在撕裂与重返之间：前交叉韧带重建康复过程中四种声音的前瞻性叙事分析
简介
本研究采用前瞻性叙事分析方法，纵向追踪4名（20-29岁，2男2女）前交叉韧带（ACL）重建患者的康复历程，从受伤至达成自定康复目标，通过多次半结构化访谈（伤后、术前、术后早期及每2个月一次）收集数据。关键发现：康复并非线性过程，而是身份认同、情绪和意义不断演变的动态叙事——患者经历了从无助到重建运动身份、从单调康复到团队回归、从二次ACL损伤后重新设定优先…
英文摘要
IMPORTANCE: Anterior cruciate ligament (ACL) injury is a common sports injury with substantial physical and psychological consequences. Qualitative studies have explored patient experiences, but most use cross-sectional designs, limiting insight into how experiences evolve throughout rehabilitation. OBJECTIVE: The purpose of this study was to explore patients' experiences of ACL injury and recovery using a prospective, narrative approach, from injury to achievement of self-defined rehabilitation goals. DESIGN: This was a longitudinal qualitative study with narrative analysis. SETTING: The study was conducted at an outpatient sports rehabilitation clinic in Sweden. PARTICIPANTS: Four adults (ages 20 to 29 years; 2 male, 2 female) undergoing ACL reconstruction were included using consecutive sampling. INTERVENTION(S) OR EXPOSURE(S): Serial one-to-one semi-structured interviews were conducted around injury, pre-surgery, early post-surgery, and every 2 months until each participant achieved a rehabilitation goal defined at study entry. Interviews were analyzed using Narrative Oriented Inquiry with attention to story structure, tone, positioning, and context. MAIN OUTCOME(S) AND MEASURE(S): The main outcome were the evolving narratives of participants' recovery experiences, expressed through first-person interpretative stories. RESULTS: The longitudinal narratives revealed shifting identities, emotions, and meanings attached to rehabilitation milestones. One participant described moving from helplessness to renewed athletic identity; another portrayed a pragmatic recovery marked by monotony and team reintegration; a third experienced progress until a second ACL injury reframed priorities; and the fourth navigated prolonged knee pain, missed timelines, and gradual acceptance. Across cases, rehabilitation was experienced not as a linear sequence but as an ongoing negotiation of trust, belonging, and confidence. CONCLUSIONS AND RELEVANCE: Prospective narrative inquiry illuminated how recovery after ACL reconstruction is lived as a personal, evolving story. For physical therapists, recognizing the temporal dynamics of identity, trust, and confidence may support more individualized rehabilitation, complementing standardized protocols. These findings highlight the importance of attending to both physical and narrative dimensions of ACL recovery in clinical practice.