PhD Scientific Days 2025

Poster Session III. - P: Health Sciences

Anterior Cruciate Ligament Rehabilitation: Associations Between Physical and Psychological Parameters

Name of the presenter

Simon-Szabó Daniella

Institute/workplace of the presenter

National Institute of Sport Medicine, Semmelweis University Doctoral School, Mental Health Sciences Division, Health Sciences

Authors

Simon-Szabó Daniella¹, Dr. Szilvia Ádám^2,3

1: National Institute of Sport Medicine, Semmelweis University Doctoral School, Mental Health Sciences Division, Health Sciences
2: Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
3: Health Services Management Training Center, Semmelweis University, Budapest, Hungary

Text of the abstract

Introduction
In anterior cruciate ligament rehabilitation, the focus has traditionally been on restoring physical parameters, such as range of motion and muscle mass. Recently, however, psychological factors, including general anxiety and pain-related anxiety, have gained increased attention.
Aim: Our study presents the results of the first phase of a four-stage follow-up project, focusing on the associations between knee flexion, extension, thigh circumference on the operated side, and anxiety levels (general anxiety and pain-related anxiety). Although the full project includes the ACL-RSI, QOL, K-SES, and PANAS questionnaires, the present analysis is based exclusively on the PHQ-4 and Pain Anxiety Questionnaires.
Methods
We analyzed the data of fifty-two patients who underwent ACL surgery. We measured the flexion and extension range of motion and thigh circumference of the operated knee. Psychological status was assessed using the PHQ-4 and Pain Anxiety scales. Due to the non-normal distribution of the data, Spearman correlation analysis was applied. In the gender-specific analysis, robust linear regression (using the Huber T norm) was conducted to predict PHQ-4 total scores based on pain anxiety subscales.
Results
No significant associations were found between physical parameters and total scores on the PHQ-4 or Pain Anxiety scales. However, slight trends were observed: a smaller thigh circumference tended to be associated with higher pain anxiety, particularly in the avoidance/escape subscale. Flexion and extension range of motion showed no substantial correlation with anxiety levels. In the gender-specific analysis, no significant associations were found between pain anxiety subscales and PHQ-4 scores among males. In females, however, the pain-related fear subscale (FSZ_fear) emerged as a significant positive predictor of PHQ-4 total scores (β = +0.289, p = 0.009).
Conclusions
The first-phase results showed only weak trends between physical function and psychological status. Gender-specific findings suggest pain-related fear plays a key role in anxiety and depressive symptoms among female patients. Psychological support should be emphasized during rehabilitation. Later phases will provide deeper insights into long-term associations.