Considerations for a women's rehabilitation programme following anterior cruciate ligament reconstruction: a concept mapping approach to enhance women's outcomes.

Abstract

OBJECTIVE To identify gender/sex-specific considerations to enhance anterior cruciate ligament (ACL) rupture rehabilitation experiences and outcomes among women. METHODS Mixed-methods concept mapping. 19 women 1-3 years post-ACL rupture and 28 rehabilitation practitioners (68% physiotherapists) who regularly treat women following ACL rupture brainstormed statements to a prompt ('What factors should be addressed in ACL rehabilitation for women (18-45 years)?') before thematically sorting and rating the statements for importance and feasibility (5-point Likert scales). RESULTS Ninety unique statements were brainstormed, sorted and rated. A seven-cluster solution was identified-from most to least important (number of statements, cluster mean importance/5)-1. foster goal-driven rehabilitation (18, 3.98); 2. promote mental and emotional well-being (13, 3.96); 3. create adaptable and supportive environments (10, 3.74); 4. provide education and resources (16, 3.73); 5. engage the whole team for the whole woman (13, 3.52); 6. address accessibility and competing demands (8, 3.36) and 7. build peer, group and social support (12, 3.22). 'Goal-driven rehabilitation' was deemed the most, and 'peer, group and social support' the least feasible cluster to address in women-specific ACL rehabilitation. CONCLUSION Enhancing ACL rehabilitation strategies could reduce the gender/sex disparity for women most at risk of inferior short- and long-term outcomes. Practitioners can leverage our seven-cluster solution for practical guidance in creating supportive and empowering environments that prioritise collaboration and active listening, enabling women-centred goal-driven rehabilitation practices. Lower-rated clusters, such as peer, group and social support, may remain crucial, as they reflect known influences on rehabilitation motivation and adherence.