What is the Tegner Activity Scale?
The Tegner Activity Scale (TAS) is a self-administered patient-reported measure that describes the level of work- and sports-based activity in which a patient can engage. It was developed by Dr. Yelverton Tegner and Dr. Jack Lysholm in Sweden and first described in 1985 (1). Rather than a stand-alone test, the TAS was designed with the purpose of complementing the Lysholm score (2) used to measure outcomes of knee ligament surgery (3).
Structure and Scoring
The TAS is a one-item questionnaire that is scored on an 11-item scale (0 to 10) based on the patient’s reported level of activity/work. A level of 0 represents maximum disability while a level of 10 represents elite sports athletes. Patients are asked to choose the highest level of activity they partake in at that moment, using the following levels:
Level 10 – Competitive sports: soccer, football, rugby (national or international elite)
Level 9 – Competitive sports: soccer, football, rugby (lower divisions); ice hockey; wrestling; gymnastics; basketball
Level 8 – Competitive sports: racquetball, squash or badminton, track and field athletics (jumping, etc.), downhill skiing
Level 7 – Competitive sports: tennis, running, motorcar speedway, handball; recreational sports: soccer, football, rugby, ice hockey, basketball, squash, racquetball, running
Level 6 – Recreational sports: tennis and badminton, handball, racquetball, downhill skiing, jogging at least 5 times per week
Level 5 – Work: heavy labor (construction, etc.); competitive sports: cycling, cross-country skiing; recreational sports: jogging on uneven ground at least twice weekly
Level 4 – Work: moderately heavy labor (e.g. truck driving, etc.); recreational sports: cycling, cross-country skiing, jogging on even ground at least twice weekly
Level 3 – Work: light labor (nursing, etc.); competitive and recreational sports: swimming, walking in forest possible
Level 2 – Walking on uneven ground is possible but impossible to backpack or hike
Level 1 – Work: sedentary (secretarial, etc.)
Level 0 – Sick leave or disability pension because of knee problems
Strengths
The TAS is widely used in the clinical setting alongside the Lysholm score. It has been validated in a variety of knee injuries and pathologies involving ligaments, menisci, articular cartilage, and even patellar dislocations. It is also used and validated in the setting of other joints such as the hip and ankle.
A widely-cited study by Briggs et al. in 2009 evaluated the psychometric properties of the TAS in a cohort of over 500 patients that were treated with ACL reconstruction and had other concomitant injuries, such as meniscal tears and chondral defects. It demonstrated acceptable test-retest reliability (ICC of 0.82); good content, criterion, and construct validity; and generally great responsiveness that did not differ between isolated and combined ACL injuries (3).
The TAS has been validated in a variety of languages including English, Spanish, Dutch, Italian, German, Greek, Chinese, Turkish, and Arabic, among others (3).
Considerations
While a reliable and valid tool, the TAS does not have a gold standard comparison scale to describe its validation. The measure was also developed in Europe, where perceptions of sports and activity levels may differ to those within the United States (3).
Additionally, the TAS score combines both sports and work activities onto the same scale. Competitive sports make up levels 6 through 10, while work-related activities start at level 5. As a result, a patient could have a lower score only because they work in heavy labor, such as construction, and do not play competitive sports.
Overall, the TAS is a validated tool that includes only one item, making it a quick and easy-to-understand patient-reported outcome tool. However, it is important to keep in mind that the TAS was created to be used alongside other tools, specifically the Lysholm Knee Questionnaire.
Licensing
The TAS is free to use and does not have any licensing requirements.
Resources
(1) Rating systems in the evaluation of knee ligament injuries | (2) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale | (3) The reliability, validity, and responsiveness of the Lysholm score and Tegner activity scale for anterior cruciate ligament injuries of the knee: 25 years later
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