Cross-cultural adaptation and longitudinal validation of the Simplified Chinese PHOSA-ACLR after anterior cruciate ligament reconstruction: a prospective cohort study

Abstract Background To cross-culturally adapt the Photographic Series of Sports Activities for Anterior Cruciate Ligament Reconstruction into Simplified Chinese and evaluate its measurement properties and responsiveness after anterior cruciate ligament reconstruction. Methods The instrument underwent forward translation, synthesis, back-translation, expert review, and pretesting in nine patients. A prospective longitudinal cohort of 177 patients aged 18 to 55 years undergoing primary unilateral anterior cruciate ligament reconstruction was assessed at one, two, four, and six months postoperatively. Internal consistency, preliminary structural validity, construct validity, floor and ceiling effects, longitudinal responsiveness, and seven- to eleven-day test-retest reliability were evaluated. The twelve-item version was used for primary analyses, with the original ten-item scoring and a clinically homogeneous subgroup examined in sensitivity analyses. Results At six months, the twelve-item Simplified Chinese instrument showed excellent internal consistency, with Cronbach alpha and McDonald omega both 0.968, and no substantial floor or ceiling effects. Correlations with kinesiophobia, psychological readiness to return to sport, knee self-efficacy, and knee function were in the prespecified directions. Scores decreased by 17.36 points from one to six months, with a standardized response mean of minus 0.70, compared with minus 0.13 for the seventeen-item Tampa Scale for Kinesiophobia and 0.23 for the Anterior Cruciate Ligament–Return to Sport after Injury scale. Among 168 retested patients, the intraclass correlation coefficient was 0.919, with a standard error of measurement of 7.02 points and a minimal detectable change at the 95% confidence level of 19.47 points. Sensitivity analyses were consistent. Conclusions The twelve-item Simplified Chinese Photographic Series of Sports Activities for Anterior Cruciate Ligament Reconstruction demonstrates excellent reliability, expected construct validity, and good early postoperative responsiveness. It may provide clinically useful task-specific information on fear of harm that complements broader psychological measures during rehabilitation.