Assessing participation in the ACL injured population: Selecting a patient reported outcome measure on the basis of measurement properties

• Tegner, Marx, CSAS and IKDC participation PROMs are investigated.
• Measurement properties are defined according to the COSMIN guideline.
• Tegner activity rating scale has benefits over the other scales.
• Tegner activity rating scale can be interpreted using SDC = 2 and MIC = 1.
• Participation outcomes can be appropriately assessed in UK NHS clinical practice.

Background/aimA return to pre injury activity participation remains a common but often elusive goal following ACL injury. Investigations to improve our understanding of participation restrictions are limited by inconsistent use of insufficiently investigated measurement tools. The aim of this study was to follow the consensus based standards for the selection of health measurement instruments (COSMIN) guideline to provide a comparative evaluation of four patient reported outcomes (PROMs) on the basis of measurement properties. This will inform recommendations for measuring participation of ACL injured subjects, particularly in the United Kingdom (UK) National Health Service (NHS).MethodsThirteen criteria were compiled from the COSMIN guideline. These included reliability, measurement error, content validity, construct validity, responsiveness and interpretability. Data from 51 subjects collected as part of a longitudinal observational study of recovery over the first year following ACLR was used in the analysis.ResultsOf the thirteen criteria, the required standard was met in 11 for Tegner, 11 for International Knee Documentation Committee (IKDC), 6 for Cincinnati Sports Activity Scale (CSAS) and 6 for Marx. The two weaknesses identified for the Tegner are more easily compensated for during interpretation than those in the IKDC; for this reason the Tegner is the recommended PROM.ConclusionsThe Tegner activity rating scale performed consistently well in respect of all measurement properties in this sample, with clear benefits over the other PROMs. The measurement properties presented should be used to inform implementation and interpretation of this outcome measure in clinical practice and research.Level of evidenceLevel II prospective study.