The Short Version of the ALR-RSI Scale is a Valid and Reproducible Scale to Evaluate Psychological Readiness to Return to Sport After Ankle Lateral Reconstruction

Overview

Journal J Exp Orthop

Publisher Wiley

Specialty Orthopedics

Date 2025 Feb 19

PMID 39968527

Authors

Alizee Mahieu

Mohamad K Moussa

Eugenie Valentin

Ronny Lopes

Alexandre Hardy

Affiliations

Soon will be listed here.

Abstract

Purpose: To develop and validate a short and mini version of the ALR-RSI (Ankle Ligament Reconstruction-Return to Sport after Injury) scale.

Methods: The ALR-RSI scale contains 12 items and was administered to 109 patients following arthroscopic anatomical lateral ankle reconstruction. The short (6-item) and mini (3-item) versions were developed using a systematic selection process to eliminate items based on their category, mean, standard deviation and pertinence. A second group of 75 patients participated in an analysis to validate the predictive value of these scores. These patients filled out all three ALR-RSI versions 6 months after arthroscopic anatomical reconstruction of the lateral ankle to determine the predictive value for the return to sport (RTS) at 12 months. The predictive value was evaluated with receiver operating characteristic curves (area under the curve [AUC]).

Results: The long version of the ALR-RSI had a high internal consistency (Cronbach's = 0.97), suggesting redundancy of certain items. A short version of 6 items was developed (Cronbach's = 0.94). A mini version of 3 items was also developed which retained one key item from each category. Factorial analysis confirmed that only one factor explained 76% of the total variance in the mini version (Cronbach's = 0.89). The scores of the three versions were higher in patients who returned to sport at the same pre-injury level of play or better ( < 0.0001). Both versions were found to have a good predictive value for the RTS at 12 months, with comparable AUC values (full version AUC 0.70 [95% confidence interval; CI, 0.57-0.83]; short version AUC 0.72 [95% CI, 0.59-0.84]); mini version, AUC 0.73 [95% CI, 0.61-0.85].

Conclusion: The shorter versions (6 and 3 items) of the ALR-RSI may be used to predict the RTS at the pre-injury level without affecting the psychometric characteristics of the long score.

Level Of Evidence: Level II prospective cohort study.

Citing Articles

The short version of the ALR-RSI scale is a valid and reproducible scale to evaluate psychological readiness to return to sport after ankle lateral reconstruction.

Mahieu A, Moussa M, Valentin E, Lopes R, Hardy A J Exp Orthop. 2025; 12(1):e70160.

PMID: 39968527 PMC: 11832589. DOI: 10.1002/jeo2.70160.

References

Picot B, Fourchet F, Rauline G, Freiha K, Wikstrom E, Lopes R . Ankle-GO score is associated with the probability of becoming coper after lateral ankle sprain: a 1-year prospective cohort study. Br J Sports Med. 2024; 58(19):1115-1122. PMC: 11503120. DOI: 10.1136/bjsports-2024-108361. View

Perez-de la Cruz S . Validation and Application of a Spanish Version of the ALR-RSI Scale (Ankle Ligament Reconstruction-Return to Sport after Injury) in an Active Non-Athlete Population. J Pers Med. 2023; 13(4). PMC: 10142652. DOI: 10.3390/jpm13040606. View

Webster K, Feller J . Development and Validation of a Short Version of the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) Scale. Orthop J Sports Med. 2018; 6(4):2325967118763763. PMC: 5894922. DOI: 10.1177/2325967118763763. View

Valderrabano V, Hintermann B, Horisberger M, Fung T . Ligamentous posttraumatic ankle osteoarthritis. Am J Sports Med. 2005; 34(4):612-20. DOI: 10.1177/0363546505281813. View

Gerometta A, Klouche S, Herman S, Lefevre N, Bohu Y . The Shoulder Instability-Return to Sport after Injury (SIRSI): a valid and reproducible scale to quantify psychological readiness to return to sport after traumatic shoulder instability. Knee Surg Sports Traumatol Arthrosc. 2017; 26(1):203-211. DOI: 10.1007/s00167-017-4645-0. View

Worner T, Thorborg K, Webster K, Stalman A, Eek F . Psychological readiness is related to return to sport following hip arthroscopy and can be assessed by the Hip-Return to Sport after Injury scale (Hip-RSI). Knee Surg Sports Traumatol Arthrosc. 2020; 29(5):1353-1361. PMC: 8038984. DOI: 10.1007/s00167-020-06157-4. View

Pioger C, Guillo S, Bouche P, Sigonney F, Elkaim M, Bauer T . The ALR-RSI score is a valid and reproducible scale to assess psychological readiness before returning to sport after modified Broström-Gould procedure. Knee Surg Sports Traumatol Arthrosc. 2022; 30(7):2470-2475. PMC: 9206630. DOI: 10.1007/s00167-022-06895-7. View

Clanton T, Matheny L, Jarvis H, Jeronimus A . Return to play in athletes following ankle injuries. Sports Health. 2013; 4(6):471-4. PMC: 3497954. DOI: 10.1177/1941738112463347. View

Webster K, Feller J, 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(1):9-15. DOI: 10.1016/j.ptsp.2007.09.003. View

10.

Ajaka N, Bouche P, Dagher M, Lopes R, Bauer T, Hardy A . The French Ankle Ligament Reconstruction - Return to Sport after Injury (ALR-RSI-Fr) is a valid scale for the French population. J Exp Orthop. 2022; 9(1):27. PMC: 8938531. DOI: 10.1186/s40634-022-00463-1. View

11.

Podlog L, Heil J, Schulte S . Psychosocial factors in sports injury rehabilitation and return to play. Phys Med Rehabil Clin N Am. 2014; 25(4):915-30. DOI: 10.1016/j.pmr.2014.06.011. View

12.

Sigonney F, Lopes R, Bouche P, Kierszbaum E, Moslemi A, Anract P . The ankle ligament reconstruction-return to sport after injury (ALR-RSI) is a valid and reproducible scale to quantify psychological readiness before returning to sport after ankle ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2020; 28(12):4003-4010. PMC: 7669765. DOI: 10.1007/s00167-020-06020-6. View

13.

Pasqualini I, Rossi L, Brandariz R, Tanoira I, Fuentes N, Ranalletta M . The Short, 5-Item Shoulder Instability-Return to Sport After Injury Score Performs as Well as the Longer Version in Predicting Psychological Readiness to Return to Sport. Arthroscopy. 2022; 39(5):1131-1138.e1. DOI: 10.1016/j.arthro.2022.10.010. View

14.

Mukaka M . Statistics corner: A guide to appropriate use of correlation coefficient in medical research. Malawi Med J. 2013; 24(3):69-71. PMC: 3576830. View

15.

Clement D, Arvinen-Barrow M, Fetty T . Psychosocial responses during different phases of sport-injury rehabilitation: a qualitative study. J Athl Train. 2014; 50(1):95-104. PMC: 4299742. DOI: 10.4085/1062-6050-49.3.52. View

16.

Picot B, Lopes R, Rauline G, Fourchet F, Hardy A . Development and Validation of the Ankle-GO Score for Discriminating and Predicting Return-to-Sport Outcomes After Lateral Ankle Sprain. Sports Health. 2023; 16(1):47-57. PMC: 10732116. DOI: 10.1177/19417381231183647. View

17.

Shitrit E, Valentin E, Baudrier N, Bohu Y, Rauline G, Lopes R . The ALR-RSI score can be used to evaluate psychological readiness to return to sport after acute Achilles tendon tear. Knee Surg Sports Traumatol Arthrosc. 2023; 31(11):4961-4968. PMC: 10598148. DOI: 10.1007/s00167-023-07548-z. View

18.

Martin R, Irrgang J, Burdett R, Conti S, Van Swearingen J . Evidence of validity for the Foot and Ankle Ability Measure (FAAM). Foot Ankle Int. 2005; 26(11):968-83. DOI: 10.1177/107110070502601113. View

19.

Picot B, Hardy A, Terrier R, Tassignon B, Lopes R, Fourchet F . Which Functional Tests and Self-Reported Questionnaires Can Help Clinicians Make Valid Return to Sport Decisions in Patients With Chronic Ankle Instability? A Narrative Review and Expert Opinion. Front Sports Act Living. 2022; 4:902886. PMC: 9204606. DOI: 10.3389/fspor.2022.902886. View

20.

Ardern C, Taylor N, Feller J, Webster K . A systematic review of the psychological factors associated with returning to sport following injury. Br J Sports Med. 2012; 47(17):1120-6. DOI: 10.1136/bjsports-2012-091203. View