ACL-RTS ACL Return to Sport Questionnaire - Short Version Question Title * 1. Client name: Surname, First Name Question Title * 2. Who is your Physiotherapist? Mandi Hayes Jennifer Duke Anthony Giorgianni Jeanine Stott Beata Sadowska Heather Clegg Chris Cosby I cannot remember 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 feel right now relative to the two extremes. Question Title * 3. Are you confident that you can perform at your previous level of sport participation? 0 Not at all Confident 10 20 30 40 50 60 70 80 90 100 Fully Confident Question Title * 4. Do you think you are likely to reinjure your knee by participating in your sport? 0 Extremely Likely 10 20 30 40 50 60 70 80 90 100 Not at all Likely Question Title * 5. Are you nervous about playing your sport? 0 Extremely Nervous 10 20 30 40 50 60 70 80 90 100 Not at all Nervous Question Title * 6. Are you confident that you could play your sport without concern for your knee? 0 Not at all confident 10 20 30 40 50 60 70 80 90 100 Fully Confident Question Title * 7. Do you find it frustrating to have to consider your knee with respect to your sport? 0 Extremely Frustrating 10 20 30 40 50 60 70 80 90 100 Not at all Frustrating Question Title * 8. Are you fearful of reinjuring your knee by playing your sport? 0 Extremely Fearful 10 20 30 40 50 60 70 80 90 100 Not Fearful at all Question Title * 9. Interpretation of scores (for office use only)Score: (add up score from each question)/6 = _______ Score Range: 0%-100% on psychological readiness to RTS A score > 60 at 6 months post injury is correlated with good likelihood of RTS Webster, K. E., & Feller, J. A. (2018). Development and Validation of a Short Version of the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) Scale. Orthopaedic journal of sports medicine, 6(4). Done
