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OpenTrials
Completed

NCT Number: NCT04914689

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

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.

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Key information

Conditions

Anterior Cruciate Ligament Injuries Knee Injuries Leg Injuries Wounds and Injuries

Age range

18 year–35 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

UNC Charlotte

Charlotte, North Carolina, 28223, United States

About this study

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.

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

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

Treatment and study plan

Internal focus of attention feedback

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 internal focus of attention feedback

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

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.

Primary outcomes

  1. Changes from baseline in lower extremity biomechanics during landing.

    Time frame: 1-week post-intervention, 4-weeks post-intervention

    Hip and knee angles and loads measured via 3D biomechanics

  2. Differences in biomechanical changes between visual and auditory external focus of attention feedback.

    Time frame: 1-week post-intervention, 4-weeks post-intervention

    Hip and knee angles and loads measured via 3D biomechanics

Secondary outcomes

  1. Changes from baseline in cortical activity during landing

    Time frame: 1-week post-intervention, 4-weeks post-intervention

    Electroencephalography recording of cortical activity during landing

Sponsors and collaborators

Lead sponsor

University of North Carolina, Charlotte

Other

Registry information

Important dates

Study start
2021
Primary completion
2025
Study completion
2025
First posted
Jun 7, 2021
Registry last updated
Jun 3, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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