Assessing activity participation in the ACL injured population: a systematic review of activity rating scale measurement properties

Abstract

Background: Participation is an important factor in assessing both the requirement for and outcome from anterior cruciate ligament reconstruction. Many patient-reported rating scales exist; however, measurement properties have not been well established. Objective: To provide a systematic review to identify currently available activity rating scales for anterior cruciate ligament injured subjects and to evaluate current knowledge of their measurement properties. Methods: Systematic searches of four databases (Medline, AMED, EMBASE, and CINAHL) without date or language restriction, using terms structured around the PICOS system were completed on 1st March 2011. Citation tracking, reference screening and contact with lead authors of key papers completed the search strategy. Studies using participation rating scales were identified to assess frequency of reporting and cited validation. Studies assessing one or more psychometric properties of the identified rating scales were subject to independent data extraction and critical appraisal by two independent authors using published tools. Results: Thirty-one rating scales were identified from 241 outcome studies. Most scales were inadequately developed or validated prior to use. Only three scales (Tegner, CSAS, and Marx) had psychometric analysis in eight studies of mixed quality. Only the Tegner scale has adequate assessment of reliability, validity, and responsiveness. The use of type, intensity, and frequency variables in the identified scales is discussed. Conclusions: The Tegner scale has been adequately validated; however, other rating scales require further validation. A comprehensive comparative analysis of clinical applicability and psychometric testing of existing scales, including clinically useful statistics, is required.

Decision to Return to Sport Participation After Anterior Cruciate Ligament Reconstruction, Part II: Self-Reported and Functional Performance Outcomes

“…The PROs used in this study have been established as valid and reliable measures of symptoms, 24,[48][49][50] function, 20,24,49 or activity levels 20,24,49 in people with knee disorders and are useful for monitoring overall knee improvement beginning with preoperative status. 19,23,49,51 Within our sample, few between-groups differences were identified for the PROs. However, clinically meaningful differences were observed.…”

Return to Sports: A Risky Business? A Systematic Review with Meta-Analysis of Risk Factors for Graft Rupture Following ACL Reconstruction

“…Taken together, these results corroborate that participating in and returning to a high activity level that imposes substantial load on the knees leads to a higher risk of graft rupture, irrespective of time point of return and the sports involved. While the pre-injury Marx score was not significantly associated with graft rupture, the Marx score was reported in only two studies and has poorer psychometric properties [ 208 ], which may explain differences in the result between these two scales of activity level/participation.…”

Adolescent Patients Exhibit Significant Improvements in Strength and Functional Performance From 6 to 9 Months After ACL Reconstruction With Quadriceps Autograft

“…The absolute change in Tegner score between the 2 time points was 1.3, which was greater than the minimal detectable change of 1.0. 23 The absolute change in score for the Lysholm was 4.5, below the minimal clinically important difference of 10.1. 24 Thus, while statistically significant, the improvement in the Lysholm score is unlikely to be of clinical importance.…”