title: A novel patient-reported outcome measure for anterior cruciate ligament injury: evaluating the reliability, validity, and responsiveness of Japanese anterior cruciate ligament questionnaire 25.
abstract: OBJECTIVE
  Despite objectively good results, up to 70 % of individuals may not return to their pre-injury level of sports activity after anterior cruciate ligament (ACL) reconstruction surgery. Although psychological responses have been shown to affect outcomes after ACL injury, an appropriate means of measuring their effects, in addition to functional status, has not been determined. The purpose of this study was to develop a patient-reported questionnaire for measuring psychological factors associated with outcomes after ACL injury and to evaluate its reliability, validity, and responsiveness.
  
  
  METHODS
  After item analysis based on the results of two pilot studies and a short relevance assessment, 25 questionnaire items were selected for the Japanese Anterior Cruciate Ligament Injury Questionnaire 25 (JACL-25) and assessed for validity, reliability, and responsiveness in subjects with ACL injury.
  
  
  RESULTS
  The JACL-25 had no floor or ceiling effects and no confounding factors. A Cronbach's alpha coefficient of 0.981 and a Guttman split-half coefficient of 0.983 indicated excellent reliability. Large standardized response means (1.30-1.62) and effect sizes (0.96-1.51) from the preoperative to postoperative period indicated good responsiveness. Construct structures were created, and these items were separated into three domains. Strong correlations between the JACL-25 and the International Knee Documentation Committee Subjective Knee Form (r s = -0.86), Lysholm Score (r s = -0.73), and Tegner Activity Scale (r s = -0.65) indicated good concurrent validity of the JACL-25.
  
  
  CONCLUSIONS
  The present study demonstrated that the JACL-25 was valid, reliable, and responsive enough to evaluate psychological factors associated with outcomes in individuals with ACL injuries.
  
  
  METHODS
  Diagnostic study, Level III.
authors.affiliation: Department of Orthopedic Surgery, Juntendo University Nerima Hospital, 3-1-10 Takanodai Nerima-ku, Tokyo, 177-8521, Japan. nagao@juntendo.ac.jp.
authors.forename: Masashi
authors.initials: M
authors.lastname: Nagao
authors.affiliation: Hakucho Geriatric Healthcare Facility, Tokyo, Japan.
authors.forename: Tokuhide
authors.initials: T
authors.lastname: Doi
authors.affiliation: Department of Orthopedic Surgery, Juntendo University Hospital, Tokyo, Japan.
authors.forename: Yoshitomo
authors.initials: Y
authors.lastname: Saita
authors.affiliation: Department of Orthopedic Surgery, Juntendo University Hospital, Tokyo, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Kobayashi
authors.affiliation: Department of Orthopedic Surgery, Juntendo University Hospital, Tokyo, Japan.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Kubota
authors.affiliation: Department of Orthopedic Surgery, Juntendo University Hospital, Tokyo, Japan.
authors.forename: Haruka
authors.initials: H
authors.lastname: Kaneko
authors.affiliation: Department of Orthopedic Surgery, Juntendo University Hospital, Tokyo, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Takazawa
authors.affiliation: Department of Orthopedic Surgery, Juntendo University Hospital, Tokyo, Japan.
authors.forename: Muneaki
authors.initials: M
authors.lastname: Ishijima
authors.affiliation: Department of Orthopedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Kurosawa
authors.affiliation: Department of Orthopedic Surgery, Juntendo University Hospital, Tokyo, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kaneko
authors.affiliation: Department of Orthopedic Surgery, Juntendo University Nerima Hospital, 3-1-10 Takanodai Nerima-ku, Tokyo, 177-8521, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Nozawa
authors.affiliation: Department of Orthopedic Surgery, Juntendo University Hospital, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ikeda
authors.affiliation: Department of Orthopedic Surgery, Juntendo University Nerima Hospital, 3-1-10 Takanodai Nerima-ku, Tokyo, 177-8521, Japan.
authors.forename: Sung-Gon
authors.initials: SG
authors.lastname: Kim
mesh_terms: D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries / Q000523:psychology* / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D065466:Lysholm Knee Score; D008297:Male; D000071066:Patient Reported Outcome Measures; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires
keywords: Anterior cruciate ligament injury; JACL-25; Questionnaires; Validation study