title: The Achilles tendon total rupture score: a study of responsiveness, internal consistency and convergent validity on patients with acute Achilles tendon ruptures.
abstract: BACKGROUND
  The Achilles tendon Total Rupture Score was developed by a research group in 2007 in response to the need for a patient reported outcome measure for this patient population. Beyond this original development paper, no further validation studies have been published.Consequently the purpose of this study was to evaluate internal consistency, convergent validity and responsiveness of this newly developed patient reported outcome measure within patients who have sustained an isolated acute Achilles tendon rupture.
  
  
  METHODS
  Sixty-four eligible patients with an acute rupture of their Achilles tendon completed the Achilles tendon Total Rupture Score alongside two further patient reported outcome measures (Disability Rating Index and EQ 5D). These were completed at baseline, six weeks, three months, six months and nine months post injury. The Achilles tendon Total Rupture Score was evaluated for internal consistency, using Cronbach's alpha, convergent validity, through correlation analysis and responsiveness, by analysing floor and ceiling effects and calculating its relative efficiency in comparison to the Disability Rating Index and EQ 5D scores.
  
  
  RESULTS
  The Achilles tendon Total Rupture Score demonstrated high internal consistency (Cronbachs alpha > 0.8) and correlated significantly (p < 0.001) with the Disability Rating Index at five time points (pre-injury, six weeks, three, six and nine months) with correlation coefficients between -0.5 and -0.9. However, the confidence intervals were wide. Furthermore, the ability of the new score to detect clinically important changes over time (responsiveness) was shown to be greater than the Disability Rating Index and EQ 5D.
  
  
  CONCLUSIONS
  A universally accepted outcome measure is imperative to allow comparisons to be made across practice. This is the first study to evaluate aspects of validity of this newly developed outcome measure, outside of the developing centre. The ATRS demonstrated high internal consistency and responsiveness, with limited convergent validity. This research provides further support for the use of this outcome measure, however further research is required to advocate its universal use in patients with acute Achilles tendon ruptures. Such areas include inter-rater reliability and research to determine the minimally clinically important difference between scores.All authors have read and concur with the content of this manuscript. The material presented has not been and will not be submitted for publication elsewhere, except as an abstract. All authors have made substantial contributions to all of the following: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content and (3) final approval of the submitted version. This research has been funded by Arthritis Research UK, no conflicts of interests have been declared by the authors.
authors.affiliation: Warwick Orthopaedics, Division of Health Sciences, Warwick Medical School, Clinical Sciences Research Laboratories, University Hospital, Clifford Bridge Road, Coventry CV2 2DX, UK. r.s.kearney@warwick.ac.uk
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Kearney
authors.forename: Juul
authors.initials: J
authors.lastname: Achten
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Lamb
authors.forename: Nicholas
authors.initials: N
authors.lastname: Parsons
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Costa
mesh_terms: D000125:Achilles Tendon / Q000293:injuries* / Q000601:surgery; D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology / Q000523:psychology; D011379:Prognosis; D011594:Psychometrics / Q000295:instrumentation; D015203:Reproducibility of Results; D018570:Risk Assessment; D012737:Sex Factors; D011795:Surveys and Questionnaires; D013708:Tendon Injuries / Q000175:diagnosis / Q000523:psychology* / Q000534:rehabilitation / Q000601:surgery*; D006113:United Kingdom; D055815:Young Adult