The TSK-11: The importance using of Patient Reported Outcome for Return to Play decisions

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The TSK-11 and Patient Reported Outcome Measures

DorsaVi’s Athletic Movement Index (AMI) is an amazing tool for clinicians to make Return to Play decisions, but we hope to encourage our customers to increase the validity of their Return to Play assessments by utilizing Patient Reported Outcomes Measures (PROMs), specifically the Tampa Scale Kinesophobia-11 (TSK-11).


What is the TSK-11? And why is this PROM so important in ACL Return to Play assessments? 

The TSK-11 is a questionnaire designed to assess an athlete’s mental status after sustaining a lower extremity injury; primarily used in the ACL sphere, it also has some application with foot, ankle and hip injuries (click here to check out the TSK-11 questionnaire).


Ultimately, the TSK-11 assesses the athlete’s fear to bear weight and trust their previously injured limb. For example, if an athlete sustains an ACL injury and has reconstructive surgery on his right leg, they are likely fearful of cutting right and weight bearing on the right leg. This consideration is hugely significant when a clinician is making a Return to Play decision, as an athlete’s mental status hugely affects their performance. This has been made clear by the research:

  • According to a study conducted by Dr Mark Paterno, if an athlete scores 19 or greater on the TSK-11 after sustaining an ACL injury, they are 13x more likely to reinjure with return to sport (Paterno, American Journal of Sports Medicine, 2018).
  • Another study used the Vertical Drop Jump Test to show that those who scored poorly on the TSK-11 were likely to keep their weight off their previously injured side. So, if an athlete sustained an ACL injury on their left leg, they would unload the involved side and favour the right. If this is not corrected, then the athlete faces a greater risk of reinjury (Noehren, Orthopaedic Jounral of Sports Medicine, 2017).


It is clear that the TSK-11 scores are strongly associated with an athlete’s reinjury risk and are also able to reflect the confidence of an athlete’s movement. Thus, using the TSK-11 assessment would make a great addition to Return to Play protocol, especially in tandem with the AMI.


How does the TSK-11 complement dorsaVi’s AMI Assessment?

Historically, when a clinician makes a Return to Play decision it is done with the naked eye, as they watch the athlete jump, run and complete a series of activities. This is not very accurate or reproducible and as a result movement fault can be missed, with the AMI the athlete’s movement is measured with accurate, easy to read objective data. To tie the AMI with the TSK-11 will make the AMI an even more powerful tool.


These two assessments share a symbiotic relationship. If an athlete scores poorly on their TSK-11, they can be assessed under an AMI assessment. The AMI test results will then reflect whether an athlete is fearful of weight-bearing as the Single Leg tests will reveal any apprehension in using their previously injured leg.

In fact, Dr Trent Nessler is conducting a research study with ASMI (American Sports Medicine Institute, Alabama) in order to assess the correlation between the TSK-11 and the AMI. This is a multi-state study, with multiple clinics around the US. Already, the findings appear very positive: suggesting that poor scores on the TSK-11 are reflected in the athlete’s AMI assessment.

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