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

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  1 , Jed A Diekfuss  2 , Joseph D Lamplot  3 , Anne-Inger Mørtvedt  4 , Lauren C Hoey  5 , Kevin Heo  6 , Camryn B Petit  7 , Kim D Barber Foss  7 , Shayla M Warren  7 , Alexis B Slutsky-Ganesh  8 , Charles D Kenyon  6 , April L McPherson  9 , Michael E Biller  10 , Michael Newsome  11 , Brian Jennings  10 , John W Xerogeanes  6 , Gregory D Myer  12
Affiliations

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 et al. Orthop J Sports Med. .

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.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: J.D.L. has received education payments from United Orthopedics, Smith & Nephew, and Elite Orthopedics; consulting fees from DePuy Synthes; and hospitality payments from Arthrex and Smith & Nephew. J.W.X. has received education payments from United Orthopedics, consulting fees from Arthrex and Trice Medical, nonconsulting fees from Arthrex, and royalties from Arthrex and has stock options in My-Eye. G.D.M. has received research support from Q30 Innovations and ElMinda and royalties from Human Kinetics and Wolters Kluwer and holds a patent in rehabilitation-enhancing biofeedback technologies (US11350854B2). AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval for this study was waived by Michigan Technological University (reference No. M2152).

Figures

Figure 1.
Figure 1.
Stacked bar chart with percentage of respondents that selected each PROM item as one of their top 2 items of greatest utility for each construct. Patient data were acquired for only 1 timepoint, specifically the timepoint that best aligned with the respective patient's current postoperative recovery stage. Preoperative data were not collected from practitioners for the constructs of donor site issues or psychological readiness, as these 2 constructs would have limited relevance. ADL, activities of daily living; postop, postoperative; preop, preoperative; PROMs, patient-reported outcome measures; RTS, return to sport.
Figure 2.
Figure 2.
Proportion of responses of importance ratings for various PROM constructs. PROM, patient-reported outcome measure.
Figure 3.
Figure 3.
Proportion of responses for when it would be necessary to assess the 4 PRO constructs. ADL, activities of daily living; postop, postoperative; preop, preoperative; PRO, patient-reported outcome; RTS, return to sport.
Figure 4.
Figure 4.
Usefulness proportions across various items and constructs. Percentages shown indicate combined proportion of “very useful” and “extremely useful” ratings for each item (light blue + dark blue shadings). PROM, patient-reported outcome measure.
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