Validation of a Survey to Characterize Barriers to Physical Activity After Anterior Cruciate Ligament Reconstruction

Christopher Kuenze; Caroline Lisee; Ashley Triplett; Katherine Collins; Michelle Walaszek; Jordan Lewis; Nathan Farner; Matthew Harkey; Shelby Baez

doi:10.4085/1062-6050-0436.22

Validation of a Survey to Characterize Barriers to Physical Activity After Anterior Cruciate Ligament Reconstruction

J Athl Train. 2023 Oct 1;58(10):841-848. doi: 10.4085/1062-6050-0436.22.

Authors

Christopher Kuenze¹, Caroline Lisee², Ashley Triplett³, Katherine Collins³, Michelle Walaszek¹, Jordan Lewis⁴, Nathan Farner⁴, Matthew Harkey³, Shelby Baez²

Affiliations

¹ Department of Kinesiology, University of Virginia, Charlottesville.
² MOTIONScience Institute, University of North Carolina at Chapel Hill.
³ Department of Kinesiology, Michigan State University, East Lansing.
⁴ College of Osteopathic Medicine, Michigan State University, East Lansing.

PMID: 36521177
DOI: 10.4085/1062-6050-0436.22

Abstract

Context: Although 84% of patients expected to return to activity within 1 year of anterior cruciate ligament (ACL) reconstruction (ACLR), as few as 24% will return to their preinjury level of activity. By considering a patient's perceptions of reengagement in activity after ACLR, clinicians and researchers may be better equipped to implement interventions that are patient centered.

Objective: To describe the validation of the ACL Reasons survey, a tool to aid clinicians and researchers in understanding patient perceptions of barriers to physical activity (PA) engagement after ACLR.

Design: Cross-sectional study.

Patients or other participants: The ACL Reasons survey was administered via Qualtrics to 78 patients 6 to 24 months after primary, unilateral ACLR. Patients were categorized as active, more challenging, or less active based on their responses to the ACL Reasons.

Main outcome measure(s): Development of the ACL Reasons survey occurred via an iterative process of drafting and revising based on feedback from a team of external expert reviewers. Tegner activity level, Marx activity score, the Knee injury and Osteoarthritis Outcomes Score (KOOS), ACL Return to Sport after Injury score, and Tampa Scale of Kinesiophobia score were compared among groups using analysis-of-variance and Kruskal Wallis tests.

Results: Groups differed based on Tegner activity level (P < .001), Marx activity score (P = .01), KOOS pain score (P = .02), KOOS symptom score (P = .04), KOOS sports and recreation score (P < .001), KOOS quality of life score (P < .001), ACL Return to Sport after Injury score (P < .001), and Tampa Scale of Kinesiophobia score (P < .001), with the less active group performing worse on each. Knee symptoms, fear of knee symptoms or movement, and fear of injury were the most common reasons for the change in PA engagement.

Conclusions: These results support the validity of the ACL Reasons survey as a tool for identifying barriers to PA engagement after ACLR. This tool may help facilitate communication between patients with ACLR and their health care providers to enhance patient-centered care.

Keywords: patient-centered care; patient-reported outcome measures; qualitative tool.

MeSH terms

Anterior Cruciate Ligament Injuries* / surgery
Anterior Cruciate Ligament Reconstruction* / methods
Cross-Sectional Studies
Exercise
Humans
Quality of Life
Return to Sport / physiology