Reid, DuncanSims, StacyO'Loughlin, Emma2023-10-052023-10-052023http://hdl.handle.net/10292/16740Anterior cruciate ligament (ACL) injury rates are rising in females in New Zealand and worldwide. It is well reported that females, overall, have inferior outcomes following rehabilitation compared to men. Specifically, females have reduced quadricep strength recovery as compared to men after anterior cruciate ligament reconstruction (ACLR). Recent research provides support for follicular phase (FP)-based resistance training (RT) for enhancing RT strength outcomes in eumenorrheic females. This research also recommends that, when possible, athletes with an ovulatory menstrual cycle (MC) focus on RT during the FP of their MC. This thesis is, therefore, focused on the development and the evaluation of a novel, MC phase-based rehabilitation (MCPBR) programme for females post ACLR. In Chapter 2 via a scoping review, the first step was to establish what is known about MC phase-based RT in injured and non-injured females. The authors searched seven databases for primary studies or reviews describing MC phase-based RT programmes. Fourteen studies were included in the final analysis (eight primary studies). No studies were found that investigated MC phase-based RT in females post-ACLR. Studies were limited by methodological issues. However, the results suggest that MC phase-based training may influence outcomes pertinent to females post-ACLR. Furthermore, the results suggested that there is scope to investigate FP-based RT in females following ACLR. However, it was unclear whether health professionals and athletes routinely and openly discuss this sometimes-sensitive topic in the sports medicine clinic, and if there would be barriers to discussing the MC in the sports medicine clinic. Therefore, Chapter 3 explored different members of the sports medicine community's knowledge, perceptions of, and comfort in discussing the MC. Focus group sessions were conducted with athletes, patients post ACLR, physiotherapists, and orthopaedic surgeons. Overall, participants described the MC as 'a pertinent and evolving topic in the sports medicine clinic'. Whilst participants reported a dearth of education, perceived lack of MC knowledge, and some hesitancy with discussing the MC in the sports medicine clinic, the participants, specifically health professionals, described pragmatic approaches to tackle these barriers. They described developing trust, giving context, and being aware of athletes' concerns and sociocultural status as important when discussing the MC in the sports medicine clinic. Therefore, it was considered feasible to discuss the MC as part of a study investigating MC phase-based training in the sports medicine clinic. In Chapter 4, a focus group methodology was also used to develop a novel MC phase-based ACLR rehabilitation (MCPBR) programme appropriate for testing on females following ACLR. Participants reported a preference for a consistent gym-based programme, however they need support from the physiotherapists to attend and engage. In addition, physiotherapists reported that strength is important but challenging to measure. Overall, input from these key stakeholders enabled the development of a new MCPBR programme. In Chapter 5, a randomised controlled trial assessed the effectiveness of MCPBR versus UC on limb symmetry index (LSI) quadriceps maximum strength and self-reported lower limb function for females following ACLR. Forty one females participated in a 12-week intervention from six to 18 weeks post ACLR. Participants were randomly assigned to one of two groups: MCPBR or UC. Thirty eight females completed the trial, and a further four were excluded in post hoc analysis. Females were highly engaged with both MCBPR and UC. Participants had similar LSIs and self-reported function following MCPBR and UC at 18 weeks post ACLR. Overall, both groups achieved excellent limb symmetry and self-reported functional outcomes. Therefore, this thesis supports twice-weekly, supervised, gym-based rehabilitation, with targeted quadriceps strengthening and regular strength testing for females following ACLR. In conclusion, MCPBR and UC following ACLR rehabilitation in this study showed similar but positive results on knee strength and function at 18 weeks post operatively. Future research should investigate MCPBR in a larger cohort of females, including pre and post strength measures of both legs over a longer period. Similarly, it would be pertinent to understand female's experience of MCPBR post-ACLR. Furthermore, this thesis should assist health professionals and researchers in considering female-specific approaches that could improve outcomes for females post-ACLR. Future research should address the thesis limitations and build on the ideas presented in this thesis for a better understanding of the role of the MC hormonal fluctuations, sex-specific considerations, and female outcomes following ACLR.enOpenAccess