND

• Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS)--development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998 Aug;28(2):88-96. doi: 10.2519/jospt.1998.28.2.88.

  PMID: 9699158 BACKGROUND

• Howie JG, Heaney DJ, Maxwell M, Walker JJ. A comparison of a Patient Enablement Instrument (PEI) against two established satisfaction scales as an outcome measure of primary care consultations. Fam Pract. 1998 Apr;15(2):165-71. doi: 10.1093/fampra/15.2.165.

  PMID: 9613486 BACKGROUND

• Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983 Dec;24(4):385-96. No abstract available.

  PMID: 6668417 BACKGROUND

• Kendzierski D, DeCarlo KJ. Physical Activity Enjoyment Scale: Two Validation Studies. Journal of Sport and Exercise Psychology 1991;13(1):50-64. doi: 10.1123/jsep.13.1.50

  BACKGROUND

• Ardern CL, Osterberg A, Sonesson S, Gauffin H, Webster KE, Kvist J. Satisfaction With Knee Function After Primary Anterior Cruciate Ligament Reconstruction Is Associated With Self-Efficacy, Quality of Life, and Returning to the Preinjury Physical Activity. Arthroscopy. 2016 Aug;32(8):1631-1638.e3. doi: 10.1016/j.arthro.2016.01.035. Epub 2016 Mar 24.

  PMID: 27020461 BACKGROUND

• Cederstrom N, Graner S, Nilsson G, Ageberg E. Effect of motor imagery on enjoyment in knee-injury prevention and rehabilitation training: A randomized crossover study. J Sci Med Sport. 2021 Mar;24(3):258-263. doi: 10.1016/j.jsams.2020.09.004. Epub 2020 Sep 10.

  PMID: 32958377 BACKGROUND

• Cederstrom N, Graner S, Nilsson G, Dahan R, Ageberg E. Motor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS) after traumatic knee injury: study protocol for an adaptive randomized controlled trial. Trials. 2021 Oct 21;22(1):729. doi: 10.1186/s13063-021-05713-8.

  PMID: 34674738 BACKGROUND

• Cederstrom N, Nilsson G, Dahan R, Graner S, Ageberg E. Using an integrated motor imagery and physical training intervention after knee injury: an interim analysis of the MOTIFS randomised controlled trial. BMJ Open Sport Exerc Med. 2024 Oct 2;10(4):e002064. doi: 10.1136/bmjsem-2024-002064. eCollection 2024.

  PMID: 39371411 DERIVED

• Cederstrom N, Ageberg E, Graner S. Lived experiences of patients undergoing treatment for traumatic knee injury using integrated psychological training (MOTIFS) in the context of care-as-usual training: a phenomenological interview study. BMJ Open Sport Exerc Med. 2022 Nov 22;8(4):e001409. doi: 10.1136/bmjsem-2022-001409. eCollection 2022.

  PMID: 36439865 DERIVED

MeSH Terms

Conditions

Anterior Cruciate Ligament Injuries; Knee Injuries

Condition Hierarchy (Ancestors)

Leg Injuries; Wounds and Injuries

Study Officials

• Eva Ageberg, PhD

  Lund University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: The outcomes assessor will be blinded, but due to the nature of the study, neither the primary investigator, participant, nor the care providers can be blinded
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: 1:1 single assessor-blinded adaptive randomized controlled trial, which will conform to the CONSORT statement

Study Record Dates

• First Submitted: February 28, 2018
• First Posted: March 22, 2018
• Study Start: March 25, 2018
• Primary Completion: June 6, 2023
• Study Completion: June 1, 2024
• Last Updated: April 24, 2024

Record last verified: 2024-04

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP
• Time Frame: Upon completion of data collection (estimated completion January 2022). Data availability in accordance with data management guidelines at Lund University (e.g. available up to 15 years after publication/finalized project)
• Access Criteria: Data may be shared upon reasonable request by contacting the corresponding author: Niklas Cederström niklas.cederstrom@med.lu.se

Locations

SE (1)