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Integração da intervenção psicológica na reabilitação da lesão ligamentar do joelho
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Introdução: As lesões do ligamento cruzado anterior (LCA) são comuns e a maioria ocorre durante a prática de desporto. Embora a cirurgia de reconstrução do LCA (R-LCA) seja eficaz em restaurar a função, menos de 50% dos atletas retornam ao nível competitivo de atividade física, sendo que alguns não retornam à atividade pré-lesão e relatam que o principal fator é o medo de recorrência da lesão.
Objetivos: Analisar a influência do medo após a R-LCA na incidência de uma segunda lesão do LCA e a pertinência de incluir intervenções psicológicas específicas na reabilitação pós-cirúrgica.
Métodos: Através de uma revisão de literatura nas bases de dados PubMed e ScienceDirect, foram selecionados estudos que consideraram o medo e a sua influência na reincidência da lesão. Foram excluídos artigos que abordavam outras lesões ou que não abordavam o medo.
Resultados: Foram selecionados 13 artigos. Dois demonstraram um aumento do risco de sofrer uma lesão subsequente do LCA com níveis superiores de medo e dois artigos evidenciaram uma relação positiva entre uma menor melhoria na prontidão psicológica e maior risco de outra lesão; um artigo relatou que o risco aumentava com uma maior prontidão psicológica. Quanto à eficácia de intervenções psicológicas, um artigo mostrou evidência do método Videoinsight e dois suportaram técnicas cognitivo-comportamentais (CBPT-ACLR e um programa multimédia interativo). Um estudo apoiou a técnica de imagery motora, um não mostrou evidência de benefício e outro obteve resultados discrepantes. Dois estudos não evidenciaram eficácia da modelagem de vídeo ou de um website interativo como recurso de suporte.
Conclusões: O medo de recorrência da lesão e a prontidão psicológica podem representar fatores de risco para uma lesão subsequente do LCA. Algumas intervenções com evidência de benefício como complemento ao programa de reabilitação são o método Videoinsight, a CBPT-ACLR e um programa cognitivo-comportamental interativo de multimédia.
Introduction: Anterior cruciate ligament (ACL) injuries are common and mostly occur during sports. Although reconstructive surgery (ACL-R) is effective in restoring function, less than 50% of athletes return to a competitive level of physical activity, and some of them don’t return to pre-injury activity and report that the main factor is fear of re-injury. Purpose: To analyse the influence of fear after ACL-R on the incidence of a second ACL injury and the pertinence of including specific psychological interventions in post-surgical rehabilitation. Methods: Through a literature review in the PubMed and ScienceDirect databases, studies that considered the fear and its influence on injury recurrence were selected. Articles that focused on other types of injuries or that did not target fear were excluded. Results: 13 articles were selected. Two showed an increased risk of sustaining a subsequent ACL injury in patients with higher levels of fear and two papers showed a positive correlation between less improvement in psychological readiness and higher risk of another injury; one article reported an increased risk with greater psychological readiness. As for the psychological interventions of psychological interventions, one article showed evidence of the Videoinsight method and two supported cognitive-behavioral techniques (CBPT-ACLR and an interactive multimedia program). One study supported the motor imagery technique, one showed no evidence of benefit and another had conflicting results. Two studies did not show the effectiveness of modeling videos and an interactive website as a support resource. Conclusions: Fear of re-injury and psychological readiness may represent risk factors for a subsequent ACL injury. Some of the interventions with evidence of benefit as a complement to the rehabilitation program include the Videoinsight method, the CBPT-ACLR and an interactive multimedia cognitive-behavioral program.
Introduction: Anterior cruciate ligament (ACL) injuries are common and mostly occur during sports. Although reconstructive surgery (ACL-R) is effective in restoring function, less than 50% of athletes return to a competitive level of physical activity, and some of them don’t return to pre-injury activity and report that the main factor is fear of re-injury. Purpose: To analyse the influence of fear after ACL-R on the incidence of a second ACL injury and the pertinence of including specific psychological interventions in post-surgical rehabilitation. Methods: Through a literature review in the PubMed and ScienceDirect databases, studies that considered the fear and its influence on injury recurrence were selected. Articles that focused on other types of injuries or that did not target fear were excluded. Results: 13 articles were selected. Two showed an increased risk of sustaining a subsequent ACL injury in patients with higher levels of fear and two papers showed a positive correlation between less improvement in psychological readiness and higher risk of another injury; one article reported an increased risk with greater psychological readiness. As for the psychological interventions of psychological interventions, one article showed evidence of the Videoinsight method and two supported cognitive-behavioral techniques (CBPT-ACLR and an interactive multimedia program). One study supported the motor imagery technique, one showed no evidence of benefit and another had conflicting results. Two studies did not show the effectiveness of modeling videos and an interactive website as a support resource. Conclusions: Fear of re-injury and psychological readiness may represent risk factors for a subsequent ACL injury. Some of the interventions with evidence of benefit as a complement to the rehabilitation program include the Videoinsight method, the CBPT-ACLR and an interactive multimedia cognitive-behavioral program.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Ligamento cruzado anterior Medo de recorrência da lesão Impacto no retorno à atividade física Cinesiofobia Reabilitação Psiquiatria Psicologia médica