Usefulness of Current Patient-Reported Outcome Scales for ACL Injury: A Mixed-Methods Evaluation of Stakeholder-Perceived Utility of Specific Constructs and Items Across the Rehabilitation Timeline

Erich J Petushek; Jed A Diekfuss; Joseph D Lamplot; Anne-Inger Mørtvedt; Lauren C Hoey; Kevin Heo; Camryn B Petit; Kim D Barber Foss; Shayla M Warren; Alexis B Slutsky-Ganesh; Charles D Kenyon; April L McPherson; Michael E Biller; Michael Newsome; Brian Jennings; John W Xerogeanes; Gregory D Myer

doi:10.1177/23259671231218964

Usefulness of Current Patient-Reported Outcome Scales for ACL Injury: A Mixed-Methods Evaluation of Stakeholder-Perceived Utility of Specific Constructs and Items Across the Rehabilitation Timeline

Orthop J Sports Med. 2024 May 22;12(3):23259671231218964. doi: 10.1177/23259671231218964. eCollection 2024 Mar.

Authors

Erich J Petushek¹, Jed A Diekfuss², Joseph D Lamplot³, Anne-Inger Mørtvedt⁴, Lauren C Hoey⁵, Kevin Heo⁶, Camryn B Petit⁷, Kim D Barber Foss⁷, Shayla M Warren⁷, Alexis B Slutsky-Ganesh⁸, Charles D Kenyon⁶, April L McPherson⁹, Michael E Biller¹⁰, Michael Newsome¹¹, Brian Jennings¹⁰, John W Xerogeanes⁶, Gregory D Myer¹²

Affiliations

¹ Department of Cognitive and Learning Sciences and the Health Research Institute, Michigan Technological University, Houghton, Michigan, USA.
² Emory Sports Performance And Research Center [SPARC], Flowery Branch, Georgia, USA; Emory Sports Medicine Center, Atlanta, Georgia, USA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA.
³ Campbell Clinic Orthopaedics, Memphis, Tennessee, USA.
⁴ the Department of Cognitive and Learning Sciences and the Health Research Institute, Michigan Technological University, Houghton, Michigan, USA.
⁵ Department of Biology, Bucknell University, Lewisburg, Pennsylvania, USA.
⁶ Emory Sports Medicine Center, Atlanta, Georgia, USA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA.
⁷ Emory SPARC, Flowery Branch, Georgia, USA; Emory Sports Medicine Center, Atlanta, Georgia, USA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA.
⁸ Emory SPARC, Flowery Branch, Georgia, USA; Emory Sports Medicine Center, Atlanta, Georgia, USA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA; Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA.
⁹ Emory SPARC, Flowery Branch, Georgia, USA; Emory Sports Medicine Center, Atlanta, Georgia, USA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA; Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
¹⁰ Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA; Emory Physical Therapy, Atlanta, Georgia, USA.
¹¹ Department of Orthopaedics, Emory University School of Medicine, Atlanta,Georgia, USA; Emory Physical Therapy, Atlanta, Georgia, USA.
¹² Emory SPARC, Flowery Branch, Georgia, USA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA; Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, USA; The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA; Youth Physical Development Centre, Cardiff Metropolitan University, Wales, UK.

Abstract

Background: Numerous patient-reported outcome measures (PROMs) have been used in patients with anterior cruciate ligament reconstruction (ACLR), often with overlapping constructs of interest and limited content validity. Inefficient scale application increases burden and diminishes overall usefulness for both the patient and practitioner.

Purpose: To isolate specific PROM items across a diverse set of constructs that patients and practitioners perceive as having the greatest value at various stages of recovery and return to sport (RTS) in patients after ACLR.

Study design: Cross-sectional study.

Methods: A combined 77 stakeholders participated in this 2-phase mixed-methods investigation. In phase 1, a total of 27 patients and 21 practitioners selected individual PROM items from various constructs that had the greatest utility or importance. In phase 2, the highest rated items were further tested in a head-to-head comparison with 29 stakeholders who attended the 2022 ACL Injury Research Retreat. In addition to the utility assessment, practitioners answered other questions related to importance and timing of PROM assessments.

Results: In phase 1, both patients and practitioners shared the same top item in 6 of the 8 (75%) constructs assessed. In phase 2, the construct of psychological burden was rated as "extremely important" by 59% of respondents, followed by physical function (54%), symptoms (35%), and donor site issues (10%). The PROM items of confidence, perceived likelihood of reinjury, and difficulty stopping quickly were rated by a respective 93%, 89%, and 86% of the sample as either "very useful" or "extremely useful." All constructs except donor site issues were rated by most stakeholders to be absolutely necessary to evaluate treatment progress and RTS readiness at the 6-month postoperative time and at RTS.

Conclusion: Overall, psychological burden, with specific items related to confidence and reinjury likelihood, were rated as most important and useful by both patients and practitioners. The second most important and useful PROM item was related to higher intensity function (eg, decelerating or jumping/landing activities during sports).

Keywords: construct relevance; content validity; item-relevance; patient-reported outcomes; psychosocial; recovery; rehabilitation; return to sport; usability.