Abstract
IMPORTANCE: In Australia, few people with acute anterior cruciate ligament (ACL) rupture are managed with rehabilitation alone despite clinical trials demonstrating similar outcomes to ACL reconstruction (ACLR). The reasons for the low uptake of rehabilitation alone for the treatment of acute ACL rupture in Australia are unclear. OBJECTIVES: The objectives of this study were to evaluate physical therapists' beliefs and the information they provide to patients about treatment options for ACL rupture, and to explore ACL rupture treatment decision-making from the perspective of physical therapists. DESIGN: The design was a mixed-methods convergent parallel design comprising an Australia-wide survey (n = 246) and semi-structured interviews (n = 10). PARTICIPANTS: Participants included physical therapists who manage people with ACL rupture in Australia. MAIN OUTCOMES: The survey contained 41 items that assessed demographics, treatment of ACL rupture, referral pathways, treatment beliefs, and the information provided to patients with ACL rupture. RESULTS: Physical therapists' beliefs about treatment options varied and did not always reflect the information they provided to patients. Although 60% agreed that ACLR and rehabilitation-alone result in similar outcomes on average, only 37% reported regularly informing patients about this. To return to pivoting/contact sport, 23% believed that ACLR was required and 79% informed patients that ACLR was the best treatment to do so. Physical therapists felt that rehabilitation-alone is underutilized as a treatment for ACL rupture. Physical therapists encountered barriers to offering and providing rehabilitation-alone for ACL rupture, reflected in 7 qualitative themes: preference for surgery reflecting societal beliefs; more weight given to surgeon's opinion; unbalanced information from surgeon; referral pathways; uncertain recovery timeline; beliefs about treatment suitability; and knowledge and experience. CONCLUSIONS: Physical therapists had mixed beliefs about treatment options and the information provided to patients was not always evidence based. Physical therapists felt that nonsurgical management was underutilized, and experienced barriers to offering and providing non-surgical management of ACL rupture in clinical practice. RELEVANCE: Informed decision-making can only occur if accurate, evidence-based information about ACL rupture treatment options is provided to patients. These findings may be used to guide professional development for physical therapists and inform strategies to improve evidence uptake by physical therapists.