The objective of this study is to examine the efficacy of Rehabilitation with Exercise
and Psychological Support (REPS), a rehabilitation approach that integrates exercise with
psychological support provided by physical therapist and patient training videos. The
central hypothesis is that REPS will facilitate better psychological response (Specific
Aim 1) and knee function (Specific Aim 2) than Standard Rehabilitation after ACL
reconstruction. The feasibility, acceptability, and fidelity of implementing REPS will be
explored. This is a pilot randomized controlled trial of 60 patients with ACL
reconstruction who receive REPS or Standard Rehabilitation. Study participants in both
treatment arms will receive exercise per a standard rehabilitation protocol. Physical
therapists providing the REPS intervention will receive didactic training in
psychologically informed practice principles and REPS procedures, clinical application
practice, and regular feedback from the study team. Study participants in REPS will
receive training videos on psychosocial aspects of recovery and mental skills to improve
the psychological response. Study visits will occur prior to surgery (baseline),
immediately before the first rehabilitation visit post-surgery, 3 months post-surgery,
and 6 months post-surgery.
Study Aims Specific Aim 1. To examine the efficacy of REPS on psychological response
after ACL reconstruction. Primary Hypothesis: Psychological readiness for sport, measured
with the ACL Return to Sport after Injury (ACL-RSI) scale, will be higher in REPS than
Standard Rehabilitation at 6 months post-surgery. Secondary Hypothesis: Kinesiophobia,
measured with the Tampa Scale for Kinesiophobia (TSK-11) questionnaire, will be lower in
REPS than Standard Rehabilitation at 6 months post-surgery.
Specific Aim 2. To examine the efficacy of REPS on knee function after ACL
reconstruction. Hypothesis: Self-reported knee function, measured with the International
Knee Documentation Committee (IKDC) subjective form, will be higher in REPS than Standard
Rehabilitation at 6 months post-surgery.
Exploratory Aim. To assess the feasibility, acceptability, and fidelity of implementing
REPS after ACL reconstruction. Research records will be used to assess the feasibility of
REPS, and develop surveys for patients and clinicians will be used to assess the
acceptability of REPS. In both treatment arms, patients will complete questionnaires that
align with anticipated clinical changes in empathy (Consultation and Relational Empathy,
CARE) and therapeutic alliance (Working Alliance Inventory-Short Revised, WAI-SR), and
documentation templates will be used to record treatments and training for descriptive
analysis of fidelity.