● 09% for the single hop. ● 25% for the crossover hop. ● 02% for the triple hop. ● 12.96% for the 6-m timed hop.
as far as possible, landing on the same leg. The crossover hop is completed by the patient hopping three consecutive times on the same leg, alternately crossing over the 15-cm-wide strip on each hop with total distance forward measured. For the triple hop, the patient completes three consecutive hops on the same leg as far as possible in a linear direction, with total distance measured. The single hop, crossover hop, and triple hop must be completed with a controlled landing on the leg being tested without additional hops or assistance of the contralateral leg to achieve balance, or the trial is re-done. Figure 2: Single-Legged Hop Tests
To avoid risk of further injury, single-legged hop tests should not be completed if pain is present during in-place unilateral hopping, QI is less than 70% during preoperative or nonoperative rehabilitation, QI is less than 80% during postoperative rehabilitation, the patient is less than 12 weeks from the time of ACL reconstruction, or the modified stroke test grade of effusion is greater than a trace. Completion of single-legged hop tests allows determination of limb-to-limb differences in function, allows assessment of patient progress throughout rehabilitation, and provides useful information to direct patient intervention (Myer et al., 2010; Paterno, Myer, Ford, & Hewett, 2004). Recent evidence by Wellsandt and colleagues (2017) indicates that postoperative performance on single-legged hop tests and strength testing may be lower on the uninvolved limb compared to preoperative levels. Therefore, symmetry indexes comparing functional performance post- operatively may underestimate an individual’s performance relative to his or her preinjury status (Wellsandt et al., 2017) Participation restrictions Following ACL injury, many patients demonstrate decreased activity levels (Daniel et al., 1994; Fitzgerald, Axe, & Snyder- Mackler, 2000c; Grindem et al., 2012; Bell et al., 2017; Spindler et al., 2018). For patients undergoing ACL reconstruction, activity limitations often continue following surgery (Hartigan et al., 2010; Logerstedt et al., 2012). Furthermore, research indicates that individuals approximately 28 months after ACL reconstruction (range 6-67 months) spend less time in moderate- to-vigorous physical activity and take fewer daily steps compared to age-, sex-, and sporting activity-matched controls (Bell et al., 2017). Factors affecting activity level after initial ACL injury include knee pain, reduced knee ROM, decreased quadriceps strength, increased knee joint effusion, knee joint instability, patient-perceived decreased knee function, and fear of reinjury. Many patients decrease participation and intensity of activity levels to avoid episodes of giving way and further impairments, including pain and effusion (Eastlack et al., 1999; McCullough et al., 2012). However, some individuals demonstrate the ability to maintain their preinjury activity levels without instability (Daniel et al., 1994; Eastlack et al., 1999; Hurd, Axe, & Snyder-Mackler, 2008a; Snyder-Mackler, Fitzgerald, Bartolozzi, & Ciccotti, 1997). Individual assessment of each patient regarding participation restrictions is indicated to develop an individualized plan of care because patients present with varying impairments following ACL injury, concomitant injuries, preinjury activity levels, goals for return to activity levels, and responses to targeted intervention (Fitzgerald, Axe, & Snyder-Mackler, 2000c; Hartigan et al., 2010; Hurd, Axe, & Snyder-Mackler, 2008a). chronic conditions (Shapiro, Richmond, Rockett, McGrath, & Donaldson, 1996). It measures eight dimensions of health, including measures of physical function, role limitations because of physical problems, bodily pain, general health, vitality, social function, role limitations due to emotional problems, and mental health (Irrgang et al., 2001). Scores from the eight categories are combined to produce a physical and mental component, and the SF-36 is valid and reliable across its scales in a variety of diverse patient populations (McHorney, Ware, Rachel Lu, & Sherbourne, 1994). Within the ACL-injured population, the SF-36 can discriminate between acute and chronic injuries, because patients with acute ACL injuries score lower than those with chronic injuries, while both groups score significantly lower than norms for the general population (Shapiro et al., 1996). By assessing the general health of a patient, the SF-36 provides
Note . Reprinted with permission. ©2013, Elizabeth Wellsandt. The 6-m timed hop is completed by the patient hopping on one leg as fast as possible along the 6-m distance. Using a stopwatch, the examiner measures the time from when the patient’s heel leaves the ground to the time the 6-m mark is reached. Each hop test is completed on the uninvolved limb first, with two practice trials of each hop test completed prior to the two measured trials to ensure understanding of the task and decrease anxiety about hopping on the injured limb. The score for each hop test is assessed by calculating the average of the two measured trials. Hops are completed on each leg to calculate inter-limb differences. The single hop, crossover hop, and triple hop are calculated as a ratio of the involved limb’s mean distance over the uninvolved limb’s mean distance, multiplied by 100. The timed hop is calculated as a ratio of the uninvolved limb’s mean time over the involved limb’s mean time, multiplied by 100. All four single-legged hop tests are valid and reliable (Reid et al., 2007; Ross, Langford, & Whelan, 2002). Minimal detectable change indexes after ACL reconstruction have been reported that enable clinicians to assess whether hop scores calculated at two different time points likely represent a true change in patient function or whether they may be due to measurement error. These are as follows (Reid et al., 2007; Ross, Langford, et al., 2002): Patient-reported outcomes Patient-reported outcome measures are an important component in providing effective care following ACL injury and reconstruction because self- report of current perceived function and activity levels assists in developing functional, patient- directed goals and establishing an individualized plan of care. Patient-reported outcome measures can also be used to monitor progress throughout the rehabilitative process. Although many patient-reported outcome measures exist, including general health questionnaires, knee-specific questionnaires, and activity scales, it is important to understand what each measure is evaluating in order to choose the most appropriate and relevant measures for a patient following ACL injury. General health questionnaires The Medical Outcomes Study Short Form-36 (SF-36) is a general measure of health status used for both acute and
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