Kinesiophobia Is Negatively Associated With Psychological Readiness to Return to Sport in Patients Awaiting Anterior Cruciate Ligament Reconstruction.

PURPOSE: To identify the factors associated with anterior cruciate ligament return to sport after injury (ACL-RSI) scores in patients awaiting ACL reconstruction (ACLR). METHODS: This was a retrospective cross-sectional observational study conducted at a single clinical center. We recruited patients scheduled for primary ACLR, aged 16-45 years, and with modified Tegner activity scale scores ≥5 before ACL injury. The main outcome was psychological readiness to return to sport (RTS), as measured using the ACL-RSI scale. Participants' personal and injury-related information were obtained, and their psychological status (Tampa Scale for Kinesiophobia [TSK] and athletic identity measurement scale) and knee functions (effusion, range of motion, joint stability, and knee flexion angle during a single-leg squat) were examined. All variables were assessed the day before the surgery. RESULTS: A total of 105 patients (median [interquartile range]: age, 20.0 [9.0] years; body mass index, 22.8 [4.3] kg/m2; days from injury to surgery, 63.0 [65.0] days; 44% female) were enrolled. Univariate analysis indicated that only the TSK score was associated with the ACL-RSI scores (r = -0.305; P = .02). Multiple regression analysis of factors, including sex, preinjury Tegner activity scale score, and days from injury to surgery, further showed that only the TSK score was associated with the ACL-RSI scores (P = .002; 95% confidence interval -1.738 to -0.394). CONCLUSIONS: In patients awaiting ACLR, kinesiophobia was moderately negatively associated with psychological readiness to RTS, while other factors were not. LEVEL OF EVIDENCE: Level III, retrospective cross-sectional observational study.

Changes in subjective knee function and psychological status from preoperation to 6 months post anterior cruciate ligament reconstruction.

PURPOSE: To determine characteristic changes in subjective knee function, kinesiophobia, and psychological readiness to return to sports between scores taken before anterior cruciate ligament reconstruction (ACLR) and those taken 6 months post-ACLR. METHODS: Thirty-two participants (median age, 20.0 years) were included. Subjective knee function was assessed using the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF). The Tampa Scale for Kinesiophobia (TSK-11) and Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) scale were used to evaluate kinesiophobia and psychological readiness to return to sport, respectively. Questionnaires were administered 1 day before surgery and at 6 months post-ACLR. A positive change was defined as an increase in IKDC-SKF and ACL-RSI scores and a decrease in TSK-11 score. The change in each score from pre-ACLR to 6 months post-ACLR was analyzed using a paired t-test. The percentage change in scores was calculated, and the correlations of the percentage change in the TSK-11 and ACL-RSI scores and that in the IKDC-SKF score were analyzed. RESULTS: All scores differed significantly positively from pre-ACLR to 6 months post-ACLR. The proportion of participants whose scores did not change positively from pre-ACLR to 6 months post-ACLR was higher for the TSK-11 (38.0%) and ACL-RSI (38.0%) than for the IKDC-SKF (6.3%). No correlation was observed between the percentage change in the IKDC-SKF score and that in the TSK-11 or ACL-RSI scores from pre-ACLR to 6 months post-ACLR. CONCLUSIONS: Changes in subjective knee function and psychological status from pre-ACLR and 6 months post-ACLR may not be interdependent.

The psychological readiness to return to sports of patients with anterior cruciate ligament reconstruction preoperatively and 6 months postoperatively.

OBJECTIVE: To determine the association of psychological readiness to return to sports preoperative and 6 months post-reconstruction in athletes with anterior cruciate ligament (ACL) injury. DESIGN: Retrospective cohort study. SETTING: Clinical center of sports medicine. PARTICIPANTS: Fifty athletes, aged 16-45 years, were included in this study. Participants had a modified Tegner activity scale score ≥5 before ACL injury. MAIN OUTCOME MEASURES: Participants were divided into High and Low groups based on ACL-return to sport after injury scale (ACL-RSI) scores 6 months post-ACL reconstruction (ACLR) (cutoff: 56 points). RESULTS: The Low group had lower ACL-RSI scores than the High group preoperatively (P < 0.001) and 6 months post-ACLR (P < 0.001). The High group had a significantly greater amount of change in ACL-RSI scores preoperatively to 6 months post-ACLR than the Low group (P = 0.003). Preoperative ACL-RSI scores increased significantly to 6 months post-ACLR in the entire group of participants (P < 0.001) and in the High group (P < 0.001). However, in the Low group, ACL-RSI scores did not increase significantly (P = 0.714). CONCLUSIONS: Participants with low ACL-RSI scores 6 months post-ACLR had low preoperative ACL-RSI scores that did not improve preoperatively to 6 months post-ACLR.

Construct Validity and Reliability of the Japanese Version of the Lumbar Stiffness Disability Index.

STUDY DESIGN: Outcome study to determine the construct validity and reliability of the Japanese version of the Lumbar Stiffness Disability Index. OBJECTIVE: The aim of this study was to evaluate the psychometric measurement properties of the Japanese version of the Lumbar Stiffness Disability Index (J-LSDI) following lumbar spinal surgery in order to assess its construct validity and reliability. SUMMARY OF BACKGROUND DATA: The LSDI was designed and validated as a tool to assess functional impacts of lumbar spine stiffness and diminished spinal flexibility. A Japanese version has been developed, but its construct validity and reliability have not been evaluated. METHODS: A Pearson correlation coefficient was calculated using flexion and extension range of motion, Oswestry Disability Index (ODI) and Tampa Scale for Kinesiophobia (TSK) as external standards to evaluate construct validity. An intraclass correlation coefficient (ICC) and a Bland-Altman analysis were used to evaluate test-retest reliability. RESULTS: A total of 244 patients following lumbar spinal surgery participated in the study. Fifty one of the 244 patients participated in the reliability study. The ICC of the J-LSDI for test-retest reliability was 0.89 (95% confidence interval, 0.79-0.93). There was no systematic error found in the results of the Bland-Altman analysis. One hundred ninety-three of the 244 patients participated in the validity study. There were significant correlations between the J-LSDI and trunk flexion range of motion (r = -0.66), extension (r = -0.51), ODI (r = 0.62), and TSK (r = 0.38). CONCLUSION: The construct validity and reliability of the Japanese version of the LSDI were confirmed. The J-LSDI can be used to evaluate lumbar stiffness and associated disability in Japanese patients following lumbar spinal surgery.Level of Evidence: 2.

Factors Associated With Psychological Readiness to Return to Sports With Cutting, Pivoting, and Jump-Landings After Primary ACL Reconstruction.

BACKGROUND: High psychological readiness is an important element for returning to sports after anterior cruciate ligament (ACL) reconstruction. Identifying factors that contribute to psychological readiness is essential for planning interventions to return to play. No studies have used multivariate analysis to clarify factors associated with psychological readiness to return to specific sports. HYPOTHESIS: To identify factors that contribute to an athlete's psychological readiness to return after ACL reconstruction to sports that require cutting, pivoting, and jump-landings. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Study participants were athletes who before injury had participated in sports with limited contact that required cutting, pivoting, and jump-landings (basketball, soccer, futsal, volleyball, badminton, tennis, and frisbee) and hoped to return to the same sport after reconstruction. Psychological readiness was measured using the Anterior Cruciate Ligament-Return to Sport After Injury Scale (ACL-RSI) in athletes more than 6 months after primary ACL reconstruction. To clarify factors associated with the ACL-RSI, univariate regression analysis and multivariate regression analysis were performed using the following independent variables: age, sex, body mass index, time from injury to reconstruction, time from reconstruction to testing, meniscal surgery, modified Tegner activity scale before injury, kinesiophobia, limb symmetry index of knee strength, limb symmetry indices of single-leg hop (SLH) distances, and subjective running ability. RESULTS: Higher subjective running ability, a lower kinesiophobia score, and greater limb symmetry in the lateral SLH were positively associated with psychological readiness. CONCLUSION: The psychological readiness of athletes aiming to return after ACL reconstruction to limited-contact sports that require cutting, pivoting, and jump-landings was affected by subjective running ability, kinesiophobia, and asymmetry of lateral SLH distance. This information may be useful in planning appropriate interventions and thereby increasing the likelihood of an athlete's returning to such sports.

The Japanese version of the anterior cruciate ligament-return to sport after injury (ACL-RSI) scale has acceptable validity and reliability.

PURPOSE: The anterior cruciate ligament-return to sports after injury (ACL-RSI) scale assesses the psychological impact of returning to sports (also referred to as psychological readiness) after ACL reconstruction. The aim of this study was to evaluate important measurement properties of the Japanese version of ACL-RSI scale. METHODS: Ninety-three participants who underwent ACL reconstruction filled out the Japanese version of ACL-RSI scale, the Tampa scale for kinesiophobia (TSK), the International Knee Documentation Committee-Subjective Knee Form (IKDC-SKF), and Knee injury and Osteoarthritis Outcome Score (KOOS). To assess test re-test reliability, 50 of the 93 participants re-answered the Japanese version of ACL-RSI scale within 10 days. Floor and ceiling effects, internal consistency, construct validity, and reliability of the Japanese version of ACL-RSI scale were analysed. RESULTS: There were no floor and ceiling effects. The Japanese version of ACL-RSI scale showed good internal consistency (Cronbach's alpha = 0.912). It was positively correlated with total points of IKDC-SKF and the Lysholm score, and with the all sub-categories of the KOOS, and it was negatively correlated with the TSK. Reliability of the Japanese version of ACL-RSI scale was satisfactory. CONCLUSION: The Japanese version of ACL-RSI scale has acceptable measurement properties. It can be a useful for evaluation of psychological readiness for return to sports in Japanese athletes who undergo primary ACL reconstruction. Information provided by the Japanese version of the ACL-RSI scale may also help to identify athletes who find return to sport a challenge, and guide conversations regarding treatment and rehabilitation plans. LEVEL OF EVIDENCE: II.