Protocol for double-blinded randomized trial to enhance postural control after anterior cruciate ligament reconstruction by balance training and concurrent cognitive demands or external focus of attention


Submitted: 13 December 2022
Accepted: 10 February 2023
Published: 10 March 2023
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Authors

  • Abdollah Tayebi Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran, Islamic Republic of.
  • Hossein Kouhzad Mohammadi Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran, Islamic Republic of.
  • Gholamhossein Nassadj Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran, Islamic Republic of.
  • Mohammad Mehravar Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran, Islamic Republic of.

Anterior cruciate ligament (ACL) injury is one of the most common injuries among athletes that lead to postural control disorders. The aim of this study is to compare the effects of balance training with and without cognitive task and external focus of attention on postural control in individuals with ACL reconstruction. Sixty participants with ACL reconstruction, between the ages of 18 and 47 will be randomly allocated to three group’s including routine balance training, balance training with external focus of attention. Patients will be assessed at the baseline, after receiving eight weeks of intervention, and four weeks later. A double-blinded design will be used. Center of pressure data acquired from a forceplate will be used to assess amount and velocity of sway, local dynamical stability, and global stability of upright balance. Also, dynamic balance will be assessed using Star Excursion balance test. The results of this research will be used to establish effectiveness of treatment strategies for postural control in individuals with anterior cruciate ligament reconstruction. The suggested interventions would be clinically applicable in the athlete with ACL injury.


Ihara H, Takayama M, Fukumoto T. Postural control capability of ACL-deficient knee after sudden tilting. Gait Posture. 2008 Oct;28(3):478-82. Epub 2008 May 12. PMID: 18468899. DOI: https://doi.org/10.1016/j.gaitpost.2008.03.009

Gokeler A, Neuhaus D, Benjaminse A, Grooms DR, Baumeister J. Principles of Motor Learning to Support Neuroplasticity After ACL Injury: Implications for Optimizing Performance and Reducing Risk of Second ACL Injury. Sports Med. 2019 Jun;49(6):853-865. Erratum in: Sports Med. 2019 Feb 21;: PMID: 30719683; PMCID: PMC6548061. DOI: https://doi.org/10.1007/s40279-019-01058-0

Negahban H, Ahmadi P, Salehi R, Mehravar M, Goharpey S. Attentional demands of postural control during single leg stance in patients with anterior cruciate ligament reconstruction. Neurosci Lett. 2013 Nov 27;556:118-23. Epub 2013 Oct 21. PMID: 24157849. DOI: https://doi.org/10.1016/j.neulet.2013.10.022

Benjaminse A, Gokeler A, Dowling AV, Faigenbaum A, Ford KR, Hewett TE, Onate JA, Otten B, Myer GD. Optimization of the anterior cruciate ligament injury prevention paradigm: novel feedback techniques to enhance motor learning and reduce injury risk. J Orthop Sports Phys Ther. 2015 Mar;45(3):170-82. Epub 2015 Jan 27. PMID: 25627151. DOI: https://doi.org/10.2519/jospt.2015.4986

Ahmadi P, Salehi R, Mehravar M, Goharpey S, Negahban H. Comparing the effects of external focus of attention and continuous cognitive task on postural control in anterior cruciate ligament reconstructed athletes. Neurosci Lett. 2020 Jan 10;715:134666. Epub 2019 Nov 30. PMID: 31794793. DOI: https://doi.org/10.1016/j.neulet.2019.134666

Wulf G. Attentional focus and motor learning: a review of 15 years. International Review of sport and Exercise psychology. 2013;6(1):77-104. DOI: https://doi.org/10.1080/1750984X.2012.723728

Minoonejad H, Bazrafshan H, Akoochakian M, Aslani M. Effect of Attention Instructions of Balance Training in Athletes With Ankle Instability. Physical Treatments. 2018; 8(1):45-54. DOI: https://doi.org/10.32598/ptj.8.1.45

Richer N, Saunders D, Polskaia N, Lajoie Y. The effects of attentional focus and cognitive tasks on postural sway may be the result of automaticity. Gait Posture. 2017 May;54:45-49. Epub 2017 Feb 24. PMID: 28259038. DOI: https://doi.org/10.1016/j.gaitpost.2017.02.022

Lajoie Y, Richer N, Jehu DA, Tran Y. Continuous Cognitive Tasks Improve Postural Control Compared to Discrete Cognitive Tasks. J Mot Behav. 2016 May-Jun;48(3):264-9. Epub 2015 Oct 26. PMID: 26503343. DOI: https://doi.org/10.1080/00222895.2015.1089833

Laufer Y, Rotem-Lehrer N, Ronen Z, Khayutin G, Rozenberg I. Effect of attention focus on acquisition and retention of postural control following ankle sprain. Arch Phys Med Rehabil. 2007 Jan;88(1):105-8. PMID: 17207684. DOI: https://doi.org/10.1016/j.apmr.2006.10.028

Chan AW, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, Krleža-Jerić K, Hróbjartsson A, Mann H, Dickersin K, Berlin JA, Doré CJ, Parulekar WR, Summerskill WS, Groves T, Schulz KF, Sox HC, Rockhold FW, Rennie D, Moher D. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013 Feb 5;158(3):200-7. PMID: 23295957; PMCID: PMC5114123. DOI: https://doi.org/10.7326/0003-4819-158-3-201302050-00583

Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, Altman DG, Barbour V, Macdonald H, Johnston M, Lamb SE, Dixon-Woods M, McCulloch P, Wyatt JC, Chan AW, Michie S. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014 Mar 7;348:g1687. PMID: 24609605. DOI: https://doi.org/10.1136/bmj.g1687

Slade SC, Dionne CE, Underwood M, Buchbinder R. Consensus on Exercise Reporting Template (CERT): Explanation and Elaboration Statement. Br J Sports Med. 2016 Dec;50(23):1428-1437. Epub 2016 Oct 5. PMID: 27707738. DOI: https://doi.org/10.1136/bjsports-2016-096651

Gokeler A, Benjaminse A, Welling W, Alferink M, Eppinga P, Otten B. The effects of attentional focus on jump performance and knee joint kinematics in patients after ACL reconstruction. Phys Ther Sport. 2015 May;16(2):114-20. Epub 2014 Jul 2. PMID: 25443228. DOI: https://doi.org/10.1016/j.ptsp.2014.06.002

Zouita Ben Moussa A, Zouita S, Dziri C, Ben Salah FZ. Single-leg assessment of postural stability and knee functional outcome two years after anterior cruciate ligament reconstruction. Ann Phys Rehabil Med. 2009 Jul;52(6):475-84. English, French. Epub 2009 May 23. PMID: 19477706. DOI: https://doi.org/10.1016/j.rehab.2009.02.006

Henriksson M, Ledin T, Good L. Postural control after anterior cruciate ligament reconstruction and functional rehabilitation. Am J Sports Med. 2001 May-Jun;29(3):359-66. PMID: 11394609. DOI: https://doi.org/10.1177/03635465010290031801

Harrison EL, Duenkel N, Dunlop R, Russell G. Evaluation of single-leg standing following anterior cruciate ligament surgery and rehabilitation. Phys Ther. 1994 Mar;74(3):245-52. PMID: 8115458. DOI: https://doi.org/10.1093/ptj/74.3.245

Negahban H, Mostafaee N, Sohani SM, Mazaheri M, Goharpey S, Salavati M, Zahednejad S, Meshkati Z, Montazeri A. Reliability and validity of the Tegner and Marx activity rating scales in Iranian patients with anterior cruciate ligament injury. Disabil Rehabil. 2011;33(23-24):2305-10. Epub 2011 Apr 14. PMID: 21491968. DOI: https://doi.org/10.3109/09638288.2011.570409

Salavati M, Mazaheri M, Negahban H, Sohani SM, Ebrahimian MR, Ebrahimi I, Kazemnejad A, Salavati M. Validation of a Persian-version of Knee injury and Osteoarthritis Outcome Score (KOOS) in Iranians with knee injuries. Osteoarthritis Cartilage. 2008 Oct;16(10):1178-82. Epub 2008 Apr 14. PMID: 18411065. DOI: https://doi.org/10.1016/j.joca.2008.03.004

Sonepat H. Effect of wobble board balance training program on static balance, dynamic balance & triple hop distance in male collegiate basketball athlete. Int J Physiother Res. 2014;2(4):657-62.

Gokeler A, Benjaminse A, Seil R, Kerkhoffs G, Verhagen E. Using principles of motor learning to enhance ACL injury prevention programs. Sports Orthopaedics and Traumatology.2018:34(1);23-30. DOI: https://doi.org/10.1016/j.orthtr.2017.12.006

Kupper C, Roemer K, Jusko E, Zentgraf K. Distality of Attentional Focus and Its Role in Postural Balance Control. Front Psychol. 2020 Feb 21;11:125. PMID: 32153451; PMCID: PMC7050164. DOI: https://doi.org/10.3389/fpsyg.2020.00125

Shiraishi M, Mizuta H, Kubota K, Otsuka Y, Nagamoto N, Takagi K. Stabilometric assessment in the anterior cruciate ligament-reconstructed knee. Clin J Sport Med. 1996 Jan;6(1):32-9. PMID: 8925363. DOI: https://doi.org/10.1097/00042752-199601000-00008

Monjezi S, Negahban H, Tajali S, Yadollahpour N, Majdinasab N. Effects of dual-task balance training on postural performance in patients with Multiple Sclerosis: a double-blind, randomized controlled pilot trial. Clin Rehabil. 2017 Feb;31(2):234-241. Epub 2016 Jul 10. PMID: 27006419. DOI: https://doi.org/10.1177/0269215516639735

Donovan L, Hertel J. A new paradigm for rehabilitation of patients with chronic ankle instability. Phys Sportsmed. 2012 Nov;40(4):41-51. PMID: 23306414. DOI: https://doi.org/10.3810/psm.2012.11.1987

Pamukoff DN, Holmes SC, Garcia SA, Vakula MN, Shumski EJ, Moffit TJ. Influence of body mass index and anterior cruciate ligament reconstruction on gait biomechanics. J Orthop Res. 2022 Oct 7. Epub ahead of print. PMID: 36205181. DOI: https://doi.org/10.1002/jor.25451

Saito M, Morikawa T, Iwasaki J, Hosokawa H, Sakamoto T, Nakagawa K, Sasho T. Influence of Age on Signal Intensity of Magnetic Resonance Imaging and Clinical Outcomes in Double-Bundle Anterior Cruciate Ligament Reconstruction: Comparisons Among Different Age Groups. Am J Sports Med. 2022 Jan;50(1):93-102. Epub 2021 Nov 26. PMID: 34825843. DOI: https://doi.org/10.1177/03635465211059158

Tayebi , A., Kouhzad Mohammadi, H., Nassadj , G., & Mehravar, M. (2023). Protocol for double-blinded randomized trial to enhance postural control after anterior cruciate ligament reconstruction by balance training and concurrent cognitive demands or external focus of attention. European Journal of Translational Myology, 33(1). https://doi.org/10.4081/ejtm.2023.11085

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