Reconstrução do ligamento cruzado anterior e retorno ao esporte: influência das instruções verbais de foco atencional nos testes funcionais e inclusão dos domínios do modelo biopsicossocial nas diretrizes de prática clínica

Abstract

We researched return to sport (RTS) after anterior cruciate ligament (ACL) reconstruction, performing two studies: (1) a cross-sectional study and (2) a systematic review (SR). In the cross-sectional study, we aimed to investigate the influence of attentional focus verbal instructions on the results of functional tests for the RTS after ACL-R, as well as to understand which attentional focus strategy can favor better results. In all, 60 subjects were evaluated in the single hop test (SHT), 6m timed hop test (6mTHT), and “T” agility. Participants performed the tests following randomly determined verbal instructions, which induced a neutral focus (NF - control condition), internal focus (IF), and external focus (EF). The EF resulted in more distant jumps in the SHT about the NF (p = 0.001) and the IF (p = 0.03). However, there were no differences between IF and NF (p = 0.41). In 6mTHT, NF and EF generated more agility when compared to IF (p = 0.001, p = 0.001, respectively). Between NF and EF, there was no difference (p = 1,000). The limb symmetry index was not influenced by the attentional focus in both jumping tests. In the agility “T” test, the NF generated more agility when compared to the EF (p = 0.01) and the IF (p = 0.001), with no difference between IF and EF (p = 0.07). The results of this study contribute to the formation of the scientific literature, demonstrating that a motor skill performed after ACL-R can be improved and influenced by attentional demands, which may imply an increase in performance in the tests used to assess readiness for RTS. In SR, our objective was to analyze the inclusion of biopsychosocial model domains in clinical practice guidelines (CPGs) for ER after R-LCA, as well as the quality of these guidelines. We performed the search strategy in the following databases: (1) Ovid/MEDLINE, (2) Embase, and (3) PEDro. In all, 715 records were found and 7 CPGs were included. The RTS criteria were evaluated according to the link rules already established and the CPGs were evaluated through the Appraisal of Guidelines for Research and Evaluation II (AGREE II Checklist). This study shows that CPGs do not satisfactorily include the domains of the biopsychosocial model, with an emphasis on the domains of body functions and activity, and participation. Thus, the model of human functioning advocated by the World Health Organization (WHO) has not been adequately incorporated into the recommendations for RTS after R-LCA. Furthermore, 71.42% of CPGs are of low or moderate quality. This fact emphasizes the need for the current literature to include the biopsychosocial model for the assessment and treatment of patients with ACL injuries since CPGs depend on the literature to compile recommendations. It is also necessary to increase the quality of the CPGs, since only two are of high quality, directly interfering with the risk of bias contained in the recommendations.