The POP-ACLR Feasibility Study
Research type
Research Study
Full title
The PreOperative management of Patients awaiting Anterior Cruciate Ligament Reconstruction (POP-ACLR) Feasibility Study
IRAS ID
333180
Contact name
Hayley Carter
Contact email
Sponsor organisation
University Hospitals of Derby and Burton NHS Foundation Trust
ISRCTN Number
ISRCTN17801081
Duration of Study in the UK
0 years, 6 months, 1 days
Research summary
Summary of Research:
The anterior cruciate ligament (ACL) is the most commonly injured ligament in the knee. The median annual incidence of ACL rupture in the general population is 0.03%, equating to approximately 20,200 ruptures each year in the UK. Once diagnosed, treatment may follow a non-surgical or surgical approach. Surgery rates for ACL injuries increased 12-fold in the UK between 1997 and 2017, with a rate of 24.2 ACL reconstructions (ACLR) per 100,000 of the population. However, surgical treatment isn’t necessary for all patients. 3–5 At present, the evidence is uncertain, and it is not clear who is most appropriate for surgical or non-surgical treatment.A nominal group consensus study was conducted to develop an intervention for ACL patients post-injury/pre-surgery. This intervention was co-designed with patients and key stakeholders including physiotherapists, occupational therapists, a surgeon and therapy manager. The developed intervention is a shared decision making (SDM) tool to support patients to make decisions about the treatment of their ACL tear.
Patient-centred care is a core ethos of the National Health Service, outlined in the Long Term Plan as a key deliverable. Involving patients in their healthcare decisions is an important part of patient centred care. As the evidence is unclear to determine what treatment is most appropriate for patients following an ACL rupture, SDM practices are important.
ACL injuries, surgery and rehabilitation are costly to the NHS, costing upwards of £63 million each year. With a lack of clinical guidelines or standard treatment pathway to inform clinicians, the effectiveness of care provided by the NHS is questionable. Ensuring the patient journey is successful is therefore hugely important. Ensuring treatment decisions are shared between healthcare professions and clinicians will ensure patients are on appropriate treatment pathways which could improve service and patient outcomes and ensure greater value for money.
Summary of results:
Background After an Anterior Cruciate Ligament (ACL) rupture (also known as a tear), patients may have surgery or may manage without surgery and undergo rehabilitation. Research has shown that up to 50% of patients with an ACL rupture manage well without surgery. This can make decision-making about treatment challenging as it is not clear who is best suited to surgery and who may manage well without it.A shared decision-making tool was developed with patients, NHS managers, healthcare professionals (including a surgeon, occupational therapist and physiotherapists) and researchers. The tool was designed to help patients make choices about their treatment following an ACL rupture.
Methods
We trialled the shared decision-making tool in an NHS orthopaedic and physiotherapy pathway. We collected data on:
1. Feasibility – practicality of delivering the shared decision-making tool
2. Acceptability – overall agreement about the acceptability of the tool to all patients taking part
3. Indicators of Effectiveness – whether the tool was useful to patients and healthcare professionals
We also interviewed patients and physiotherapists about their experiences.Results
20 patients and 11 physiotherapists took part in the study. The shared decision-making tool was found to be practical to use in the NHS, so feasibility was achieved. The shared decision-making tool was also well received, with 94% overall agreement that it met the standards for being acceptable.The shared decision-making tool also seemed to be useful:
1) It helped patients make choices about their treatment
2) Patients said they were satisfied with their treatment decisions, scoring an average of 24.85 out of 30 on a satisfaction survey
3) It made it easier for patients and healthcare providers to talk about treatment options
4) It helped patients to understand and use medical terms
5) Patients said it helped them focus on questions that were important to them
These results were collected in patient surveys and during interviews with patients and physiotherapists.Conclusion
This study showed that the shared decision-making tool was easy to use and helpful for patients with an ACL rupture in an NHS setting. The tool helped patients make informed treatment choices, encouraged open conversations with healthcare professionals, and improved their understanding of medical terms. Both patients and physiotherapists reported high levels of satisfaction with the tool. Overall, the shared decision-making tool seemed like a useful resource for supporting patients to make shared decisions about their care.REC name
East Midlands - Nottingham 1 Research Ethics Committee
REC reference
23/EM/0263
Date of REC Opinion
21 Dec 2023
REC opinion
Further Information Favourable Opinion