Development and validation of a scale to assess risk-taking intentions during return to sport following anterior cruciate ligament reconstruction.

INTRODUCTION/

OBJECTIVES

Psychological factors influence return-to-sport (RTS) decisions after anterior cruciate ligament reconstruction (ACLR). While existing tools measure fear and confidence, none specifically capture athletes' risk-taking tolerance and intentions. This study proposes the development and validation of a scale assessing Risk-taking Intentions and Sport Engagement after ACLR (RISE-ACL scale).

METHODS

Scale development consisted of deductive (literature review) and inductive (expert panel) methods. Eleven experts generated and rated relevant items to be included in the consensus RISE-ACL scale. Content validity was established through expert agreement. For scale validation, 162 ACLR participants, 4-24 months postoperatively (median age: 26.5 years; 65% male), completed the newly developed RISE-ACL scale. Criterion validity used a self-rated risk-tolerance scale (0-100%). Construct validity was examined through correlations with the anterior cruciate ligament (ACL)-Return to Sport after Injury (ACL-RSI) scale and clinical/demographic variables, followed by multivariate modeling. Exploratory factor analysis (principal axis factoring) identified factor structure, and principal component analysis explored a short form. Reliability was assessed via Cronbach's alpha and test-retest intraclass correlation coefficient (ICC).

RESULTS

Scale development aimed to a 16-item RISE-ACL scale with good content validity (mean agreement: 86%) and face validity feasibility (mean completion time = 2:05). Criterion validity against the self-rated risk-tolerance scale (0-100%) was moderate and statistically significant (ρ = 0.348, p < 0.001). Construct validity analyses showed that in multivariate modeling, only ACL-RSI remained a statistically significant independent predictor of RISE-ACL scores (Wald χ2 = 6.36, p = 0.012). Factor analysis yielded three interpretable factors: (1) External Pressure, (2) Internal Pressure/Defiance, and (3) Urgency-explaining 47.72% of variance. Factor 3 correlated most with self-perceived risk-taking (ρ = 0.340) and factor 2 most negatively with ACL-RSI (ρ = -0.166). Reliability showed good internal consistency (Cronbach's α = 0.84) and test-retest reliability (ICC = 0.84). A 6-item short form was proposed, showing a strong correlation with the total score (ρ = 0.891).

CONCLUSION

The RISE-ACL is a 16-item self-administered scale designed to assess patients' risk-taking intentions during RTS after ACLR. Validation demonstrated it is a reliable and valid tool, supporting shared decision-making to enhance RTS quality.

CLINICAL TRIAL REGISTRATION: This study was registered under the clinical trial registration number NCT06748066.

LEVEL OF EVIDENCE: II.