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Jane

Jane Rooney

Year of Award: 2016 Award State: Victoria Health And Medicine > Rehabilitation And Pain Management
To investigate contemporary conservative management programs for Anterior Cruciate knee injuries - Denmark, Sweden, Norway, Netherlands, UK, USA
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Recommendations:

The following recommendations are offered as a result of my observations throughout my fellowship:

  1. Australian primary care providers (General Practitioners, Sports Physicians, Emergency Doctors and Physiotherapists’) performing acute triage to people who have sustained an anterior cruciate ligament (ACL) injury, need education of current world best practice recommendations for ACL injury management.
  2. Implementation of world best practice recommendations requires primary care practitioners to engage in a shared decision-making process informing the individual of all possible risks and benefits of a non-operative and operative management pathway for ACL injury. This ensures individual outcome goals and adequate informed consent, which is important in Australia’s medicolegal climate.
  3. Accessible education for patients of the possible disadvantages and advantages of non-operative and operative ACL injury management clinical pathways, will enable patients to make a better-informed decision about their individual management. This may require a multimedia approach.
  4. Revised funding models from health funds to support both prehabilitation, non - operative, post-operative and long-term rehabilitation physiotherapy programs would be more cost effective than the high rates of expensive early ACL operative intervention, that is the current accepted standard practice model in Australia.
  5. Early medical referral following ACL injury for prehabilitation programs will optimise post-surgical outcomes if the operative pathway is selected and is the start of the non-operative pathway. This prehab time may also enable the person to make a better-informed decision about their preferred management pathway.
  6. Educating physiotherapists of appropriate prehabilitation and rehabilitation protocols. Selected Australian physiotherapy centres also need to have access to an adequate physical environment to conduct these programs.
  7. Prevention programs need to be more broadly implemented to have an impact on ACL injury rates and public health, supported by coaches, teams, athletes, sporting and health insurance agencies, sporting federations, education facilities and governments.
  8. Initiation of an Australian ACL register would provide a mechanism for accurate data collection, informing patient safety, quality improvement and identifying best clinical practice. A register is also imperative for evaluating ACL injury prevention initiatives.
  9. Australian Health policy and health insurance bodies need to support the above recommendations to assist change in our current Australian ACL injury management algorithm to better align clinical pathways to world best practice.
  10. A public awareness campaign would be beneficial to promote these recommendations

 Keywords: Physical rehabilitation, anterior cruciate ligament injury, conservative management, ACL management algorithms, prehabilitation, ACL prevention

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