information on factors beyond impaired knee function that may affect patient response to rehabilitation. The Knee Quality of Life 26-item (KQoL-26) questionnaire is a self-report questionnaire for patients with a suspected ligamentous or meniscal injury and is reliable, valid, and responsive (Garratt et al., 2008). The questionnaire contains 26 items with three subscales of knee-related quality of life on physical functioning, activity limitations, and emotional functioning. Knee-specific questionnaires The International Knee Documentation Committee Subjective Knee Form (IKDC 2000) is a knee-specific measure of symptoms, function, and sports activities used to assess patient-perceived function for a variety of knee conditions scored on a scale from 0 to 100. It is calculated from 18 items, with higher scores indicating higher self-reported levels of knee function (American Orthopaedic Society for Sports Medicine [AOSSM], 2009). The IKDC 2000 can be used to categorize patients via their current physical activity levels and assist with determining knee function by comparing current levels to preinjury levels. Level I represents sports that involve cutting and pivoting (e.g., soccer, basketball, and football); level II represents activities with lateral movements but less jumping (e.g., skiing, hockey, racquet sports, and manual labor occupations); level III represents light activities (e.g., running, low-impact aerobics, and weight lifting); and level IV represents sedentary activities (e.g., housework and activities of daily living; Daniel et al., 1994; Hefti, Müller, Jakob, & Stäubli, 1993). The IKDC 2000 is reliable and is positively correlated to the physical component of the SF-36 (Irrgang et al., 2001). It is also responsive and able to detect clinically meaningful change, with a change score of 11.5 indicating improved self-perceived knee function (Irrgang, 2006). The IKDC 2000 questionnaire is more useful than the Knee Injury and Osteoarthritis Outcome Score (KOOS) for young, active individuals early and within 1 year after ACL reconstruction (Hambly & Griva, 2010; van Meer et al., 2013). Higher knee function on the IKDC 2000 is also related to more on-field training sessions and better muscle strength recovery (Villa et al., 2015). The Knee Outcome Survey – Activities of Daily Living Scale (KOS-ADLS) is a patient-reported measure of impairments and functional limitations experienced during activities of daily living within a population possessing a wide variety of knee pathologies and impairments (Irrgang, Snyder- Mackler, Wainner, Fu, & Harner, 1998). It is reliable and uses an ordinal scaling system, with the overall score out of a possible 70 points represented as a percentage (Irrgang et al., 1998). A score of 100% represents the absence of knee impairments or functional limitations with ADLs (Irrgang et al., 1998). The KOOS consists of five subscales assessing patient symptoms, complaints of pain, function in daily life, function during sports and recreational activities, and knee-related quality of life designed for patients with ACL injury, meniscus injury, or posttraumatic knee osteoarthritis (Roos, Roos, Ekdahl, & Lohmander, 1998). The score for each subscale ranges from 0 to 100, with increased scores indicating higher subjective knee function (Roos et al., 1998). All subscales of the KOOS are reliable within the population for which they were developed (Roos et al., 1998). Higher correlations are seen between the KOOS-ADL and KOOS Sport and Recreation Function subscales with the physical function scales of the SF-36, compared to mental health components of the SF-36 (Roos et al., 1998). KOOS-QoL sub-scores of 74.5 were lower than previously reported healthy population norms with no knee symptoms of 90 and general population norms of 82.4 (Filbay, Ackerman, Russell, Macri, & Crossley, 2013). Meniscus injuries, revision surgery, and severe radiographic osteoarthritis are factors associated with poor KOOS-QoL sub- scores (Filbay et al., 2013). The risk of an ACL revision surgery is 3.7-times higher in patients with a 2-year postoperative KOOS-QoL score of less than 44 compared to those with a score greater than or equal to 44 (Granan, Baste,
Engebretsen, & Inacio, 2015). Additionally, for every 10- point drop in KOOS-Qol sub-score, there is a 33.6% higher risk for ACL reconstruction revision surgery (Granan et al., 2015). Although the usefulness of each of the subscales – except for Sport and Recreation Function – has been questioned for the acute ACL-injury and ACL- reconstructed populations (van Meer et al., 2015), the measure is widely used in these populations (Ahldén et al., 2012; Filbay et al., 2013; Granan, Inacio, Maletis, Funahashi, & Engebretsen, 2013; Spindler et al., 2011). The Global Rating Scale of Perceived Function (GRS) consists of a single question that evaluates a patient’s current overall subjective knee function on a scale from 0 to 100. Zero represents the inability to perform any activity, and 100 indicates the level of knee function prior to injury (Logerstedt et al. 2013b; Marx, Stump, Jones, Wickiewicz, & Warren, 2001). An analogue GRS was found to be reliable in the ACL population, demonstrating good repeatability, with a minimal detectable change of 6.49 representing true change in patient-reported The ACL – Return to Sport after Injury (ACL-RSI) scale is a patient-reported measure that assesses emotions, confidence in performance, and risk appraisal associated with return-to- sport activities following ACL reconstruction (Webster, Feller, & Lambros, 2008). The ACL-RSI score ranges from 0 to 100, representing an average of the scores on 12 questions, with lower scores indicating more negative psychological responses in regard to returning to sport (Webster et al., 2008). Scores on the ACL-RSI have been shown to increase with time after ACL reconstruction, with a minimal detectable change of 19, and patients who have returned to preinjury sports activity levels score significantly higher on the ACL-RSI (Kvist et al., 2013; Langford, Webster, & Feller, 2009). The ACL-RSI has been shown to be reliable and valid, because patients with increased ACL-RSI scores also score higher on all the KOOS subscales. The use of the ACL-RSI can be used to assess psychological preparedness so that appropriate interventions can be implemented to allow for timely return to competitive sport levels (Langford et al., 2009). A recent study by Zarzycki and colleagues (2018) found a weak association between ACL-RSI scores and knee kinematic asymmetry during gait. Another scale that assesses fear of movement and reinjury from involvement in physical activity is a modified version of the Tampa Scale for Kinesiophobia, known as the TSK-11 . (Please note, however, that this scale is not specific to patients with knee pathology.) The TSK-11 includes 11 items and has a range of possible scores from 11 to 44. Lower scores indicate lower levels of fear of movement and reinjury. The scale is reliable and demonstrates both construct and predictive validity (Woby, Roach, Urmston, & Watson, 2005). TSK-11 scores have been shown to be elevated following ACL reconstruction, and they relate to lower self-report of function and rate of return to preinjury activity levels (Chmielewski et al., 2008; Kvist, Ek, Sporrstedt, & Good, 2005; Lentz et al., 2009). Although scores on the TSK-11 decrease with time following ACL reconstruction, they are associated with knee function only after 6 months following surgery, corresponding to the time frame when return- to-sports activities are often allowed (Barber-Westin & Noyes, 2011b; Chmielewski et al., 2008). Lower scores on the TSK-11 have been associated with increased ACL-RSI scores (Kvist et al., 2013). A reduction of four points on the TSK-11 maximizes the likelihood of correctly identifying patients who have reduced their fear of movement and reinjury (Woby et al., 2005). Recent evidence indicates that patients after ACL reconstruction who have higher TSK-11 scores are more likely to report lower levels of activity, lower quadriceps strength, and poorer hop limb symmetry; they may also be at greater risk for second ACL tear (Paterno et al., 2018). It has been suggested that TSK-11 could be shortened to a three-item fear of injury scale (items 1, 2, 10) in the early postoperative phase (less than 12 weeks after surgery), but TSK-11 is not recommended in the late function (Hopper et al., 2002). Psychological questionnaires
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