{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T09:39:55Z","timestamp":1785231595104,"version":"3.55.0"},"reference-count":36,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2024,9,17]],"date-time":"2024-09-17T00:00:00Z","timestamp":1726531200000},"content-version":"unspecified","delay-in-days":16,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"HEE\/NIHR","award":["NIHR302104"],"award-info":[{"award-number":["NIHR302104"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,9,4]]},"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>This study aimed to understand the lived experiences of patients on the anterior cruciate ligament reconstruction (ACLR) pathway up to 3\u2009months before, 3\u2009months after and 1\u2009year after surgery. Study objectives were to explore (1) patient experiences of preoperative and postoperative treatment, (2) views of\/involvement in prehabilitation and (3) sources and consistency of healthcare advice.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Semi-structured interviews analysed using reflexive thematic analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Midlands, England.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>Purposive sample of 18 participants aged 18\u201345. Three identified as female and 15 as male. Participants\u2019 ethnic origin was white (n=14), Indian (n=2), British Asian (n=1) and Pakistani (n=1). 10 participants were awaiting ACLR, six were 3months postsurgery and two were 1\u2009year postsurgery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Participants gave a rich account of ACLR pathway experiences discussing negative impacts of the injury, difficulties with navigating the pathway and making decisions about surgery. Interacting with healthcare professionals and managing the variety of resources, advice and opinions were also highlighted as challenges. Participants reflected on their preoperative journey accounting a wide spectrum of expectations and realities of returning to work and physical activity postoperatively. Prehabilitation was perceived to offer an advantage to recovery, mental well-being, injury knowledge, postoperative rehabilitation and supports a faster return to physical activity. Five themes were identified:<\/jats:p>\n                  <jats:list list-type=\"order\">\n                     <jats:list-item>\n                        <jats:p>Injury experience, impact and support.<\/jats:p>\n                     <\/jats:list-item>\n                     <jats:list-item>\n                        <jats:p>Navigating the treatment pathway.<\/jats:p>\n                     <\/jats:list-item>\n                     <jats:list-item>\n                        <jats:p>Sense making in the preoperative period.<\/jats:p>\n                     <\/jats:list-item>\n                     <jats:list-item>\n                        <jats:p>Uncertainty, expectations and reality of the postsurgical period.<\/jats:p>\n                     <\/jats:list-item>\n                     <jats:list-item>\n                        <jats:p>Balancing resources, advice and opinions.<\/jats:p>\n                     <\/jats:list-item>\n                  <\/jats:list>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>This study has illuminated patient experiences of the National Health Service (NHS) ACLR pathway, novel to the evidence base.<\/jats:p>\n                  <jats:p>The results highlight the perceived shortcomings in patient support. They also demonstrate the difficulty patients face when navigating the NHS system, communicating with clinicians, making decisions about treatment and managing conflicting sources of healthcare advice. These problems are more prominent than previously recognised in the literature.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Registration<\/jats:title>\n                  <jats:p>ClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" specific-use=\"clinicaltrial results\" xlink:href=\"NCT05529511\">NCT05529511<\/jats:ext-link>.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-079468","type":"journal-article","created":{"date-parts":[[2024,9,17]],"date-time":"2024-09-17T21:25:15Z","timestamp":1726608315000},"page":"e079468","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["\u2018Going through the motions\u2019; a rich account of the complexity of the anterior cruciate ligament reconstruction pathway, a UK qualitative study"],"prefix":"10.1136","volume":"14","clinical-trial-number":[{"clinical-trial-number":"nct05529511","registry":"10.18810\/clinical-trials-gov","type":"results"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0837-0802","authenticated-orcid":false,"given":"Hayley M","family":"Carter","sequence":"first","affiliation":[{"name":"Physiotherapy Outpatients, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK"},{"name":"School of Medicine, University of Nottingham, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7884-6389","authenticated-orcid":false,"given":"David J","family":"Beard","sequence":"additional","affiliation":[{"name":"Surgical Intervention Trials Unit, Botnar Research Centre, NDORMS, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Leighton","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Nottingham, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona","family":"Moffatt","sequence":"additional","affiliation":[{"name":"School of Health Sciences, University of Nottingham, Nottingham, Nottinghamshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4723-0028","authenticated-orcid":false,"given":"Benjamin E","family":"Smith","sequence":"additional","affiliation":[{"name":"Physiotherapy Outpatients, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK"},{"name":"School of Medicine, University of Nottingham, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate E","family":"Webster","sequence":"additional","affiliation":[{"name":"La Trobe University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillipa","family":"Logan","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Nottingham, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,9,17]]},"reference":[{"key":"2025101810264332000_14.9.e079468.1","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1080\/15438627.2012.680633","article-title":"Systematic review: annual incidence of ACL injury and surgery in various populations","volume":"20","author":"Moses","year":"2012","journal-title":"Res Sports Med"},{"key":"2025101810264332000_14.9.e079468.2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2018-100195"},{"key":"2025101810264332000_14.9.e079468.3","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.berh.2019.01.018","article-title":"Evidence-based recommendations for the management of Anterior Cruciate Ligament (ACL) rupture","volume":"33","author":"Filbay","year":"2019","journal-title":"Best Practice & Research Clinical Rheumatology"},{"key":"2025101810264332000_14.9.e079468.4","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.knee.2020.12.018","article-title":"Current preoperative physiotherapy management strategies for patients awaiting Anterior Cruciate Ligament Reconstruction (ACLR): a worldwide survey of physiotherapy practice","volume":"28","author":"Carter","year":"2021","journal-title":"Knee"},{"key":"2025101810264332000_14.9.e079468.5","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2018-100310"},{"key":"2025101810264332000_14.9.e079468.6","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2022-105495"},{"key":"2025101810264332000_14.9.e079468.7","unstructured":"National Health Service . 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