Cognitive‐behavioural physical therapy improves psychological readiness for return to sport, knee function, and resilience in patients after anterior cruciate ligament reconstruction: A randomised controlled trial

PURPOSE: Psychological preparation prior to the return to sport (RTS) has a significant impact on knee function following anterior cruciate ligament reconstruction (ACLR). The objective of this study was to evaluate the efficacy of a cognitive-behavioural-based physical therapy (CBPT) program in enhancing patients' psychological well-being, psychological preparation for RTS and knee function. METHODS: A randomised parallel-group controlled trial was conducted. Seventy-two patients awaiting ACLR were randomly assigned to the CBPT or control group. The evaluation comprised the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI), Lysholm score, Knee Self-Efficacy Scale (K-SES), Tampa Scale for Kinesiophobia (TSK), Brief Resilience Scale (BRS) and locus of control (LOC). These were measured preoperatively and at 6, 12 and 24 weeks postoperatively. RESULTS: Sixty-one subjects were finally included, 29 in the CBPT and 32 in the control group. At the 6th, 12th, and 24th postoperative weeks, the CBPT group had significantly higher ACL-RSI scores (66.4 vs. 62.2, 73.7 vs. 67.8, 85.1 vs. 80.1; p = 0.035, 0.012, 0.032, respectively), K-SES future scores (7.1 vs. 5.6, 7.9 vs. 6.8, 8.2 vs. 7.3; p = 0.002, 0.028, 0.047, respectively), and BRS scores (3.6 vs. 3.2, 4.1 vs. 3.7, 5.0 vs. 4.3; p = 0.025, 0.029, <0.001, respectively) compared to the control group. Lysholm scores were better in the CBPT group at Weeks 12 and 24 (73.7 vs. 65.3, 83.2 vs. 72.2; p = 0.038, <0.001, respectively), and the Week 24 mean difference exceeded the minimal clinically important difference (MCID) (10.0). No significant differences were found in TSK, K-SES present and LOC scores. CONCLUSION: CBPT-based psychological interventions facilitate enhanced psychological preparation for RTS, improved knee function and elevated confidence and resilience for future rehabilitation in patients who have undergone ACLR. LEVEL OF EVIDENCE: Level I, randomised controlled trial. CLINICAL TRIAL REGISTRATION: ChiCTR2400087631.