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Validity, Reliability, and Responsiveness of the Anterior Cruciate Ligament Quality of Life Measure: A Continuation of Its Overall Validation

Lafave, Mark R. PhD; Hiemstra, Laurie MD, PhD; Kerslake, Sarah MSc, BPhty; Heard, Mark MD; Buchko, Greg MD

Clinical Journal of Sport Medicine: January 2017 - Volume 27 - Issue 1 - p 57–63
doi: 10.1097/JSM.0000000000000292
Original Research

Objective: The purpose is to provide more validity, reliability, and responsiveness testing of the anterior cruciate ligament–quality of life instrument (ACL-QOL), particularly in light of consensus-based standards for the selection of health status measurement instruments (COSMIN) guidelines.

Design: Prospective case series.

Setting: An orthopedic surgical practice for consultation.

Patients: A convenience sample of 579 ACL-deficient patients.

Intervention: Anterior cruciate ligament reconstructive surgery.

Main Outcome Measures: Patients completed the ACL-QOL at initial visit and underwent reconstructive surgery. Patients were followed at 6, 12, and 24 months using the ACL-QOL to determine its validity and responsiveness. Cronbach's alpha was used to determine the unidimensionality of the ACL-QOL. A subset of patients took the ACL-QOL twice in a test–retest reliability analysis (intraclass correlation coefficient or ICC 2,k). Another subset of 24-month postsurgical patients measured the success of their surgery using a 7-point global rating scale of improvement as an anchor-based method of responsiveness.

Results: Cronbach's alpha coefficients = 0.93, 0.95, 0.96, and 0.98 at 6, 12, and 24 months, respectively. Intraclass correlation coefficient = 0.60, SEM = 6.16, and confidence interval of 12.1 (CI 95%). Responsiveness was measured by comparing the 4 serial time periods. Patients improved significantly at each time period (P < 0.05, ETA squared 0.61). A 24-month ACL-QOL was significantly correlated (P > 0.05) to being “significantly better” or “somewhat better.”

Conclusions: The results of this study added more validity, reliability, and responsiveness for the ACL-QOL. The ACL-QOL has completed 8 of 9 COSMIN criteria.

*Mount Royal University, Calgary, Alberta, Canada; and

Banff Sport Medicine, Banff, Alberta, Canada.

Corresponding Author: Mark R. Lafave, PhD, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB, T3E 6K6 (

The authors report no conflicts of interest.

Received May 24, 2015

Accepted September 23, 2015

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.