Evaluation of the Responsiveness of the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) Scale

Abstract

Background: The Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale is a reliable and valid tool for evaluation of psychological readiness to return to sport after ACL injury, but its responsiveness to change has not been extensively evaluated. Purpose: To determine the responsiveness of the ACL-RSI scale. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: The ACL-RSI scale and the knee confidence question from the Knee injury and Osteoarthritis Outcome Score–Quality of Life subscale was completed at 6 and 12 months after ACL reconstruction surgery. Responsiveness was assessed using distribution and anchor-based methods for the full- and short-form versions of the scale and subgroup analyzed for sex. From distribution statistics, the standardized response mean (SRM) and the smallest detectable change (SDC) were calculated. Using the anchor-based method, the minimally important change (MIC) that was associated with an improvement in knee confidence was determined using receiver operating characteristic analysis. Results: A total of 441 patients (257 men, 184 women; mean age of 25 years) were included in this study. An SRM of 0.7 was found for both versions, indicating a moderate level of responsiveness. The MIC was 13.4 points for the full-form version and 15.1 points for the short-form version. These values were larger than SDC values at the group level but not at the individual patient level. Responsiveness was similar between male and female patients. Conclusion: The ACL-RSI scale had sufficient responsiveness to investigate the efficacy of an intervention at a group level, but it may be more limited at an individual patient level.

Wide Variability in Return-to-Sport Criteria used by Team Physicians After Anterior Cruciate Ligament Reconstruction in Elite Athletes—A Qualitative Study

“…For that reason, in addition to the traditional knee outcome scores, several studies created new scores or modifications of preexisting scores to assess the psychological aspects after injury and reconstruction such as the Tampa Scale for Kinesophobia, Emotional Responses of Athletes to Injury Questionnaire, Profile of Mood States, and ACL-Return to Sport Injury Scale. 26,30 Patient-reported psychological readiness, subjective feeling of knee stability, and pain-free return to sporting movements were considered by some participants as some of the most important RTS criteria. The current study revealed that even when the participants considered that these subjective factors play an essential role, most of them did not use PROMs or a specific score to assess psychological factors in the RTS decision e6 making.…”

“…For that reason, in addition to the traditional knee outcome scores, several studies created new scores or modifications of preexisting scores to assess the psychological aspects after injury and reconstruction such as the Tampa Scale for Kinesophobia, Emotional Responses of Athletes to Injury Questionnaire, Profile of Mood States, and ACL-Return to Sport Injury Scale. 26 , 30 …”

Patients that maintain their pre-injury level of physical activity 3–5 years after ACL reconstruction are, 18 months after surgery, characterised by higher levels of readiness to return to sport

“…Statistical analysis was performed using the IBM SPSS Statistics for Windows, version 25, 2017 (IBM Corp., Armonk, N.Y., USA). The sample-size calculation was made for the main outcome (ACL-RSI at the 18-month follow-up), where the estimated mean was based on data in a previous study [ 35 ]. A sample-size calculation showed that a total sample size of 72 patients were required to be able to identify a 13.4-point difference, corresponding to the minimal detectable change (MDC) [ 35 ] between groups with 80% power at an alpha level of 0.05.…”

Relationships between Jumping Performance and Psychological Readiness to Return to Sport 6 Months Following Anterior Cruciate Ligament Reconstruction: A Cross-Sectional Study

“…The ACL–Return to Sport after Injury scale (ACL-RSI) is considered a reliable tool to assess psychological readiness to return to sport after ACL surgery [ 17 , 18 ]. It has been demonstrated that patients with lower ACL-RSI scores are at higher risk for ACL re-rupture [ 19 ], and recently much emphasis is given to the recovery of psychological responses as a criterion used to clear athletes to return to sport following ACL reconstruction.…”