Associate Professor Gisela Sole has developed an impressive body of research work in the area of ACL research.
We talked to her about her interests in the area and the work of her students.
What sparked your interest in this area of research?
I worked in a South African hospital in the mid-1980’s when auto-grafts replaced carbon fibres, and rehabilitation was extremely conservative. This can lead to significant thigh weakness, often accompanied with permanent loss for full knee extension.
Over the years, accelerated rehabilitation and improved surgical procedures allowed individuals to regain function and return to sports and occupation sooner. But the paradox is that there are now emerging findings that earlier return to sports may be one of the risk factors for osteoarthritis. Rehabilitation appears to become more conservative again in terms of readiness for return to sports.
My interest emanates from clinical practice, guiding many patients through their recovery, and following the changes in management over the years.
Why is this physiotherapy research important?
ACL injuries affect the individual person in terms of recreation, sports and occupation, and their psychosocial well-being and quality of life. While for some, the changes are protracted yet temporary, for others, impairments and disability linger for many years.
Long term health costs associated with osteoarthritis and health conditions due to decreased physical activity also need to be considered.
We need to explore strategies to optimise management and long term well-being of those individuals. Besides considering the outcomes of the injury, research in this field is important as it provides the opportunity to explore risk factors for OA in an ‘accelerated’ time-frame.
You have mentored a number of undergraduate and graduate researchers working on ACL projects. Can you tell us a bit more about the project students have worked on and the value this brings to ACL research.
We initially explored physiotherapists’ and patients’ perspectives of ACL rehabilitation using qualitative research:
Arlene von Aesch [BPhty (Hons) 2014] found that physiotherapists were passionate and enthusiastic about their work with such patients, clearly seeking evidence-informed strategies. They also described playing large role in the psychosocial well-being of their patients, yet feeling that they had not received formal training in this sphere.
Sarah Scott [BPhty (Hons) 2015] found that patients with ACL ruptures described their ‘journey’ as ‘long and arduous’, considering it to be a significant and life-changing event.
Her findings were supported by those of Mandeep Kaur (PhD candidate) who explored patients’ perspectives more than 2 years following their ACL rupture. Her study described the changing levels of fear of re-injury versus confidence, that persisted as long as 10 years post-rupture.
This year (2018) Ciaran Mahood will explore strategies used by athletes who have successfully returned to their sports.
Concurrently over the past 4 years, Mandeep Kaur and I have used biomechanical studies to explore long term outcomes in terms of muscle strength and movement patterns, in addition to patient reported outcomes. Our findings reflect those of concurrent international research, namely, that long-term persistence of impairment and disability is of concern.
Where to next for ACL research?
In most cases, early rehabilitation of ACL ruptures, both non-surgically and surgically-managed, is guided by well-defined protocols and progressive clinical criteria. We will be exploring clinical strategies relevant for individuals who may not have progressed according to the clinical criteria following the first few months of rehabilitation. A multi-factorial approach is needed, considering biopsychosocial dimensions.
Exciting new opportunities exist: for example, Hannah Fox (MPhty student) is currently scoping the literature on the potential role of virtual reality as part of rehabilitation. For some individuals, rehabilitation may include changed priorities in life to accommodate their long-term knee health.
We already have inter-disciplinary involvement with colleagues from the Department of Anatomy and School of Physical Education, Sports and Exercise Sciences.
Further collaboration with clinicians, orthopaedic surgeons, funders (such as ACC), sporting bodies and other stakeholders are needed. Overall, we will focus on optimising rehabilitation in the mid- and long-term with the goal of minimising risk for OA and continued disability
To learn more about about ACL research, including Dr Meredith Perry's research in ACL and netball, visit our dedicated ACL research page.