Efficacy of Psychological self-monitoring and goal-setting Intervention in Anterior Cruciate Ligament Reconstruction Rehabilitation mid-phase: A Randomized Controlled Trial

Background: Despite achieving clinical stability, many athletes fail to reach their pre-injury level of activity following anterior cruciate ligament reconstruction due to unresolved psychological barriers. Factors such as kinesiophobia, low self-efficacy, and a lack of psychological readiness often persist even when physical milestones are met, creating a psychological gap in traditional rehabilitation. Current evidence suggests that addressing these modifiable deficits through targeted interventions is essential for a successful return to sport. Objective: This randomized controlled trial evaluated the impact of a structured psychological self-monitoring and goal-setting intervention on kinesiophobia, psychological readiness, and adherence during the mid-phase of ACLR rehabilitation. Methods: Twelve patients (N=12) in the mid-phase of ACLR recovery were randomized to receive either a 4-week integrated psychological intervention or standard-of-care physical therapy. The experimental protocol focused on goal setting, positive self-talk, and imagery skills previously shown to correlate with higher adherence to home-based exercise. Results: The analysis of the baseline demographics confirms that both groups were well-matched. The primary behavioral outcome was measured using the Rehabilitation Compliance Questionnaire, a 20-item scale assessing attendance, instruction following, intensity of effort, and communication. For the Intervention Group, the improvement did not reach statistical significance (p = 0.144). The Control Group showed a trend toward significance (p = 0.063). Conclusion: Implementing psychological self-monitoring and goal-setting during the mid-phase of ACLR rehabilitation addresses the biopsychosocial complexities of recovery. This approach potentially enhances the alignment between physical function and mental readiness, providing a more comprehensive pathway for athletes returning to pivoting sports