Mental Skills Coaching for ACL Tear

(ROAR 2:Pilot Trial)

Overseen By Shannon McGurty, BS

Age: < 65

Sex: Any

Trial Phase: Academic

Sponsor: Boston Children's Hospital

Disqualifiers: MCL, LCL, PCL tears

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 10

Duration: 9 months

30 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Mental Skills Coaching for ACL Tear?

Research shows that psychological interventions, like cognitive-behavioral programs, can help people recovering from ACL surgery by reducing pain and fear of movement, and improving confidence in coping with recovery challenges. ^{1 2 3 4 5}

Is Mental Skills Coaching safe for humans?

The research suggests that psychological interventions, like Mental Skills Coaching, are generally safe and can help people cope with challenges after ACL surgery, reducing pain and fear of movement. ^{2 3 6 7 8}

How does mental skills coaching differ from other treatments for ACL tears?

Mental skills coaching for ACL tears is unique because it focuses on the psychological aspects of recovery, such as mental readiness and goal setting, which are often overlooked in traditional physical rehabilitation. This approach aims to address psychological impairments and improve patients' mental recovery, which can enhance their overall rehabilitation and readiness to return to sports. ^{1 3 9 10 11}

What is the purpose of this trial?

This study aims to determine the feasibility of implementing a mental skills training intervention for adolescent athletes who tear their ACL and undergo ACL reconstruction surgery alongside receiving standard-of-care clinical treatment. The study will also determine if the mental skills coaching program has any effect on the psychological readiness of patients to return to sport after undergoing surgery and postoperative recovery and rehabilitation. If feasible and if the mental skills training program shows promising effect on athletes' confidence in returning to sport, a large-scale clinical trial can be explored to assess the relationship between mental skills' impact on readiness to return to sport, which could in turn provide evidence on the benefits of integrating mental skills directly into standard clinical care.

Research Team

Matthew D Milewski, MD

Principal Investigator

Boston Children's Hospital

Eligibility Criteria

This trial is for English-speaking adolescent athletes aged 8 to 25 who are undergoing ACL reconstruction surgery at Boston Children's Hospital due to a complete tear. It's not for those with additional severe ligament tears requiring reconstruction.

Inclusion Criteria

My ACL is completely torn.

English-speaking

I am between 8 and 25 years old at the time of my surgery.

Exclusion Criteria

I need surgery for a torn MCL, LCL, or PCL.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Preoperative Consultation

Participants undergo a preoperative consultation to discuss the mental skills training and standard ACL reconstruction procedure

1 visit

1 visit (in-person)

Treatment

Participants receive mental skills training alongside standard-of-care ACL reconstruction and follow-up care

9 months

6 visits (in-person)

Follow-up

Participants are monitored for psychological readiness to return to sport and stress levels after treatment

6-9 months

3 visits (in-person)

Treatment Details

Interventions

• Mental Skills Coaching

Trial Overview The study tests if mental skills coaching can help young athletes feel more ready to return to sports after ACL surgery and recovery. Participants will receive this training along with standard clinical care, assessing its feasibility and impact.

Participant Groups

Group I: Intervention Experimental Treatment 1 Intervention

Participants will receive mental skills training in addition to receiving standard-of-care ACL reconstruction and follow-up care. The goal of mental skills training is to help athletes maximize performance, reach self-determined goals, and build confidence in their fields of play. Many of the same tools that benefit athletes in sport performance also translate to their injury experience. Mental conditioning helps athletes navigate the many ups and downs that accompany ACL injury and recovery. Athletes are taught techniques to maintain their sport mindset by capitalizing on motivation, consistency, and resilience. One-on-one sessions are athlete-centered, and are designed to encourage exploration and growth through tangible mental skills strategies.

Who Is Running the Clinical Trial?

Boston Children's Hospital

Lead Sponsor

Trials

801

Recruited

5,584,000+

Findings from Research

Sports physical therapists (PTs) recognize that psychological impairments following an ACL injury can be more significant than physical ones, highlighting the need for better training and resources to address these issues during rehabilitation.

PTs expressed a desire for specific knowledge and interventions focused on psychological aspects of recovery, suggesting that developing psychologically centered rehabilitation programs could enhance patient outcomes after ACL injuries.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Psychological impairments after ACL injury - Do we know what we are addressing? Experiences from sports physical therapists. Piussi, R., Krupic, F., Senorski, C., et al.[2021]

A study involving 69 patients undergoing ACL surgery showed that an interactive cognitive-behavioral multimedia program significantly improved preoperative confidence and reduced postoperative pain and fear of movement compared to standard care.

The multimedia program also enhanced the use and perceived usefulness of educational materials, indicating it could be an effective and cost-efficient way to support patients during ACL surgery and rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An Interactive Cognitive-Behavioural Multimedia Program Favourably Affects Pain and Kinesiophobia During Rehabilitation After Anterior Cruciate Ligament Surgery: An Effectiveness Trial. Brewer, BW., Van Raalte, JL., Cornelius, AE.[2023]

In the ACL-SPORTS trial, 95% of male athletes returned to sport one year after ACL reconstruction, with 78% returning to their preinjury level, and by two years, all athletes had returned to sport, with 95% at their preinjury level.

The incidence of second ACL injuries was very low, with only one athlete experiencing a second injury, indicating that the training program may effectively reduce the risk of re-injury compared to previous literature.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

TWO YEAR ACL REINJURY RATE OF 2.5%: OUTCOMES REPORT OF THE MEN IN A SECONDARY ACL INJURY PREVENTION PROGRAM (ACL-SPORTS). Arundale, AJH., Capin, JJ., Zarzycki, R., et al.[2022]

A study involving 11 UK student physiotherapists revealed that while they understand the importance of goal setting in ACL rehabilitation, they feel unprepared and have received minimal training on the subject.

Participants expressed a desire for more training in goal setting practices, highlighting a need for improved education in psychological strategies within physiotherapy programs to enhance patient involvement in rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An exploration of UK student physiotherapists' goal setting practices within anterior cruciate ligament rehabilitation. Alexanders, J., Chesterton, P., Brooks, A., et al.[2022]

References

1. Denmark pubmed.ncbi.nlm.nih.gov

Psychological impairments after ACL injury - Do we know what we are addressing? Experiences from sports physical therapists. [2021]

2. United States pubmed.ncbi.nlm.nih.gov

An Interactive Cognitive-Behavioural Multimedia Program Favourably Affects Pain and Kinesiophobia During Rehabilitation After Anterior Cruciate Ligament Surgery: An Effectiveness Trial. [2023]

3. Germany pubmed.ncbi.nlm.nih.gov

It is time to target psychological readiness (or lack of readiness) in return to sports after Anterior Cruciate Ligament tears. [2023]

4. United States pubmed.ncbi.nlm.nih.gov

Greater Psychological Readiness to Return to Sport, as Well as Greater Present and Future Knee-Related Self-Efficacy, Can Increase the Risk for an Anterior Cruciate Ligament Re-Rupture: A Matched Cohort Study. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Improving ACL Reconstruction Outcomes. [2019]

6. Switzerland pubmed.ncbi.nlm.nih.gov

An Investigation of the Nature of Fear within ACL-Injured Subjects When Exposed to Provocative Videos: A Concurrent Qualitative and Quantitative Study. [2022]

7. Switzerland pubmed.ncbi.nlm.nih.gov

Understanding Fear after an Anterior Cruciate Ligament Injury: A Qualitative Thematic Analysis Using the Common-Sense Model. [2023]

8. United States pubmed.ncbi.nlm.nih.gov

TWO YEAR ACL REINJURY RATE OF 2.5%: OUTCOMES REPORT OF THE MEN IN A SECONDARY ACL INJURY PREVENTION PROGRAM (ACL-SPORTS). [2022]

9. England pubmed.ncbi.nlm.nih.gov

An exploration of UK student physiotherapists' goal setting practices within anterior cruciate ligament rehabilitation. [2022]

10. England pubmed.ncbi.nlm.nih.gov

Preventing ACL injuries in team-sport athletes: a systematic review of training interventions. [2018]

11. United States pubmed.ncbi.nlm.nih.gov

Instruction and jump-landing kinematics in college-aged female athletes over time. [2022]