Motor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS): Integrating Dynamic Motor Imagery in Current Treatment of Knee Injury

Traumatic knee injury is common in physical activity that includes jumping and cutting movements, and most commonly include anterior cruciate ligament (ACL) or meniscus injuries. Surgical or non-surgical intervention strategies may be chosen, but treatment will include a physical-therapist led physical training program. The aim of this training is to strengthen and stabilize the knee. Despite receiving best-practice treatment, many are unable to return to their pre-injury activity level. Recent research has suggested that this may be explained, in part, by psychological factors such as fear of re-injury or lack of confidence. In addition to physical treatment, guidelines include recommendations to address psychological factors. The detail of how this can be done is lacking, and the extent to which psychological variables are adequately addressed is questionable. In response to this gap, we have developed the novel Motor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS) model, which integrates psychological training into physical rehabilitation protocols using a dynamic motor imagery intervention. MOTIFS increases realism and relevance while simultaneously physically and psychologically simulating activity-specific and individualized rehabilitation exercises. The aim of this thesis is therefore to develop and explore the efficacy of the MOTIFS model in physically and psychologically preparing knee-injured people for return to activity compared to care-as-usual rehabilitation. The primary hypothesis of this thesis is that the MOTIFS model will provide greater effects on patient-relevant outcomes and muscle function than current programs. In a first step, the effect of MOTIFS model on enjoyment and other self-reported outcomes was evaluated in a cross-over study (Paper I) in which uninjured people underwent training according to both MOTIFS and care-as-usual training protocols. Next, a protocol detailing an ongoing randomized controlled trial (Paper II) which will compare 12 weeks of MOTIFS and care-as-usual training in terms of psychological readiness to return to activity and functional performance. Finally, two interview studies were conducted in which physical therapists (Paper III) and Patients (Paper IV) in both MOTIFS and care-as-usual groups were interviewed about the experiences of rehabilitation training following traumatic knee injury.Results of this thesis show that the MOTIFS model has the potential to increase enjoyment of knee injury prevention and treatment exercises. Other self-reported outcomes were also improved, and the MOTIFS model does not seem to sacrifice movement quality, indicating that it is possible to modify exercises by integrating a dynamic motor imagery intervention. Results of the interview study with physical therapists indicates that those in the MOTIFS group perceive a greater focus on psychological factors while using the new training model, and believe that it is an effective method of increasing patient readiness to return to activity. Those in the care-as-usual group described their perception of rehabilitation training as having a mainly physical focus. They expressed a desire for more tools to address psychological factors, as they perceived patient reactions to be psychological in nature and felt they were ill equipped to handle these factors. Patients in the MOTIFS group perceived MOTIFS to be meaningful and a positive method of increasing their readiness to return to sport, owing to early exposure to activity, which helps them to feel that they have longer to prepare for their return. Those in the care-as-usual group perceive a lack of psychological focus, and their success was measured in terms of their physical progress through rehabilitation. Results indicate that the MOTIFS model may be a feasible and clinically implementable method of addressing psychological factors in rehabilitation training. As the randomized controlled trial is still ongoing, no conclusions can be drawn regarding the efficacy of the intervention on rehabilitation outcomes. However, given the results of Papers I, III and IV, it seems a promising start to bridge the gap between physical and psychological rehabilitation outcomes

Lived experiences of physical therapists treating traumatic knee injury using integrated psychological training (MOTIFS): a qualitative interview study

BackgroundThe novel Motor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS) training model, which began development in 2018, integrates psychological training into physical rehabilitation in knee-injured people.ObjectiveThis qualitative interview study aims to understand, interpret, and describe how physical therapists perceive using the MOTIFS Model.MethodsOne-on-one semi-structured interviews were conducted with six physical therapists familiar with the MOTIFS model and eight with experience with care-as-usual training only, analyzed using Interpretive Phenomenological Analysis.ResultsTwo major themes were generated in the MOTIFS group: 1) “MOTIFS increases psychological focus during rehabilitation training”; and 2) “Care-as-Usual training is mainly physical, and lacks the necessary psychological focus.” Physical therapists perceived structured methods of addressing psychological factors, such as using imagery to influence patients’ motivation, fear, and preparation for return to activity. Three major themes were generated in the Care-as-Usual group: 1) “Rehabilitation is mainly to restore physical function”; 2) “Rehabilitation training includes a biopsychosocial interaction”; and 3) “Psychological factors are important to address, but strategies are lacking.”ConclusionPhysical therapists perceive MOTIFS as a method of consciously shifting perspective toward an increased focus on psychological factors in knee-injury rehabilitation. Results indicate that a training model with integrated psychological strategies to create more holistic rehabilitation may be beneficial

A new lower Cambrian eodiscoid trilobite fauna from Swedish Lapland and its implications for intercontinental correlation

A lower Cambrian eodiscoid trilobite fauna and an associated holmiid trilobite, Holmia sp., are described from a bioclastic limestone at the top of the Tornetr¨ask Formation in the Luob´akti section, south of Lake Tornetr¨ask, northern Sweden. Other associated polymerid trilobites include Orodes? lapponica and Strenuaeva inflata. The precise age of the trilobite fauna cannot be determined, but its generic composition and stratigraphical position at the top of the lower Cambrian suggest that it was recovered from the Ornamentaspis? linnarssoni Assemblage Zone. Two species of eodiscoids are present: Neocobboldia aff. dentata and Chelediscus acifer. The latter species is known previously from England and southeastern Newfoundland, and provides a novel link between upper lower Cambrian successions in Baltica and Avalonia

Lived experiences of patients undergoing treatment for traumatic knee injury using integrated psychological training (MOTIFS) in the context of care-as-usual training : a phenomenological interview study

The objective was to increase understanding of how knee-injured people make sense of using the Motor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS) training intervention. This model integrates structured psychological skills training into existing care-as-usual (CaU) rehabilitation protocols. To better understand patients' lived experiences of MOTIFS, it was necessary to understand those of CaU training. Interviews were conducted with five people undergoing knee-injury rehabilitation according to the MOTIFS model, as well as seven receiving treatment according to CaU. Interpretive phenomenological analysis was used to explore patients' lived experiences. Results indicate that patients in the MOTIFS group perceive individualised meaning and sport relevance in their rehabilitation training. Imagery is perceived to be a concrete strategy that can be difficult, but encourages a biopsychosocial interaction to improve confidence, motivation, enjoyment and sport-relevant context, thereby aiding in physically and psychologically preparing patients for return to activity. CaU training is discussed in terms of physical factors, though patients identify psychological factors as important, perceiving a lack of focus on this, resulting in inadequate psychological readiness to return to activity. In conclusion, the MOTIFS model is perceived as focusing more on psychological factors in rehabilitation, helping to develop coping strategies and physically and psychologically prepare for return to activity. Patients in the CaU group perceive rehabilitation training as restoring strength and function, but lack structured psychological strategies to aid in return to activity preparation

Patient-Reported Outcomes but not Demographic Factors Predict Normal Muscle Function 2-5 Years After ACL Injury: A Cross-Sectional Study

Patient-reported outcomes but not Demographic Factors Predict Normal Muscle Function 2-5 Years After ACL Injury: A Cross-Sectional StudyNiklas Cederström1, Ewa Roos2, Eva Ageberg1(1)Musculoskeletal Function Research Group, Department of Health Sciences, Faculty of Medicine, Lund University(2)Institute of Sport Science and Clinical Biomechanics, Musculoskeletal Function and Physiotherapy, University of Southern DenmarkPurpose:The purpose of this cross-sectional cohort study was to examine associations of patient-reported outcomes and demographic factors with muscle function mean 3 years after anterior cruciate ligament (ACL) injury or reconstruction.Methods:Fifty-four patients were measured to determine whether knee strength and hop test scores from the injured knee had reached 90% of the uninjured knee (Ageberg, Thomeé et al. 2008). Age, gender, body mass index (BMI), activity level (Tegner Activity Scale [TAS]), and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were analyzed using simple and multiple logistic regressions to determine their association with limb symmetry indices (LSIs) at mean 3.2 (SD 0.85) years post-injury. Results:Simple logistic regressions indicate that activity level (p = .02) and the KOOS subscale Quality of Life (QOL; p = .02) were significantly associated with a normal knee extension LSI. Vertical jump showed significant odds ratio increases of 4-15% for all KOOS subscales, and 42% for TAS (p = .03). Side-hop tests indicated a 3% increase for both function - sport and recreational activities (Sport/Rec; p = .02) and QOL (p = .03). KOOS variables were strongly correlated to one another, and weakly correlated to activity level and BMI. Conclusions:Better self-reported outcomes were associated with normal function in knee extension, vertical jump, and side-hop tests 2-5 years after ACL injury. However, biological demographic variables were not associated with normal muscle function. This lack of biological causation counters previous research (Ardern, Webster et al. 2011) and supports the need for future research into the psychology of ACL injury rehabilitation outcomes.References:Ageberg, E., R. Thomeé, C. Neeter, K. G. Silbernagel and E. M. Roos (2008). "Muscle strength and functional performance in patients with anterior cruciate ligament injury treated with training and surgical reconstruction or training only: A two to five-year followup." Arthritis & Rheumatism: Arthritis Care & Research 59(12): 1773-1779.Ardern, C. L., K. E. Webster, N. F. Taylor and J. A. Feller (2011). "Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play." British Journal of Sports Medicine 45(7): 596-606. Contact:[email protected]