Internal health status belief and lower perceived functional deficit are related among anterior cruciate ligament-deficient patients

Arthroscopy. 2002 May-Jun;18(5):515-8. doi: 10.1053/jars.2002.32217.


Purpose: Health locus of control has been shown to influence the recovery process after injury and surgery. This study attempted to determine relationships between patient perceptions of health locus of control and their perceived functional limitations after anterior cruciate ligament (ACL) rupture. An external health locus of control refers to the belief that one's outcome after injury or surgery is under the control of powerful others or is determined by fate, luck, or chance. An internal health locus of control refers to the belief that one's outcome is directly related to individual patient behaviors.

Type of study: Quasi-experimental, posttest only design.

Methods: Over a 1-year time period, 70 consecutive patients with unilateral ACL deficiency (acute, <1 month after onset) agreed to participate in this study. All data were collected 1 week before ACL reconstruction. Subjects completed the Health Locus of Control Scale (HLC) and the physical function section of the Short Form 36 (SF-36) Health Survey. A Kruskal-Wallis 1-way analysis of variance was used to assess group differences (P <.05) based on SF-36 physical function score classification.

Results: Subjects with minimal perceived functional limitations (SF-36 physical function group 3) displayed lower (more internal) HLC scores (29.6 +/- 4.4; range, 24-36) than subjects with moderate perceived functional limitations (SF-36 physical function group 2) (33.0 +/- 6.1; range, 22-44) or subjects with maximal perceived functional limitations (SF-36 physical function group 1) (33.9 +/- 2.8; range, 30-38).

Conclusions: Subjects with lower perceived functional limitations regarded their health status as being controlled more by internal factors. It is not proven whether there is a cause-and-effect relationship or which of these parameters is the antecedent. Related reports suggest that perception of control may positively influence functional outcome and disability levels. Patients who perceive preoperative pain and functional limitation to be excessive may have low tolerance for the stressors associated with surgery and postoperative rehabilitation. With these patients, a more conservative surgical and rehabilitation approach may be better. Alternatively, methods to change their perceptions, such as cognitive therapy, may have a positive role.

MeSH terms

  • Activities of Daily Living / psychology*
  • Adult
  • Analysis of Variance
  • Anterior Cruciate Ligament / surgery
  • Anterior Cruciate Ligament Injuries*
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Health Status
  • Health Surveys
  • Humans
  • Knee Joint / physiopathology
  • Male
  • Recovery of Function / physiology
  • Rupture / psychology
  • Rupture / rehabilitation
  • Rupture / surgery