External Focus of Attention Feedback to Reduce Risk of Non-contact ACL Injury

NCT ID: NCT04914689

Last Updated: 2024-04-04

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: NA
• Total Enrollment: 60 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2021-08-15
• Study Completion Date: 2025-03-31

Brief Summary

Knee injuries, especially those to the ACL, are common among physically active people. Preventing these injuries from happening is critical to limiting the long-term pain, disability, and arthritis associated with these injuries. Our study is going to examine new ways to provide feedback about the way people move to determine if these are better at modifying movement patterns to prevent injury than current standard treatments. If you participate, you will be asked to undergo a movement analysis in a research laboratory while you perform tasks such as landing from a box and running and cutting. After this initial assessment, you will be randomly allocated to one of 3 treatment groups. Each treatment group will perform 4 weeks (3x/week) of exercises to change the way people land from a jump. Participants will then report for follow-up movement analysis testing 1- and 4-weeks after completing the intervention.

Detailed Description

Despite the popularity of injury prevention programs, anterior cruciate ligament (ACL) injuries continue to occur at a rate of 250,000 per year in the United States. It is believed that 75% of these injuries are preventable, thus alternative strategies to reduce the risk of injury are necessary. One reason current prevention strategies are not wholly successful may be their reliance on internal focus of attention (InFOCUS) feedback, which constrains movement and increases injury risk. Our project will examine an alternative approach, testing two different modes of external focus of attention (ExFOCUS) feedback to remove constrains on the way people move to reduce injury risk. We will also examine cortical activity to determine if there are differences in neuroplasticity that occur following each form of feedback to better understand how each works. Collectively, the knowledge gained from this study will inform the development of programs to reduce injury risk.

Specific Aim 1: Determine ExFOCUS's ability to reduce the risk of noncontact ACL injury by retaining improved biomechanics compared to InFOCUS. Hypothesis 1.1: the combined auditory and visual ExFOCUS groups will demonstrate greater improvements in biomechanics and will retain these improvements 1 month after cessation of the intervention.

Specific Aim 2: Determine differences in the ability of the two modes (visual and auditory) of ExFOCUS to change biomechanics. Hypothesis 2.1: Auditory ExFOCUS feedback will elicit superior results compared to visual ExFOCUS feedback immediately following the intervention. Specific Aim 3: To quantify differences in cortical activity following external focus of attention and internal focus of attention feedback. Hypothesis 3.1: External focus of attention feedback will increase cortical activity in both groups while there will be no changes in cortical activity during internal focus of attention feedback Hypothesis 3.2: Auditory feedback will elicit greater changes in auditory regions of the brain, while visual feedback will elicit greater changes in regions of the brain responsible for processing visual information.

Conditions

Anterior Cruciate Ligament Injuries

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: PREVENTION
• Blinding Strategy: DOUBLE

Study Groups

Internal focus of attention feedback

Participants will complete 12 sessions over 3 weeks receiving visual feedback in a mirror of their movement patterns.

Group Type: ACTIVE_COMPARATOR

Internal focus of attention feedback

Intervention Type: OTHER

Participants will complete 12 sessions over a 3-week period of functional movement retraining while receiving mirror feedback. Participants will be instructed to perform each functional task in a manner that keeps their knee in line with their toes.

Visual external focus of attention feedback

Participants will complete 12 sessions over 3 weeks receiving visual feedback of their movement patterns from a laser.

Group Type: EXPERIMENTAL

Visual internal focus of attention feedback

Intervention Type: OTHER

Participants will complete 12 sessions over a 3-week period of functional movement retraining while receiving visual feedback via laser. Participants will be instructed to perform each functional task in a manner that does causes the laser to move up and down but not side-to-side.

Auditory external focus of attention feedback

Participants will complete 12 sessions over 3 weeks receiving auditory feedback of their movement patterns.

Group Type: EXPERIMENTAL

Auditory external focus of attention feedback

Intervention Type: OTHER

Participants will complete 12 sessions over a 3-week period of functional movement retraining while receiving auditory feedback. Participants will be instructed to perform each functional task in a manner that does not cause the auditory tool to elicit a noise.

Interventions

Visual internal focus of attention feedback

Participants will complete 12 sessions over a 3-week period of functional movement retraining while receiving visual feedback via laser. Participants will be instructed to perform each functional task in a manner that does causes the laser to move up and down but not side-to-side.

Intervention Type: OTHER

Auditory external focus of attention feedback

Participants will complete 12 sessions over a 3-week period of functional movement retraining while receiving auditory feedback. Participants will be instructed to perform each functional task in a manner that does not cause the auditory tool to elicit a noise.

Intervention Type: OTHER

Internal focus of attention feedback

Participants will complete 12 sessions over a 3-week period of functional movement retraining while receiving mirror feedback. Participants will be instructed to perform each functional task in a manner that keeps their knee in line with their toes.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• exercise 30+ minutes 3+ days/week

Exclusion Criteria

• Body mass index >40 kg/m2
• History of lower extremity fracture or surgery to either limb
• History of ACL tear, meniscus, or collateral ligament injury at the knee to either limb
• History of ankle sprains to either limb
• History of musculoskeletal injury sustained in the 6 months prior to enrollment
• History of concussion or neurological disorders that may influence electroencephalography activity
• Visual or hearing impairments that would limit receiving the appropriate feedback
• Inability to comprehend and repeat back directions in English
• Current smoker

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 35 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

University of North Carolina, Charlotte

OTHER

Sponsor Role: lead

Responsible Party

Abbey Thomas, PhD

Assistant Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

UNC Charlotte

Charlotte, North Carolina, United States

Site Status: RECRUITING

Countries

United States

Central Contacts

Abbey Thomas, PhD

Role: CONTACT

afenwick@uncc.edu

704+687+8628

Facility Contacts

Abbey Thomas, PhD

Role: primary

afenwick@uncc.edu

704-687-8628

Other Identifiers

21-0283

Identifier Type: -

Identifier Source: org_study_id