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Fältström, A., Kvist, J., Gauffin, H. & Hägglund, M. (2019). Female Soccer Players With Anterior Cruciate Ligament Reconstruction Have a Higher Risk of New Knee Injuries and Quit Soccer to a Higher Degree Than Knee-Healthy Controls. American Journal of Sports Medicine, 47(1), 31-40
Open this publication in new window or tab >>Female Soccer Players With Anterior Cruciate Ligament Reconstruction Have a Higher Risk of New Knee Injuries and Quit Soccer to a Higher Degree Than Knee-Healthy Controls
2019 (English)In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 47, no 1, p. 31-40Article in journal (Refereed) Published
Abstract [en]

Background:

Many patients with anterior cruciate ligament (ACL) reconstruction who return to sport suffer new ACL injuries or quit sports soon after returning.

Purpose:

To prospectively follow a cohort of female soccer players with primary unilateral ACL reconstruction and matched knee-healthy controls from the same soccer teams to compare (1) the rate of new traumatic and nontraumatic knee injuries and other injuries, (2) the proportion of players who quit soccer, and (3) player-reported activity level and satisfaction with activity level and knee function.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

A total of 117 active female soccer players (mean ± SD age, 19.9 ± 2.5 years) 18.9 ± 8.7 months after ACL reconstruction and 119 knee-healthy female soccer players (19.5 ± 2.5 years) matched from the same teams were prospectively followed for 2 years for new knee injuries, other injuries, soccer playing level, activity level according to the Tegner Activity Scale, and satisfaction with activity level and knee function.

Results:

Players with ACL reconstruction had a higher rate of new ACL injuries (n = 29 vs 8; 19 vs 4 per 100 player years; rate ratio [RR], 4.82; 95% CI, 2.20-10.54; P < .001), other traumatic knee injuries (29 vs 16 per 100 player years; RR, 1.84; 95% CI, 1.16-2.93; P < .01), and nontraumatic knee injuries (33 vs 9 per 100 player years; RR, 3.62; 95% CI, 2.11-6.21; P < .001) as compared with controls. There was no difference in the rate of other (not knee) injuries (43 vs 48 per 100 player years; RR, 0.90; 95% CI, 0.65-1.23; P = .494). During the 2-year follow-up, 72 (62%) players with ACL reconstruction quit soccer, as opposed to 43 (36%) controls (P = .001). The median Tegner Activity Scale score decreased in both groups (P < .001) but more for the ACL-reconstructed group (P < .015).

Conclusion:

Female soccer players with ACL reconstruction had nearly a 5-fold-higher rate of new ACL injuries and a 2- to 4-fold-higher rate of other new knee injuries, quit soccer to a higher degree, and reduced their activity level to a greater extent as compared with knee-healthy controls.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Female, football, soccer, anterior cruciate ligament, return to sports, reinjury, satisfaction
National Category
Physiotherapy Orthopaedics Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-153246 (URN)10.1177/0363546518808006 (DOI)000454146900010 ()30481050 (PubMedID)
Available from: 2018-12-05 Created: 2018-12-05 Last updated: 2019-01-11Bibliographically approved
Arundale, A., Kvist, J., Hägglund, M. & Fältström, A. (2019). Jumping performance based on duration of rehabilitation in female football players after anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy, 27(2), 556-563
Open this publication in new window or tab >>Jumping performance based on duration of rehabilitation in female football players after anterior cruciate ligament reconstruction
2019 (English)In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 27, no 2, p. 556-563Article in journal (Refereed) Published
Abstract [en]

Purpose

To determine if female football players who had longer durations of rehabilitation, measured in months, after anterior cruciate ligament reconstruction would have lower tuck jump scores (fewer technique flaws) and smaller asymmetries during drop vertical jump landing.

Methods

One-hundred-and-seventeen female football players, aged 16ᅵ25 years, after primary unilateral ACL reconstruction (median 16 months, range 6ᅵ39) were included. Athletes reported the duration of rehabilitation they performed after anterior cruciate ligament reconstruction. Athletes also performed the tuck jump and drop vertical jump tests. Outcome variables were: tuck jump score, frontal plane knee motion and probability of peak knee abduction moment during drop vertical jump landing.

Results

There was no difference in tuck jump score based on duration of rehabilitation (n.s.). No interaction (n.s.), difference between limbs (n.s.), or duration of rehabilitation (n.s.) was found for peak knee abduction moment during drop vertical jump landing. No interaction (n.s.) or difference between limbs (n.s.) was found for frontal plane knee motion, but there was a difference based on duration of rehabilitation (P?=?0.01). Athletes with >?9 months of rehabilitation had more frontal plane knee motion (medial knee displacement) than athletes with <?6 months (P?=?0.01) or 6ᅵ9 months (P?=?0.03).

Conclusion

As there was no difference in tuck jump score or peak knee abduction moment based on duration of rehabilitation, the results of this study press upon clinicians the importance of using objective measures to progress rehabilitation and clear athletes for return to sport, rather than time alone.

Place, publisher, year, edition, pages
Springer Berlin/Heidelberg, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology Physiotherapy Sport and Fitness Sciences
Identifiers
urn:nbn:se:liu:diva-151695 (URN)10.1007/s00167-018-5154-5 (DOI)000460315200027 ()30267186 (PubMedID)
Note

Funding agencies: Swedish Research Council for Sport Science [CIF P2015-0150, FO2016-0021]; Futurum-the Academy for Healthcare, Region Jonkoping County; Medical Research Council of Southeast Sweden; Faculty of Health Sciences at Linkoping University; Swedish Football Assoc

Available from: 2018-10-01 Created: 2018-10-01 Last updated: 2019-03-20Bibliographically approved
Kvist, J., Gauffin, H., Tigerstrand Grevnerts, H., Ardern, C., Hägglund, M., Stalman, A. & Frobell, R. (2018). Natural corollaries and recovery after acute ACL injury: the NACOX cohort study protocol. BMJ Open, 8(6), Article ID e020543.
Open this publication in new window or tab >>Natural corollaries and recovery after acute ACL injury: the NACOX cohort study protocol
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2018 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 6, article id e020543Article in journal (Refereed) Published
Abstract [en]

Introduction Anterior cruciate ligament (ACL) injury can result in joint instability, decreased functional performance, reduced physical activity and quality of life and an increased risk for post-traumatic osteoarthritis. Despite the development of new treatment techniques and extensive research, the complex and multifaceted nature of ACL injury and its consequences are yet to be fully understood. The overall aim of the NACOX study is to evaluate the natural corollaries and recovery after an ACL injury. Methods and analysis The NACOX study is a multicentre prospective prognostic cohort study of patients with acute ACL injury. At seven sites in Sweden, we will include patients aged 15-40 years, within 6 weeks after primary ACL injury. Patients will complete questionnaires at multiple occasions over the 3 years following injury or the 3 years following ACL reconstruction (for participants who have surgical treatment). In addition, a subgroup of 130 patients will be followed with clinical examinations, several imaging modalities and biological samples. Data analyses will he specific to each aim. Ethics and dissemination This study has been approved by the regional Ethical committee in Linkoping, Sweden (Dnr 2016/44-31 and 2017/221-32). We plan to present the results at national and international conferences and in peer-reviewed scientific journals. Participants will receive a short summary of the results following completion of the study.

Place, publisher, year, edition, pages
BMJ PUBLISHING GROUP, 2018
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-151521 (URN)10.1136/bmjopen-2017-020543 (DOI)000442924700037 ()29950463 (PubMedID)
Note

Funding Agencies|Swedish Medical Research Council [VR 2015-03687]; Swedish Research Council for Sport Science [CIF P2016-0063, P2017-0151]; Medical Research Council of Southeast Sweden FORSS [FORSS -662081]; Medical Faculty at Linkoping University, Sweden

Available from: 2018-09-21 Created: 2018-09-21 Last updated: 2018-10-08
Gustafsson, K., Rolfson, O., Eriksson, M., Dahlberg, L. & Kvist, J. (2018). Study protocol for an observational register-based study on health and risk factors in patients with hip and knee osteoarthritis. BMJ Open, 8(10), Article ID e022812.
Open this publication in new window or tab >>Study protocol for an observational register-based study on health and risk factors in patients with hip and knee osteoarthritis
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2018 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 10, article id e022812Article in journal (Refereed) Published
Abstract [en]

Introduction Hip and knee osteoarthritis is a leading cause of disability worldwide. Currently, the course of deterioration in pain and physical functioning in individuals with osteoarthritis is difficult to predict. Factors such as socioeconomic status and comorbidity contribute to progression of osteoarthritis, but clear associations have not been established. There is a need for early identification of individuals with slow disease development and a good prognosis, and those that should be recommended for future joint replacement surgery.

Methods and analysis This nationwide register-based study will use data for approximately 75 000 patients who sought and received core treatment for osteoarthritis in primary healthcare, and were registered in the Swedish population-based National Quality Register for Better Management of Patients with Osteoarthritis. These data will be merged with data for replacement surgery, socioeconomic factors, healthcare consumption and comorbidity from the Swedish Hip Arthroplasty Register, the Swedish Knee Arthroplasty Register, Statistics Sweden and the National Board of Health and Welfare, Sweden. The linkage will be performed using personal identity numbers that are unique to all citizens in Sweden.

Ethics and dissemination The study was approved by the Regional Ethical Review Board in Gothenburg, Sweden (dnr 1059–16). The results from this study will be submitted to peer-reviewed journals and reported at suitable national and international meetings.

Trial registration number NCT03438630.

Place, publisher, year, edition, pages
British Medical Journal Publishing Group, 2018
National Category
Occupational Therapy
Identifiers
urn:nbn:se:liu:diva-151890 (URN)10.1136/bmjopen-2018-022812 (DOI)000454739500118 ()
Note

Funding agencies: AFA Insurance, Sweden [160176]; Futurum-Academy for Health and Care, Region Jonkoping County, Sweden [559951, 557821]

Available from: 2018-10-09 Created: 2018-10-09 Last updated: 2019-05-03
Ardern, C., Tagesson (Sonesson), S., Forssblad, M. & Kvist, J. (2017). Comparison of patient-reported outcomes among those who chose ACL reconstruction or non-surgical treatment.. Scandinavian Journal of Medicine and Science in Sports, 27(5), 535-544
Open this publication in new window or tab >>Comparison of patient-reported outcomes among those who chose ACL reconstruction or non-surgical treatment.
2017 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 27, no 5, p. 535-544Article in journal (Refereed) Published
Abstract [en]

The aim of our study was to cross-sectionally compare patient-reported knee function outcomes between people who chose non-surgical treatment for ACL injury and those who chose ACL reconstruction. We extracted Knee Injury and Osteoarthritis Outcome Score (KOOS) and EuroQoL-5D data entered into the Swedish National ACL Registry by patients with a non-surgically treated ACL injury within 180 days of injury (n = 306), 1 (n = 350), 2 (n = 358), and 5 years (n = 114) after injury. These data were compared cross-sectionally to data collected pre-operatively (n = 306) and at 1 (n = 350), 2 (n = 358), and 5 years (n = 114) post-operatively from age- and gender-matched groups of patients with primary ACL reconstruction. At the 1 and 2 year comparisons, patients who chose surgical treatment reported superior quality of life and function in sports (1 year mean difference 12.4 and 13.2 points, respectively; 2 year mean difference 4.5 and 6.9 points, respectively) compared to those who chose non-surgical treatment. Patients who chose ACL reconstruction reported superior outcomes for knee symptoms and function, and in knee-specific and health-related quality of life, compared to patients who chose non-surgical treatment.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2017
Keywords
Anterior cruciate ligament, Knee Injury and Osteoarthritis Outcome Score, knee, quality of life
National Category
Medical and Health Sciences Health Sciences Physiotherapy
Identifiers
urn:nbn:se:liu:diva-136094 (URN)10.1111/sms.12707 (DOI)000398783800010 ()27333943 (PubMedID)
Available from: 2017-03-27 Created: 2017-03-27 Last updated: 2018-05-03Bibliographically approved
Tagesson (Sonesson), S. & Kvist, J. (2017). Dynamic and static tibial translation in patients with anterior cruciate ligament deficiency initially treated with a structured rehabilitation protocol. Knee Surgery, Sports Traumatology, Arthroscopy, 25(8), 2337-2346
Open this publication in new window or tab >>Dynamic and static tibial translation in patients with anterior cruciate ligament deficiency initially treated with a structured rehabilitation protocol
2017 (English)In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 25, no 8, p. 2337-2346Article in journal (Refereed) Published
Abstract [en]

PURPOSE:

To compare dynamic and static tibial translation, in patients with anterior cruciate ligament deficiency, at 2- to 5-year follow-up, with the tibial translation after 4 months of rehabilitation initiated early after the injury. Secondarily, to compare tibial translation in the injured knee and non-injured knee and explore correlations between dynamic and static tibial translation.

METHODS:

Twelve patients with ACL rupture were assessed at 3-8 weeks after ACL injury, after 4 months of structured rehabilitation, and 2-5 years after ACL injury. Sagittal tibial translation was measured during the Lachman test (static translation) and during gait (dynamic translation) using a CA-4000 electrogoniometer.

RESULTS:

Static tibial translation was increased bilateral 2-5 years after ACL injury, whereas the dynamic tibial translation was unchanged. Tibial translation was greater in the injured knee compared with the non-injured knee (Lachman test 134 N 9.1 ± 1.0 vs. 7.0 ± 1.7 mm, P = 0.001, gait 5.6 ± 2.1 vs. 4.7 ± 1.8 mm, P = 0.011). There were no correlations between dynamic and static tibial translation.

CONCLUSION:

Dynamic tibial translation was unchanged in spite of increased static tibial translation in the ACL-deficient knee at 2- to 5-year follow-up compared to directly after rehabilitation. Dynamic tibial translation did not correlate with the static tibial translation. A more normal gait kinematics may be maintained from completion of a rehabilitation programme to mid-term follow-up in patients with ACL deficiency treated with rehabilitation only.

Place, publisher, year, edition, pages
Springer, 2017
Keywords
ACL; Knee laxity; Knee kinematics; Functional joint stability
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-123482 (URN)10.1007/s00167-015-3714-5 (DOI)000406189500005 ()26210960 (PubMedID)
Note

Funding agencies: Faculty of Health Sciences at Linkoping University; Swedish Centre for Research in Sports

Available from: 2015-12-18 Created: 2015-12-18 Last updated: 2018-05-03
Tagesson (Sonesson), S., Kvist, J., Ardern, C., Österberg, A. & Grävare Silbernagel, K. (2017). Psychological factors are important to return to pre-injury sport activity after anterior cruciate ligament reconstruction: expect and motivate to satisfy.. Knee Surgery, Sports Traumatology, Arthroscopy, 25(5), 1375-1384
Open this publication in new window or tab >>Psychological factors are important to return to pre-injury sport activity after anterior cruciate ligament reconstruction: expect and motivate to satisfy.
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2017 (English)In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 25, no 5, p. 1375-1384Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To describe individuals' expectations, motivation, and satisfaction before, during, and after rehabilitation for ACL reconstruction and to explore how these factors were associated with return to pre-injury sport activity at 1-year follow-up.

METHODS: Sixty-five individuals (34 males), median age 22 (15-45) years, scheduled for ACL reconstruction participated. Participants completed the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) and questions about expectations, satisfaction, and motivation pre-operatively and at 16 and 52 weeks after surgery.

RESULTS: Prior to surgery, 86 % of participants stated that their goal was to return to their pre-injury sport activity. Those who had returned to their pre-injury sport activity at 52 weeks were more motivated during rehabilitation to return to their pre-injury activity level, more satisfied with their activity level and knee function at 52 weeks, and scored significantly higher on the IKDC-SKF [median 92.0 (range 66.7-100.0)] at 52 weeks, compared to those who had not returned [median 77.6 (range 50.6-97.7)].

CONCLUSION: Prior to ACL reconstruction, most participants expected to return to their pre-injury activity level. Higher motivation during rehabilitation was associated with returning to the pre-injury sport activity. The participants who had returned to their pre-injury sport activity were more satisfied with their activity level and knee function 1 year after the ACL reconstruction. Facilitating motivation might be important to support individuals in achieving their participation goals after ACL reconstruction.

LEVEL OF EVIDENCE: Prospective cohort study, Level II.

Place, publisher, year, edition, pages
Springer London, 2017
Keywords
ACL, Activity level, Patient perspective, Patient-reported outcome, Psychology, Return to sport
National Category
Medical and Health Sciences Health Sciences Physiotherapy
Identifiers
urn:nbn:se:liu:diva-136031 (URN)10.1007/s00167-016-4294-8 (DOI)000401438900004 ()27562372 (PubMedID)
Note

Funding agencies: Faculty of Health Sciences at Linkoping University; Swedish Centre for Research in Sports

Available from: 2017-03-27 Created: 2017-03-27 Last updated: 2018-05-03
Fältström, A., Hägglund, M. & Kvist, J. (2016). Factors associated with playing football after anterior cruciate ligament reconstruction in female football players.. Scandinavian Journal of Medicine and Science in Sports, 26(11), 1343-1352
Open this publication in new window or tab >>Factors associated with playing football after anterior cruciate ligament reconstruction in female football players.
2016 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 26, no 11, p. 1343-1352Article in journal (Refereed) Published
Abstract [en]

This study investigated whether player-related factors (demographic, personality, or psychological factors) or the characteristics of the anterior cruciate ligament (ACL) injury were associated with the return to playing football in females after ACL reconstruction (ACLR). We also compared current knee function, knee related quality of life and readiness to return to sport between females who returned to football and those who had not returned. Females who sustained a primary ACL rupture while playing football and underwent ACLR 6-36 months ago were eligible. Of the 460 contacted, 274 (60%) completed a battery of questionnaires, and 182 were included a median of 18 months (IQR 13) after ACLR. Of these, 94 (52%) returned to football and were currently playing, and 88 (48%) had not returned. Multiple logistic regression analysis identified two factors associated with returning to football: short time between injury and ACLR (0-3 months, OR 5.6; 3-12 months OR 4.7 vs reference group > 12 months) and high motivation. Current players showed higher ratings for current knee function, knee-related quality of life, and psychological readiness to return to sport (P < 0.001). Undergoing ACLR sooner after injury and high motivation to return to sports may impact a player's return to football after ACLR.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
Keywords
ACL; knee; return to sport; soccer
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-123889 (URN)10.1111/sms.12588 (DOI)000386938300009 ()26589671 (PubMedID)
Note

Funding agencies:The authors acknowledge statistician Henrik Magnusson. The study was supported financially by Futurum-The Academy for Healthcare, Jonkoping County Council, the Medical Research Council of Southeast Sweden, the Faculty of Health Sciences at Linkoping University, and the Swedish National Centre for Research in Sports (CIF).

Available from: 2016-01-13 Created: 2016-01-13 Last updated: 2017-11-30Bibliographically approved
Tagesson, S. & Kvist, J. (2016). Greater fear of re-injury and increased tibial translation in patients who later sustain an ACL graft rupture or a contralateral ACL rupture: a pilot study. Journal of Sports Sciences, 34(2), 125-132
Open this publication in new window or tab >>Greater fear of re-injury and increased tibial translation in patients who later sustain an ACL graft rupture or a contralateral ACL rupture: a pilot study
2016 (English)In: Journal of Sports Sciences, ISSN 0264-0414, E-ISSN 1466-447X, Vol. 34, no 2, p. 125-132Article in journal (Refereed) Published
Abstract [en]

The aim was to compare fear of re-injury, patient reported function, static and dynamic tibial translation and muscle strength assessed before and 5 weeks after an anterior cruciate ligament (ACL) reconstruction between individuals who sustained a subsequent ACL graft rupture or a contralateral ACL injury within 5 years after the reconstruction, and individuals with no subsequent injury. Nineteen patients were investigated before, and 5 weeks after an ACL reconstruction with a quadruple hamstring tendon graft. At 5 years follow up, 3 patients had sustained an ACL graft rupture and 2 patients had sustained a contralateral ACL rupture. Fear of re-injury, confidence with the knee, patient reported function, activity level, static and dynamic tibial translation and muscle strength were assessed. The re-injured group reported greater fear of re-injury and had greater static tibial translation in both knees before the ACL reconstruction compared to those who did not sustain another ACL injury. There were no other differences between groups. In conclusion, fear of re-injury and static tibial translation before the index ACL reconstruction were greater in patients who later on suffered an ACL graft rupture or a contralateral ACL rupture. These factors may predict a subsequent ACL injury.

Place, publisher, year, edition, pages
Routledge, 2016
Keywords
ACL reconstruction, graft rupture, subsequent ACL injury, fear of re-injury, tibial translation
National Category
Sport and Fitness Sciences
Identifiers
urn:nbn:se:liu:diva-123478 (URN)10.1080/02640414.2015.1035668 (DOI)000366469100004 ()25894209 (PubMedID)
Note

Funding agencies: Faculty of Health Sciences at Linkoping University; Swedish Centre for Research in Sports

Available from: 2015-12-18 Created: 2015-12-18 Last updated: 2017-12-01Bibliographically approved
Engstrand, C., Kvist, J. & Krevers, B. (2016). Patients'€™ perspective on surgical intervention for Dupuytren'€™s disease€: experiences, expectations and appraisal of results. Disability and Rehabilitation, 38(24-26), 2538-2549
Open this publication in new window or tab >>Patients'€™ perspective on surgical intervention for Dupuytren'€™s disease€: experiences, expectations and appraisal of results
2016 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 38, no 24-26, p. 2538-2549Article in journal (Refereed) Published
Abstract [en]

Purpose To explore patients’ perspectives on surgical intervention for Dupuytren’s disease (DD), focusing on patients’ appraisal of results, involving previous experiences, expectations and patient characters.

Method The participants were 21 men, mean age 66 years, scheduled for DD surgery. Qualitative interviews were conducted 2–4 weeks before surgery and 6–8 months after surgery. The model of the Patient Evaluation Process was used as theoretical framework. Data were analyzed using problem-driven content analysis.

Results Five categories are described: previous experiences, expectations before surgery, appraisal of results, expectations of the future and patient character. Previous experiences influenced participants’ expectations, and these were used along with other aspects as references for appraisal of results. Participants’ appraisal of results concerned perceived changes in hand function, care process, competency and organization, and could vary in relation to patient character. The appraisal of results influenced participants’ expectations of future hand function, health and care.

Conclusions Patients’ appraisal of results involved multidimensional reasoning reflecting on hand function, interaction with staff and organizational matters. Thus, it is not enough to evaluate results after DD surgery only by health outcomes as this provides only a limited perspective. Rather, evaluation of results should also cover process and structure aspects of care.

Implications for Rehabilitation

  • To improve health care services, it is important to be aware of the role played by patient’s previous experiences, expectations as well as staff and organizational aspects of care.
  • Knowledge about patients’ experience and view of the results from surgery and rehabilitation should be established by assessment of care effects on health as well as structure and process aspects of care.
  • Evaluation of structure and process aspects of care can be done by using questions about if the patient felt listened to, received clear information and explanations, was included in decision-making, and their view of waiting time or continuity of care.
  • Improving health care services means not only providing the best treatment method available but also developing individualized care by ensuring good interaction with the patient, providing accurate information, and working to improve the structure of the care process.
  • Before treatment, health care providers should have a dialogue with the patient and consider previous experiences and expectations in order to ensure the patient has balanced expectations of the outcome.
Keywords
Care process; hand function; hand surgery; interviews; outcome
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Nursing Physiotherapy
Identifiers
urn:nbn:se:liu:diva-125964 (URN)10.3109/09638288.2015.1137981 (DOI)000385478900020 ()26878688 (PubMedID)
Note

Funding agencies: County Council of Ostergotland, Sweden

Available from: 2016-03-10 Created: 2016-03-10 Last updated: 2017-11-30Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-3527-5488

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