The Dutch language anterior cruciate ligament return to sport after injury scale (ACL-RSI) – validity and reliability

Abstract

The ACL-Return to Sport after Injury scale (ACL-RSI) measures athletes' emotions, confidence in performance, and risk appraisal in relation to return to sport after ACL reconstruction. Aim of this study was to study the validity and reliability of the Dutch version of the ACL-RSI (ACL-RSI (NL)). Total 150 patients, who were 3-16 months postoperative, completed the ACL-RSI(NL) and 5 other questionnaires regarding psychological readiness to return to sports, knee-specific physical functioning, kinesiophobia, and health-specific locus of control. Construct validity of the ACL-RSI(NL) was determined with factor analysis and by exploring 10 hypotheses regarding correlations between ACL-RSI(NL) and the other questionnaires. For test-retest reliability, 107 patients (5-16 months postoperative) completed the ACL-RSI(NL) again 2 weeks after the first administration. Cronbach's alpha, Intraclass Correlation Coefficient (ICC), SEM, and SDC, were calculated. Bland-Altman analysis was conducted to assess bias between test and retest. Nine hypotheses (90%) were confirmed, indicating good construct validity. The ACL-RSI(NL) showed good internal consistency (Cronbach's alpha 0.94) and test-retest reliability (ICC 0.93). SEM was 5.5 and SDC was 15. A significant bias of 3.2 points between test and retest was found. Therefore, the ACL-RSI(NL) can be used to investigate psychological factors relevant to returning to sport after ACL reconstruction.

Responsiveness of the anterior cruciate ligament – Return to Sports after Injury (ACL-RSI) and Injury – Psychological Readiness to Return to Sport (I-PRRS) scales

“…A high score is indicative of a positive psychological response. ACL-RSI has shown to be valid and reliable (Slagers et al, 2017). This research showed that SDC is 15.3 for individuals and 1.5 for groups, and the SEM is 5.5.…”

“…Eligible patients received the Dutch versions of the ACL-RSI scale, I-PRRS scale (Slagers et al, 2017;Slagers et al, 2019), and an accompanying information letter by mail. To measure the current level of sports activities, patients were asked to complete the Tegner Activity Score as well (Tegner & Lysholm, 1985).…”

“…SRM values of <0.5 are considered to indicate low responsiveness, a SRM 0.5-0.8 moderate and >0.8 large responsiveness (de Vet et al, , 2006. The SDC and SEM were retrieved from the reliability and validity studies (Slagers et al, 2017;Slagers et al, 2019).…”

“…Webster, Feller, and Lambros (2008) developed and studied the validity of the ACL Return to Sports after Injury (ACL-RSI) scale, which was designed to evaluate three psychological responses of athletes in relation to sport resumption following ACL injury and/or surgery: emotions, confidence in performance, and risk appraisal. The ACL-RSI has been translated into several languages and is considered valid and reliable (Bohu, Klouche, Lefevre, Webster, & Herman, 2015;Chen et al, 2017;Harput et al, 2017;Kvist et al, 2013;Silva, Mendes, Lima, & Almeida, 2017;Slagers, Reininga, & van Den Akker-Scheek, 2017). Glazer developed the Injury Psychological Readiness to Return to Sport (I-PRRS) scale to assess the psychological readiness of injured athletes to return to sports participation, irrespectively of the type of injury (Glazer, 2009).…”

“…Distribution-based methods are based on the statistical characteristics of the sample. Using the distributionbased method the standard error of measurement (SEM) and smallest detectable change (SDC) has determined for the Dutch and Swedish translations of the ACL-RSI and the Dutch translation of the I-PRRS (Kvist et al, 2013;Slagers et al, 2017;Slagers et al, 2019). A major disadvantage of this method is that it does not provide a good indication of the importance of the observed change as perceived by the patient (de Vet et al, 2006).…”