Tegner

For Medical Students

What It Tests

The Tegner scale places a patient on a graded list of activity levels, from sedentary through recreational to competitive sport. 4.2.23 covers football.

It records what the patient does rather than how the knee feels, which is why it is used alongside a symptom score. 4.22.3 covers the Lysholm score.

It matters because activity level is the context a symptom score is read in, and the same score means different things at different activity levels. 4.22.8 covers the use of these scores.

How It Is Performed

Ask the patient to identify their current level from the graded list rather than describing their activity in their own words.

Ask them also to identify their level before the injury, since the drop is the informative quantity.

Record both values with the date. 4.1.8 covers examination documentation.

Record the sport and the position, because the same level covers different demands. 4.2.25 covers rugby.

Record it alongside a symptom score rather than on its own. 4.22.1 covers the IKDC.

Avoid converting the level into a percentage, since it is an ordered list rather than a measurement.

Record the examination separately. 4.1.4 covers the structured approach.

What a Positive Means

A current level and a pre injury level, with the difference between them, is the result.

A large drop identifies a patient whose activity has changed, which a symptom score may not show if they have adapted. 4.18.6 covers functional limitation.

No drop with a low symptom score identifies a patient continuing their sport despite symptoms. 4.2.10 covers severity.

A return to the pre injury level is one of the criteria used in return to sport work, and it is self reported. 4.21.7 covers return to sport testing.

A low pre injury level means the scale has little room to show change. 4.22.2 covers the KOOS.

No item count, score range or validation figure appears on this page. Those are properties of a published instrument and stating one from memory is the same class of claim as an invented citation, so the page describes what the instrument does and a reviewer with the questionnaire can add the numbers.

MRCS Level

How It Is Performed

In a viva this is the activity scale to name, with the point that it is a companion measure.

The expected points are the graded list, the current and pre injury levels, the difference, the sport and position, the date, the pairing with a symptom score and the separate examination record.

Say that you would record the pre injury level as well as the current one, and give the reason. 4.18.6 covers functional limitation.

Say that it is an ordinal list and not a measurement. 4.22.8 covers the use of these scores.

Say that it is used alongside a symptom score. 4.22.1 covers the IKDC.

What a Positive Means

The reasoning expected is that symptom scores are reported against the patient's current activity, so the activity level is needed to interpret them. 4.22.8 covers the use of these scores.

A patient who has reduced their activity reports fewer symptoms, which is adaptation rather than improvement. 4.18.6 covers functional limitation.

The scale's levels are ordered and unequally spaced, so arithmetic on them is not meaningful. 4.2.10 covers severity.

Activity level is also a risk factor for the problem, which is why it is recorded in a return to sport assessment. 4.21.8 covers return to play decision making.

How Good It Is

The scale is simple, quick and reproducible for a patient placing themselves on a list.

Its best contribution is supplying the context a symptom score is read in, which no symptom score provides for itself. 4.22.1 covers the IKDC.

It is coarse, so a meaningful change in activity can happen within one level.

No examination finding corresponds to it. 4.1.6 covers that relationship.

No figures appear for any accuracy comparison on this page, under decision 023, and the comparison is the claim being made.

No item count, score range or validation figure appears on this page. Those are properties of a published instrument and stating one from memory is the same class of claim as an invented citation, so the page describes what the instrument does and a reviewer with the questionnaire can add the numbers.

FRCS Level

How Good It Is

At decision level the scale contributes the activity context and one of the return to sport criteria.

A symptom score interpreted without an activity level is uninterpretable in an active patient, and this scale supplies it. 4.22.1 covers the IKDC.

A return to the pre injury level is a criterion in return to sport work and it is self reported rather than tested. 4.21.7 covers return to sport testing.

A patient who has dropped level and reports few symptoms has adapted, and identifying that changes the conversation. 4.18.6 covers functional limitation.

Sport and position matter within a level, so they are recorded rather than assumed. 4.2.25 covers rugby.

Where It Misleads

The commonest error is recording the current level without the pre injury one. 4.18.6 covers functional limitation.

The levels are treated as an interval scale and averaged. 4.22.8 covers the use of these scores.

The scale is used alone, as if it were a symptom measure. 4.22.1 covers the IKDC.

A self reported return to level is treated as evidence of recovery. 4.21.8 covers return to play decision making.

The sport within a level is not recorded, so different demands are treated as equal. 4.2.26 covers skiing.

Fellowship Level

Where It Misleads

At fellowship level this scale's coarseness is both why it is usable and why it answers less than it appears to.

A single ordered list compresses sport, frequency, intensity and position into one value, so two patients at the same level are not doing the same thing. 4.2.23 covers football.

The pre injury level is recalled rather than recorded, and recall of activity before an injury is systematically generous. 4.2.9 covers the onset.

The scale's levels were written for the sports of a particular time and place, which affects how a current patient maps onto them. 4.22.8 covers the use of these scores.

Returning to the same level is not the same as returning to the same performance, and the scale does not distinguish them. 4.23.2 covers the elite athlete.

Activity level mediates most of the relationship between a knee problem and a reported score, which makes it a confounder in every comparison that omits it. 4.22.1 covers the IKDC.

No item count, score range or validation figure appears on this page. Those are properties of a published instrument and stating one from memory is the same class of claim as an invented citation, so the page describes what the instrument does and a reviewer with the questionnaire can add the numbers.