Motor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS): Integrating Dynamic Motor Imagery in Current Treatment of Knee Injury

Sammanfattning: Traumatic knee injury is common in physical activity that includes jumping and cutting movements, and most commonly include anterior cruciate ligament (ACL) or meniscus injuries. Surgical or non-surgical intervention strategies may be chosen, but treatment will include a physical-therapist led physical training program. The aim of this training is to strengthen and stabilize the knee. Despite receiving best-practice treatment, many are unable to return to their pre-injury activity level. Recent research has suggested that this may be explained, in part, by psychological factors such as fear of re-injury or lack of confidence. In addition to physical treatment, guidelines include recommendations to address psychological factors. The detail of how this can be done is lacking, and the extent to which psychological variables are adequately addressed is questionable. In response to this gap, we have developed the novel Motor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS) model, which integrates psychological training into physical rehabilitation protocols using a dynamic motor imagery intervention. MOTIFS increases realism and relevance while simultaneously physically and psychologically simulating activity-specific and individualized rehabilitation exercises. The aim of this thesis is therefore to develop and explore the efficacy of the MOTIFS model in physically and psychologically preparing knee-injured people for return to activity compared to care-as-usual rehabilitation. The primary hypothesis of this thesis is that the MOTIFS model will provide greater effects on patient-relevant outcomes and muscle function than current programs. In a first step, the effect of MOTIFS model on enjoyment and other self-reported outcomes was evaluated in a cross-over study (Paper I) in which uninjured people underwent training according to both MOTIFS and care-as-usual training protocols. Next, a protocol detailing an ongoing randomized controlled trial (Paper II) which will compare 12 weeks of MOTIFS and care-as-usual training in terms of psychological readiness to return to activity and functional performance. Finally, two interview studies were conducted in which physical therapists (Paper III) and Patients (Paper IV) in both MOTIFS and care-as-usual groups were interviewed about the experiences of rehabilitation training following traumatic knee injury.Results of this thesis show that the MOTIFS model has the potential to increase enjoyment of knee injury prevention and treatment exercises. Other self-reported outcomes were also improved, and the MOTIFS model does not seem to sacrifice movement quality, indicating that it is possible to modify exercises by integrating a dynamic motor imagery intervention. Results of the interview study with physical therapists indicates that those in the MOTIFS group perceive a greater focus on psychological factors while using the new training model, and believe that it is an effective method of increasing patient readiness to return to activity. Those in the care-as-usual group described their perception of rehabilitation training as having a mainly physical focus. They expressed a desire for more tools to address psychological factors, as they perceived patient reactions to be psychological in nature and felt they were ill equipped to handle these factors. Patients in the MOTIFS group perceived MOTIFS to be meaningful and a positive method of increasing their readiness to return to sport, owing to early exposure to activity, which helps them to feel that they have longer to prepare for their return. Those in the care-as-usual group perceive a lack of psychological focus, and their success was measured in terms of their physical progress through rehabilitation. Results indicate that the MOTIFS model may be a feasible and clinically implementable method of addressing psychological factors in rehabilitation training. As the randomized controlled trial is still ongoing, no conclusions can be drawn regarding the efficacy of the intervention on rehabilitation outcomes. However, given the results of Papers I, III and IV, it seems a promising start to bridge the gap between physical and psychological rehabilitation outcomes.