Assessing Psychological Readiness After ACL Reconstruction

Abstract

PURPOSE: The return to sport following anterior cruciate ligament reconstruction (ACLR) may be impeded by psychological factors such as high fear of re-injury (kinesiophobia) or low confidence (self-efficacy). Screening psychological readiness for sport can identify individuals in need of additional intervention. The Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) is a 12-item questionnaire to assess psychological readiness for sport in domains of Emotions, Confidence, and Risk Appraisal. The ACL-RSI contains 2 fear of re-injury items (Emotions domain) and 5 confidence items (Confidence domain). Fear of re-injury has lower representation in the ACL-RSI total score and may not be identified to the same extent as confidence level. The purpose of this study was to examine during return to sport after ACLR 1) the relative ranking of ACL-RSI fear of re-injury item scores compared to other item scores and association with ACL-RSI total score, and 2) the association of ACL-RSI domain and total scores with kinesiophobia and self-efficacy questionnaire scores. METHODS: Participants were 21 patients with ACLR (mean 17.4 years, 11 males) enrolled in a 5 week (10 visit) group-based return to sport training program. ACL-RSI, Tampa Scale for Kinesiophobia-11 (TSK-11) and Knee Activity Self Efficacy (KASE) questionnaires were administered before and after training. RESULTS: All questionnaire scores improved from pre- to post-training (ACL-RSI: 63.2 to 73.8, TSK-11: 21.4 to 17.3, KASE: 78.5 to 92.5; p < .01). Both ACL-RSI fear of re-injury items ranked in the lowest 3 item scores at pre- and post-training, but had moderate to high correlation with ACL-RSI total score (range: r=.56 to .83, p<.01). ACL-RSI Confidence domain score and total score were positively correlated with KASE score at pre-training, post-training, and in the pre- to post-training change (range: r=.50 to .73, p <.05). ACL-RSI Emotions domain score and total score were not significantly correlated with TSK-11 score at any time point (p>.05). CONCLUSIONS: Athletes with high fear of re-injury should be appropriately identified by their ACL-RSI score. It appears necessary to administer the TSK-11 separately to identify high kinesiophobia, whereas a separate questionnaire for knee self-efficacy does not appear warranted.