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

BACKGROUND: The 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. OBJECTIVE: This qualitative interview study aims to understand, interpret, and describe how physical therapists perceive using the MOTIFS Model. METHODS: One-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. RESULTS: Two 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." CONCLUSION: Physical 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.

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. This study is part of the MOTIFS randomised controlled trial (clinicaltrials.gov registration: NCT03473821).

Cocreating injury prevention training for youth team handball: bridging theory and practice.

Although it is advocated that end-users are engaged in developing evidence-based injury prevention training to enhance the implementation, this rarely happens. The 'Implementing injury Prevention training ROutines in TEams and Clubs in youth Team handball (I-PROTECT)' uses an ecological participatory design incorporating the perspectives of multiple stakeholders throughout the project. Within the I-PROTECT project, the current study aimed to describe the development of holistic injury prevention training specifically for youth handball players through using knowledge from both end-users (coaches and players) and researchers/handball experts. Employing action evaluation within participatory action research, the cyclical development process included three phases: research team preparation, handball expert-based preparation and end-user evaluation to develop injury prevention training incorporating both physical and psychological perspectives. To grow the knowledge of the interdisciplinary research team, rethinking was conducted within and between phases based on participants' contributions. Researchers and end-users cocreated examples of handball-specific exercises, including injury prevention physical principles (movement technique for upper and lower extremities, respectively, and muscle strength) combined with psychological aspects (increase end-user motivation, task focus and body awareness) to integrate into warm-up and skills training within handball practice. A cyclical development process that engaged researchers/handball experts and end-users to cocreate evidence-based, theory-informed and context-specific injury prevention training specifically for youth handball players generated a first pilot version of exercises including physical principles combined with psychological aspects to be integrated within handball practice.

Motor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS) after traumatic knee injury: study protocol for an adaptive randomized controlled trial.

BACKGROUND: Treatment following traumatic knee injury includes neuromuscular training, with or without surgical reconstruction. The aim of rehabilitation is to restore muscle function and address psychological factors to allow a return to activity. Attention is often on rehabilitation of knee function, but deficiencies often persist. Specific interventions addressing psychological factors are sparing with varying degrees of success. We have developed a novel training program, MOTor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS), which integrates simultaneous psychological training into physical rehabilitation exercises. The MOTIFS model individualizes rehabilitation to increase central nervous system involvement by creating realistic and relevant mental images based on past experiences. We hypothesize that a 12-week MOTIFS training intervention will improve psychological readiness to return to activity and muscle function to a greater extent than current neuromuscular training (Care-as-Usual). METHODS: This pragmatic 1:1 single assessor-blinded adaptive cumulative cluster-randomized controlled trial will include 106 knee-injured people with a goal of returning to physical activity. Participants are randomized to either the MOTIFS or Care-as-Usual condition. Primary outcomes are the ACL Return to Sport after Injury Scale and change in injured leg hop performance in a side hop task from baseline to 12 weeks. Secondary outcomes include patient-reported outcomes and assessment of muscle function using a hop test battery and Postural Orientation Errors at 12-week follow-up. At 12-month follow-up, patient-reported outcomes are assessed. A sub-group (7-10 in each group) will be interviewed to gain insight into experiences of rehabilitation. DISCUSSION: Strengths of this trial include that it is a randomized and pragmatic trial examining commonly under-studied aspects of rehabilitation following a knee injury. The model uses the patient as a reference, creating simultaneous psychological and physical training exercises with easily adopted principles for clinical practice. Limitations include that blinding is limited due to study design, and shifting the clinical paradigm to a more holistic model is a challenge. If successful, the MOTIFS model has implications for a clinically useful, individualized, and patient-relevant method of improving rehabilitation outcomes by integrating psychological training into physical training. TRIAL REGISTRATION: ClinicalTrials.gov NCT03473821 . Registered March 22, 2018, with ethical approval that has been granted (Dnr 2016/413, Dnr 2018/927). TRIAL STATUS: Trial Status: Protocol Version is 2020, Dec 10 - Version 1.

Effect of motor imagery on enjoyment in knee-injury prevention and rehabilitation training: A randomized crossover study.

OBJECTIVES: The novel MOTor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS) model takes a uniquely holistic approach by integrating mental and physical aspects into current training programs. The aim of this trial was to evaluate enjoyment of MOTIFS training as compared to Care-as-Usual (CaU) knee injury and/or rehabilitation training. The primary hypothesis was that enjoyment would be greater following MOTIFS training than CaU training. DESIGN: Block-randomized 2×2 cross-over trial. METHODS: Thirty athletes (18-31years, 50% women) currently or previously active in team ball sports, with no pain or injury preventing jump and/or directional changes. MOTIFS training integrates sport-specific experiences and equipment into physical exercises to increase individualized realism and meaning. The CaU condition included solely physical exercise. The main outcome was the Physical Activity Enjoyment Scale (PACES). Secondary outcomes included Self-Assessment Manikin (SAM; subscales Valence, Arousal, Dominance), Perceived exertion, pulse, duration, and movement quality. RESULTS: PACES scores were better following MOTIFS training than CaU (point estimate 24.67; 95% CI: 19.0; 30.3). Between-groups differences in SAM Valence (median 2, quartiles 1;3), Arousal (median 1, quartiles 0;2.25), and Dominance (median 0.5, quartiles 0;2), and RPE (median 1, quartiles -0.3;2), training duration (mean 5.34, 95% CI: -0.17; -0.73), and pulse (median 7.50, quartiles 0.25;16.75) were higher following MOTIFS training than CaU training. CONCLUSIONS: Results suggest that the MOTIFS model, which integrates simultaneous physical and psychological interventions, is a clinically plausible method of influencing enjoyment and other psychological outcomes. Further studies may explore effects of the MOTIFS principles on injury prevention and rehabilitation training.

Stress Levels Escalate When Repeatedly Performing Tasks Involving Threats.

Police work may include performing repeated tasks under the influence of psychological stress, which can affect perceptual, cognitive and motor performance. However, it is largely unknown how repeatedly performing stressful tasks physically affect police officers in terms of heart rate and pupil diameter properties. Psychological stress is commonly assessed by monitoring the changes in these biomarkers. Heart rate and pupil diameter was measured in 12 male police officers when performing a sequence of four stressful tasks, each lasting between 20 and 130 s. The participants were first placed in a dimly illuminated anteroom before allowed to enter a brightly lit room where a scenario was played out. After each task was performed, the participants returned to the anteroom for about 30 s before performing the next sequential task. Performing a repeated sequence of stressful tasks caused a significant increase in heart rate (p = 0.005). The heart rate started to increase already before entering the scenario room and was significantly larger just after starting the task than just before starting the task (p < 0.001). This pattern was more marked during the first tasks (p < 0.001). Issuance of a verbal "abort" command which terminated the tasks led to a significant increase of heart rate (p = 0.002), especially when performing the first tasks (p = 0.002). The pupil diameter changed significantly during the repeated tasks during all phases but in a complex pattern where the pupil diameter reached a minimum during task 2 followed by an increase during tasks 3 and 4 (p ≤ 0.020). During the initial tasks, the pupil size (p = 0.014) increased significantly. The results suggest that being repeatedly exposed to stressful tasks can produce in itself an escalation of psychological stress, this even prior to being exposed to the task. However, the characteristics of both the heart rate and pupil diameter were complex, thus, the findings highlight the importance of studying the effects and dynamics of different stress-generating factors. Monitoring heart rate was found useful to screen for stress responses, and thus, to be a vehicle for indication if and when rotation of deployed personnel is necessary to avoid sustained high stress exposures.