Assessing activity participation in the ACL injured population: a systematic review of activity rating scale measurement properties

Figures & data

Table 1. Full search strategy used in Medline

1	Exp Anterior cruciate ligament	7652
2	ACL.mp†	6456
3	1 OR 2	10 289
4	Exp ‘reproducibility of results’	207 148
5	Reliability.mp	71 199
6	Validity.mp	76 552
7	Responsiveness.mp	67 759
8	EXP Psychometrics	43 078
9	4 OR 5 OR 6 OR 7 OR 8	348 327
10	EXP Outcomes assessment (healthcare)	505 855
11	EXP Questionnaires	227 746
12	Rating scales.mp	50 927
13	Measurement.mp	330 919
14	EXP treatment outcome	471 671
15	10 OR 11 OR 12 OR 13 OR 14	1 056 053
16	EXP Sports	88 865
17	Return to sport.mp	208
18	EXP recovery of function	19 977
19	Participation.mp	92 438
20	Physical activity.mp	34 869
21	EXP exercise	53 931
22	16 OR 17 OR 18 OR 19 OR 20 OR 21	259 219
23	3 AND 15 AND 22	362
24	3 AND 9 AND 15 AND 22	22

Note: *EXP = explode search term; †mp = keyword search.

Table 2. Evaluation criteria from the critical appraisal tool. Reproduced with permission from MacDermid et al.23

Evaluation criteria	Score
Study question	2	1	0
1. Was the relevant background work cited to define what is currently known about the psychometric properties of measures under study, and the potential contributions of the current research question?
Study design
2. Were appropriate inclusion/exclusion criteria defined?
3. Were specific psychometric hypothesis identified?
4. Was an appropriate scope of psychometric properties considered?
5. Was an appropriate sample size calculated?
6. Was an appropriate retention/follow up obtained?
Measurements
7. Were specific descriptions provided of the techniques used to collect the measurements reported?
8. Did measurement procedures use standardized techniques (and other methods required) to minimize potential sources of error/misinterpretation in the individual measures taken from the study?
Analysis
9. Were analyses conducted for each specific hypothesis or purpose?
10. Were appropriate statistical tests conducted to obtain point estimates of the psychometric property?
11. Were appropriate ancillary analysis done to describe properties beyond the point estimates (CI, benchmark comparisons, SEM/MID)
Recommendations
12. Were the conclusions/clinical recommendations supported by the study objectives, analysis and results?
Subtotals (of columns 1 and 2)
Total score (sum of subtotals/24×100)
If an item is deemed appropriate then you can sum the score of items/2× number of items ×100.

Figure 1. Flowchart showing systematic search process

Table 3. Results of the systematic critical appraisal of each psychometric paper

Study	Scale	Item evaluation criteria												Total %
		1	2	3	4	5	6	7	8	9	10	11	12
Barber-Westin et al. (1999)61	CSAS	2	1	1	1	1	2	1	0	0	1	1	2	54
Briggs et al. (2006)58	Tegner	1	1	2	2	1	2	1	1	2	2	2	2	79
Briggs et al. (2009)59	Tegner	2	1	2	1	1	2	2	1	2	2	2	2	83
Briggs et al. (2009)60	Tegner	2	2	0	1	1	NA	2	2	2	2	1	2	77
Noyes (1989)10	CSAS	1	0	0	0	0	0	2	0	1	0	0	0	17
Marx et al. (2001)17	Marx	1	1	1	1	0	1	1	0	1	1	0	1	38
Paxton et al. (2003)12	Tegner	1	2	1	1	0	1	1	1	2	2	0	2	58
Tegner and Lysholm (1985)11	Tegner	0	1	0	0	0	0	0	0	1	1	0	1	16

Note: Each of the 12 questions scored from a maximum 2 and minimum 0.

Table 4. Psychometric data extracted from each of the included studies

Study	Tegner and Lysholm (1985)11	Paxton et al. (2003)12	Briggs et al. (2006)58	Briggs et al. (2009)59	Briggs et al. (2009)60	Noyes (1989)10	Barber-Westin et al. (1999)61	Marx et al. (2001)17
Population	ACL deficient (n = 73)	Acute (n = 110) and recurrent (n = 43) patellofemoral dislocation	Meniscal injury	ACL reconstruction (n = 505)	Healthy (n = 500)	Chronic knee injured (n = 59)	Knee injured (n = 50)	Knee injured (n = 50)
					255 M; 245 F
	55 M; 21 F		Isolated or combined (n = 122)	Age 37 years (18–77 years)	Age 41 years (18–85 years)		28 M; 22 F	27 M; 23 F
			77 M; 45 F				Age 36 years (13–65 years)	Age 32·8 years (12–57 years) item generation/reduction only
			Age 48 years (14–76 years)				Healthy (n = 50)	Healthy (n = 40)
							22 M; 28 F	27 M; 13 F
							Age 34 years (20–59 years)	Age 33·7 years (18–50 years)
Reliability	N = 76	N = 119	N = 122	N = 50	–	–	N = 100	N = 40
	Retest	Retest 21 days (13–42)	Retest <4 weeks	Retest <4 weeks			Retest 4–13 days	Retest 1 week
	ICC = 0·90–0·97	ICC = 0·92	ICC = 0·817 (95%CI = 0·75–0·87)	ICC = 0·82 (95%CI = 0·66–0·89)			ICC = 0·98	ICC = 0·97
			SEM = 0·4	SEM = 0·64
			MDC = 1	MDC = 1
Content validity	–	N = 153	N = 80	N = 687	–	–	–	Excellent item generation and reduction process
		Floor = 0%	Floor = 2·5–5·5%	Floor = 8%
		Ceiling = 0%	Ceiling = 0–2%	Ceiling = 3%
Known groups validity	–	–	N = 80	N = 687	–	–	–
			All 8 hypothesis significant at P<0·05	All 6 hypothesis significant at P<0·05
Convergent validity	–	–	–	–	Lysholm stairs (p = 0·20; P = 0·01) and squat (p = 0·14; P = 0·001)	–	–	All at P<0·05
								Tegner r = 0·66
								Daniel r = 0·52
								CSAS r = 0·67
Divergent validity	–	Knee rating scales r = 0·20–0·54	–	–	Inverse correlation with age P = −0·44 P = 0·01	–	–	Age r = −0·42; P = 0·02
					Differed by gender P = 0·001
Criterion validity	–	–	N = 80	N = 170	–	–	–	–
			SF-12 physical score	SF-12 physical score
	r = 0·46; P<0·05	p = 0·2; P<0·05
				IKDC p = 0·22; P<0·001
Responsiveness	–	–	N = 80	N = 505	–	–	–	–
			Isolated ES = 0·61	ES = 1·0–1·1
			SRM 0·6	SRM = 0·84–1·2
			Combined ES = 0·83
			SRM 0·704

Note: N = number of subjects; M = male; F = female; ICC = intraclass correlation coefficient; SEM = standard error of measurement; MDC = minimal detectable change; ES = effect size; SRM = standard response mean; IKDC = international knee documentation committee. Blank sections indicate that no data were presented.

Table 5. Capability of rating scale to detect the knee abuser and non-knee related changes in activity participation

Scale	Detect knee abuser	Detect non-knee related change
IKDC	Yes	Yes
Tegner	Yes	No
CSAS	Yes	Yes
Marx	Yes	No

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