影响儿童和青少年前交叉韧带损伤后血流限制训练临床决策的因素
简介
一项针对147名物理治疗师的横断面调查显示，约55%的医生不会对儿童青少年ACL术后患者使用血流限制训练（BFRT），主要顾虑是患者耐受性（90%）；疼痛显著影响决策，仅19%的医生会在患者疼痛评分>6/10时使用BFRT。术后第4周是多数医生（97%）开始BFRT的常见时间点，但仅52%的医生有明确的停用标准。该研究提示，年龄、疼痛和术后时间是影响BFRT…
英文摘要
BACKGROUND: Research evaluating the effectiveness of blood flow restriction training (BFRT) in patients post anterior cruciate ligament (ACL) injury is growing, but the application of BFRT within clinical settings remains unknown. Understanding how BFRT is used in the pediatric and adolescent populations and what exercise prescription is followed is necessary to discern if there is concordance between research and clinical practice. HYPOTHESIS/PURPOSE: To describe the influence of patient clinical presentation on BFRT use in pediatric and adolescent patients after anterior cruciate ligament reconstruction. STUDY DESIGN: Cross-sectional survey study. METHODS: A web-based survey was sent to physical therapists (PTs) who treat pediatric and adolescent patients after ACL injury, via social media and email sent out by rehabilitation continuing education providers. Case vignettes were utilized to understand clinical decisions related to BFRT utilization. Descriptive statistics were utilized to summarize frequency of responses. RESULTS: One hundred forty-seven PTs fully completed the survey. Nearly half (55%) of participants indicated they would not use BFRT on younger patients, mostly out of concern for patient tolerance (90%). Pain impacted BFRT application for 71% of participants, with only 19% of clinicians using BFRT with patients reporting pain greater than 6/10. Postoperatively, participants were most likely to initiate BFRT at week 4 with this population (97%), while only 52% of participants indicated that they have defined criteria for discontinuing BFRT. CONCLUSION: Younger age, pain, and time from surgery influenced decision making. There were no consistent criteria utilized to determine proper timing to discontinue use of BFRT. These findings support the need for additional research to identify optimal BFRT application within common clinical scenarios, which will help standardize practice and support clinical decision making when utilizing BFRT in adolescents after ACL reconstruction. LEVEL OF EVIDENCE: 3.