Stress Response to Virtual Risky Movement Exposure and Kinesiophobia After Anterior Cruciate Ligament (ACL) Surgery

Stress Response to Virtual Exposure to Risky Movements After Anterior Cruciate Ligament (ACL) Rehabilitation and Its Relationship With Kinesiophobia

In this study, patients who have completed their rehabilitation after Anterior Cruciate Ligament (ACL) reconstruction surgery will be examined with physiological stress response test while being exposed to risky athletic movements via virtual reality headsets. In the next, step patients' functional performance tests will be examined and their relation with stress responses will be examined.

Study Overview

• Status: Recruiting
• Conditions: Anterior Cruciate Ligament Injuries; Kinesiophobia

• Study Type: Observational
• Enrollment (Estimated): 62

Contacts and Locations

• Study Contact: Name: Ogun Koyagasioglu, MD; Phone Number: +90 232 390 23 78; Email: ogunkoyagasioglu@gmail.com

Study Locations

• Turkey
  • İzmir, Turkey, 35100
    • Recruiting
    • Ege University Faculty of Medicine
    • Contact: Ogün Köyağasıoğlu; Phone Number: 02323902378; Email: ogunkoyagasioglu@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Probability Sample

Study Population

Study group consists of subjects who had ACL reconstruction surgery and willing to return to sports activities.

Description

Inclusion Criteria for Study Group:

• 18 years or older
• Male gender
• Having history of isolated unilateral ACL reconstruction surgery
• Physician clearance for unrestricted physical activity after having at least 6-months of rehabilitation following surgery
• Willing to return to sports that require cutting and landing motions
• Not having any sports injuries past three months
• Not having any previous orthopaedic surgery other than ACL reconstruction surgery

Inclusion Criteria for Control Group:

• 18 years or older
• Male gender
• Playing sports that require cutting and landing motions
• Physician clearance for unrestricted physical activity
• Not having any sports injuries past three months
• Not having any previous orthopaedic surgery

Exclusion Criteria for Study Group:

• Having a reinjury during rehabilitation
• Having multiple ligament injuries before the surgery
• Diagnosed with knee osteoarthritis
• Diagnosed with knee cartilage injury
• Diagnosed with meniscus tear

Exclusion Criteria for Control Group:

• Diagnosed with ACL injury
• Diagnosed with knee osteoarthritis
• Diagnosed with knee cartilage injury
• Diagnosed with meniscus tear

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Study Group; Study group will be examined for outcome measurements.
Control Group; Control group will be examined for outcome measurements.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Subjective Kinesiophobia Status - Anterior Cruciate Ligament - Return to Sport after Injury (ACL-RSI) scale	ACL-RSI scale evaluates psychological readiness to return to sports participation after ACL reconstruction and has items related to fear of reinjury/accidental injury during sport activities. The scale contains 12 questions and each question is scored from 0 to 100 in 10-point increments according to the visual analog scale. The scale score is calculated by adding the scores from all 12 questions and dividing by 12. A high score on the scale indicates a positive psychological response.	From 0 to 6 months
Physiological Stress Responses - Heart Rate Variability (HRV) Metrics	Metrics will be measured with Shimmer 3 GSR Development and Consensys GSR Development Kit. Low Frequency (LF), High Frequency (HF), Low Frequency to High Frequency ratio (LF/HF), root mean square of successive differences (RMMSD) will be measured from participants while watching stress evoking videos. Metrics will be measured according to the Task Force guidelines in 1996. RMSSD reflects the integrity of vagus nerve-mediated autonomic control of the heart, HF reflects parasympathetic activity, and LF is proportional to sympathetic activity but influenced by parasympathetic tone. LF/HF reflects sympathetic activity dominancy over parasympathetic activity.	From 0 to 6 months
Physiological Stress Responses - Galvanic Skin Response (GSR) Metrics	Metrics will be measured with Shimmer 3 GSR Development and Consensys GSR Development Kit. Skin conductance response (SCR) will be measured from participants while watching stress evoking videos. SCR is the measurement of the electrical conductivity of the skin and represents the activation of sweat glands in response to a particular stressor stimuli.	From 0 to 6 months
Functional Tests Landing Error Scoring System (LESS) score	Participants will be tested for their landing with a standardized jump-landing from a box task. Subjects will jump down from the box and land on the ground and then immediately jump vertically upward as high as possible. We will rate for every participant by observing in both the sagittal and the frontal plane of jump- landing technique while the subject was in contact with the ground after landing from the box. Scoring will be made as "No" (0 points) and "Yes" (1 point) for Items 1-15. For Item16, it will be evaluated as "Excellent" (0 points), "Average" (1 point) and "Hard" (2 points). For item 17, "Excellent" (0 points), "Average" (1 point) and "Bad" (2 points). The total score of 17 items will be evaluated. The higher the score obtained from the test result, the worse the jump landing. LESS scores will be interpreted in four different categories: excellent (LESS score <4), good (4<LESS score ≤5), moderate (5<LESS score ≤6), and poor (LESS score >6).	From 0 to 6 months
Functional Tests - Hop tests (single legged)	Participants will be tested for leg hop tests which described in the literature by Ross et al. 2002. >10% difference between tested legs will be considered as asymmetry. Single Hop for Distance. Subjects will be instructed to hop as far as possible forward and land on the same leg. The distance from the starting line to the point where the subject is landed will be measured. Triple Hop for Distance. Subjects will be instructed to take 3 maximal hops forward with the designated leg. The distance from the starting line to the point where the subject is landed will be measured. Crossover Hop for Distance. Subjects will be instructed to take 3 maximal hops while crossing over a line each time. The distance from the starting line to the point where the subject is landed will be measured. Six Meter Hop for Time. Subjects will be instructed to hop 6m distance as quickly as possible with the designated leg. Time will be measured from start to the time the subject crossed the finish line.	From 0 to 6 months
Functional Tests - T-test	For each participant, a running t test will be performed, which will evaluate their agility during running with changes of direction. Participants will be asked to run forward for 10 m, then change to side-steps to the right for 5 m, then 10 m of side-steps to the left, followed by 5 m of side- steps to the right, ending with 10 m of backwards running. Three repetitions will be performed at maximum speed and the average time for the three repetitions will be calculated. Completing the test in less than 11 seconds will be classified as high agility, and finishing in 11 seconds or more will be classified as low agility.	From 0 to 6 months

Collaborators and Investigators

• Sponsor: Ege University

Study record dates

Study Major Dates

• Study Start (Actual): July 15, 2023
• Primary Completion (Estimated): March 15, 2024
• Study Completion (Estimated): June 15, 2024

Study Registration Dates

• First Submitted: June 15, 2023
• First Submitted That Met QC Criteria: June 26, 2023
• First Posted (Actual): July 3, 2023

Study Record Updates

• Last Update Posted (Actual): November 8, 2023
• Last Update Submitted That Met QC Criteria: November 7, 2023
• Last Verified: November 1, 2023

More Information

Terms related to this study

• Keywords: Anterior Cruciate Ligament Injuries; Stress; Virtual Reality; Athlete; Kinesiophobia; Sports Medicine
• Additional Relevant MeSH Terms: Mental Disorders; Wounds and Injuries; Leg Injuries; Anxiety Disorders; Knee Injuries; Phobic Disorders; Anterior Cruciate Ligament Injuries; Kinesiophobia
• Other Study ID Numbers: 22-12.2Tl31

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No