Tegner Activity Scale: Understanding Its Purpose, Scoring, and Applications

What is the Tegner scale?

The Tegner Activity Scale is a widely used patient-reported outcome measure designed to quantify a person's level of physical activity, ranging from complete disability to participation in competitive sports, primarily utilized in orthopedic rehabilitation to assess functional recovery, particularly after knee injuries.

Introduction to the Tegner Activity Scale

Developed by Tegner and Lysholm in 1985, the Tegner Activity Scale serves as a crucial tool in exercise science and orthopedics for evaluating an individual's activity level. Its primary purpose is to provide a standardized, numerical representation of a patient's ability to participate in various physical activities, from daily living tasks to high-impact sports. This scale is particularly valuable for assessing pre-injury activity levels and tracking functional recovery post-injury or surgery, offering insights into a patient's return to sport or work.

How the Tegner Scale Works: Scoring System

The Tegner Activity Scale operates on a simple numerical system, assigning a score from 0 to 10 based on the highest level of physical activity an individual can perform. Each score corresponds to a specific category of activity, providing a clear progression from minimal function to elite athletic performance.

Here's a breakdown of the typical scoring criteria:

• Score 0: Sick leave or disability benefit due to knee problems, unable to perform light work.
• Score 1: Sick leave or disability benefit due to knee problems, able to perform light work.
• Score 2: Housework, light work.
• Score 3: Sedentary work (e.g., office work), walking on uneven ground.
• Score 4: Light manual work, cycling.
• Score 5: Moderate manual work, swimming, walking, cross-country skiing.
• Score 6: Heavy manual work, jogging, recreational sports (low impact, e.g., golf, bowling, cycling).
• Score 7: Competitive sports (e.g., badminton, tennis, swimming, jogging).
• Score 8: Competitive sports (e.g., running, cycling, cross-country skiing).
• Score 9: Competitive sports (e.g., soccer, basketball, handball, ice hockey).
• Score 10: Competitive sports (e.g., soccer, rugby, ice hockey) at national or international elite level.

Patients are typically asked to select the single number that best describes their highest current or pre-injury activity level.

Interpretation of Scores

Interpreting Tegner scores involves understanding the context of the assessment.

• Pre-injury vs. Post-injury: The scale is often used to compare a patient's activity level before an injury to their level at various points during rehabilitation. A significant drop in score post-injury indicates functional impairment, while an increase towards the pre-injury score signifies recovery.
• Higher Scores: Indicate greater functional capacity and participation in more demanding physical activities.
• Lower Scores: Suggest limited functional ability and restricted participation in physical activity.

Clinicians and researchers often look for a patient to return to at least 80-90% of their pre-injury Tegner score as a benchmark for successful rehabilitation, particularly in athletes aiming for a return to sport.

Applications in Clinical Practice and Research

The Tegner Activity Scale is widely applied in various settings, particularly within orthopedics and sports medicine.

• Knee Injuries: It is most frequently used in the context of knee injuries, such as anterior cruciate ligament (ACL) ruptures, meniscal tears, and patellofemoral pain syndrome. It helps quantify the impact of these injuries on a patient's daily life and athletic pursuits.
• Surgical Outcome Assessment: Surgeons and physical therapists use the Tegner scale to evaluate the effectiveness of surgical interventions (e.g., ACL reconstruction, total knee arthroplasty) and rehabilitation programs.
• Research Studies: In clinical research, the Tegner scale is a common outcome measure to compare the efficacy of different treatment protocols or rehabilitation strategies. Its standardized nature allows for consistent data collection across studies.
• Patient Counseling: It aids healthcare providers in counseling patients about realistic expectations for return to sport or activity following injury or surgery.

Strengths of the Tegner Scale

The Tegner Activity Scale possesses several strengths that contribute to its widespread adoption:

• Simplicity and Ease of Use: It is quick and straightforward to administer, requiring minimal time and training.
• Patient-Reported: As a patient-reported outcome measure (PROM), it captures the patient's subjective experience of their functional ability, which is crucial for understanding their quality of life.
• Quantifiable: It provides a numerical score, allowing for objective comparison over time and across different patient populations or treatment groups.
• Validity and Reliability: Numerous studies have demonstrated its validity and reliability in assessing activity levels, particularly in knee-injured populations.
• Widely Accepted: Its long-standing use and recognition in the medical community make it a familiar and trusted tool.

Limitations and Considerations

Despite its strengths, the Tegner Activity Scale has certain limitations that practitioners must consider:

• Subjectivity: Being patient-reported, scores can be influenced by individual perception, motivation, and pain tolerance, which may not always align perfectly with objective physical performance.
• Lack of Specificity: The scale provides a general measure of activity level but does not delve into the specific functional deficits or compensatory strategies a patient might employ. It doesn't assess pain, swelling, or range of motion directly.
• Ceiling Effect: For elite athletes, the highest score (10) might not fully capture the nuances of their pre-injury peak performance, potentially leading to a "ceiling effect" where further improvement isn't reflected in the score.
• Cultural and Activity Variation: The specific activities listed for each score might not perfectly align with all cultural contexts or the specific sports popular in all regions.
• Not a Diagnostic Tool: It is an outcome measure, not a diagnostic tool. It should always be used in conjunction with a comprehensive clinical examination and other objective assessments.

Conclusion

The Tegner Activity Scale remains an invaluable tool in the arsenal of exercise scientists, physical therapists, and orthopedic surgeons. By providing a simple yet robust method for quantifying physical activity levels, it facilitates effective communication, monitors recovery progress, and contributes significantly to both clinical decision-making and research in musculoskeletal rehabilitation. While acknowledging its subjective nature and limitations, its utility in tracking a patient's journey from injury to a return to their desired activity level is undeniable.