Mental Imagery to Improve Quadriceps Strength Post Anterior Cruciate Ligament Reconstruction: a Feasibility Study

Mental Imagery of Open and Closed Chain Exercises to Improve Quadriceps Strength Post Anterior Cruciate Ligament Reconstruction: a Feasibility Study

The goal of this clinical trial is to understand if people recovering from anterior cruciate ligament reconstruction (ACLR) surgery will complete mental imagery training and if this will improve their injured leg's strength. The main questions are:

• Will people complete a five-day mental imagery exercise schedule while in physical therapy for ACLR?
• Does mental imagery exercise help raise leg strength during ACLR recovery? Researchers will also compare if different mental imagery exercises involving leg extension or squats will change leg strength.

Participants will be asked to:

• Participate in two testing sessions to make measurements of leg function
• Complete about 10 minutes of mental imagery exercises once per day for five days at home and write down whether they complete the exercises.

Study Overview

• Status: Recruiting
• Conditions: Anterior Cruciate Ligament Reconstruction
• Intervention / Treatment: Behavioral: Mental Imagery Open Chain; Behavioral: Mental Imagery Closed Chain

• Study Type: Interventional
• Enrollment (Estimated): 20
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Allison S Hyngstrom, PT, Ph.D.; Phone Number: 4142884566; Email: allison.hyngstrom@marquette.edu

Study Locations

• United States
  • Wisconsin
    • Milwaukee, Wisconsin, United States, 53233
      • Recruiting
      • Marquette University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• post anterior cruciate ligament reconstruction (ACLR) surgery
• cleared to participate in physical therapy
• currently in physical therapy related to ACLR

Exclusion Criteria:

• greater than 9 months post ACLR surgery
• history of lower back of hip pain that would limit lower limb motor testing
• current neurological condition that limits muscle strength
• history of substance abuse in the last 5 years
• any uncontrolled medical condition
• inability to follow 2-step commands

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Mental Imagery Open Chain; Participants will receive a paper packet with instructions to imagine themselves performing seated maximal leg extension exercises. They will be instructed to imagine the feeling of the exercise for 5 seconds, rest for 5 seconds, and repeat this 50 times with a 2-minute rest period after the 25th repetition. They will also be asked to keep track of the exercises with tallies on a table within the packet and also to record on this table if they did not complete the exercises for that day. The participant is asked to perform the exercises on five consecutive days.	Behavioral: Mental Imagery Open Chain; Participants will receive a paper packet with instructions to imagine themselves performing seated maximal leg extension exercises. They will be instructed to imagine the feeling of the exercise for 5 seconds, rest for 5 seconds, and repeat this 50 times with a 2-minute rest period after the 25th repetition. They will also be asked to keep track of the exercises with tallies on a table within the packet and also to record on this table if they did not complete the exercises for that day. The participant is asked to perform the exercises on five consecutive days.
Experimental: Mental Imagery Closed Chain; Participants will receive a paper packet with instructions to imagine themselves performing maximal standing squat exercises. They will be instructed to imagine the feeling of the exercise for 5 seconds, rest for 5 seconds, and repeat this 50 times with a 2-minute rest period after the 25th repetition. They will also be asked to keep track of the exercises with tallies on a table within the packet and also to record on this table if they did not complete the exercises for that day. The participant is asked to perform the exercises on five consecutive days.	Behavioral: Mental Imagery Closed Chain; Participants will receive a paper packet with instructions to imagine themselves performing maximal standing squat exercises. They will be instructed to imagine the feeling of the exercise for 5 seconds, rest for 5 seconds, and repeat this 50 times with a 2-minute rest period after the 25th repetition. They will also be asked to keep track of the exercises with tallies on a table within the packet and also to record on this table if they did not complete the exercises for that day. The participant is asked to perform the exercises on five consecutive days.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Feasibility of Intervention	At the end of the paper packet with instructions for mental imagery exercises, there will be a survey in which participants will record whether or not they have completed the exercises. They will be instructed to fill out this form each day even if they have not done the exercise. Investigators will assess how many days participants complete the exercises.	Once per day for 5 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Knee Extension Strength	Maximal voluntary isometric contractions (MVICs) of the knee extensors will be conducted while the participant is seated in a Biodex Dynamometer and secured with waist and trunk straps. This will involve the participant kicking as hard as they can over 2-5 seconds. Participants will be verbally encouraged to achieve maximal force, and they will be able to see a monitor with visual instruction. Participants will be provided at least 60 seconds of rest between trials, and 5 trials will be performed. If the fifth trial produces a force more than 5% greater than any other trial, additional trials may be performed.	Pre and post 5 days of mental imagery intervention

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Walking speed	Participants will be asked to complete the Ten Meter Walk Test which assesses self-selected and fast walking speed over the middle 6 meters of a 10-meter distance. They will walk at their self-selected and fast walking speed 3 times each over the 10-meter distance, and average speeds will be calculated.	Pre and post 5 days of mental imagery intervention
Knee range of motion	Active and passive range of motion for knee extension and flexion.	Pre and post 5 days of mental imagery intervention

Collaborators and Investigators

• Sponsor: Marquette University

Study record dates

Study Major Dates

• Study Start (Actual): February 14, 2025
• Primary Completion (Estimated): January 28, 2026
• Study Completion (Estimated): January 28, 2026

Study Registration Dates

• First Submitted: February 27, 2025
• First Submitted That Met QC Criteria: February 27, 2025
• First Posted (Actual): March 25, 2025

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: March 5, 2025
• Last Verified: February 1, 2025

More Information

Terms related to this study

• Keywords: knee; physical therapy; strength; Mental Imagery
• Other Study ID Numbers: HR-4875

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data (IPD) will not be shared. The investigators in this study plan to publish future findings in scientific journals and/or presentations.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No