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ACL-RSI

ACL-RSI - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Questionnaires


ACL-RSI SCALE

Instructions: Please answer the following questions referring to your main sport prior
to injury. For each question tick a box  between the two descriptions to indicate how
you are feeling right now relative to the two extremes.



1. Are you confident that you can perform at your previous level of sport participation?

0

10

20

30

40

50

60

70

80

90

100




2. Do you think you are likely to re-injure your knee by participating in your sport?

0

10

20

30

40

50

60

70

80

90

100




3. Are you nervous about playing your sport?

0

10

20

30

40

50

60

70

80

90

100




4. Are you confident that your knee will not give way by playing your sport?
0

10

20

30

40

50

60

70

80

90

100




5. Are you confident that you could play your sport without concern for your knee?

0

10

20

30

40

50

60

70

80

90

100





6. Do you find it frustrating to have to consider your knee with respect to your sport?
0

10

20

30

40

50

60

70

80

90

100







Fully
confident
Not likely at
all
Extremely
likely

Not nervous
at all
Extremely
nervous

Fully
confident
Not at all
frustrating
Fully
confident

Not at all
confident

Not at all
confident

Extremely
frustrating

Not at all
confident

7. Are you fearful of re-injuring your knee by playing your sport?

0

10

20

30

40

50

60

70

80

90

100




8. Are you confident about your knee holding up under pressure?

0

10

20

30

40

50

60

70

80

90

100




9. Are you afraid of accidentally injuring your knee by playing your sport?
0

10

20

30

40

50

60

70

80

90

100





10. Do thoughts of having to go through surgery and rehabilitation again prevent you
from playing your sport?
0

10

20

30

40

50

60

70

80

90

100




11. Are you confident about you ability to perform well at your sport?
0

10

20

30

40

50

60

70

80

90

100





12. Do you feel relaxed about playing your sport?

0

10

20

30

40

50

60

70

80

90

100





To score: Sum individual item scores; divide by 12.
Maximum score = 100; higher score indicates more positive psychological response



From: Webster KE, Feller JA, Lambros C. Development and preliminary validation of a scale to
measure the psychological impact of returning to sport following anterior cruciate ligament
reconstruction surgery. Phys Ther Sport; 2008;9:9-15.
No fear
at all
Fully
confident
None of the
time
Fully
confident
Not at all
afraid
Fully relaxed
Extremely
fearful

Not at all
confident

Extremely
afraid

All of the
time

Not at all
confident

Not at all
relaxed