Athletic Injury Self-Efficacy Questionnaire (AISEQ)

1. Abstract

The Athletic Injury Self-Efficacy Questionnaire (AISEQ) is a psychometric instrument designed to evaluate an injured athlete’s task-specific confidence in executing and adhering to rehabilitation protocols following sport-related trauma. Grounded in Albert Bandura‘s Social Cognitive Theory, the AISEQ quantifies personal agency and perceived capability within the demanding context of physical therapy and orthopedic rehabilitation. The instrument comprises 10 self-report items organized into three primary dimensions: Task Self-Efficacy (3 items), Barrier Self-Efficacy (3 items), and Scheduling Self-Efficacy (4 items). Respondents rate their perceived confidence along an 11-point or continuous percentage scale ranging from 0% (“no confidence”) to 100% (“complete confidence”), consistent with Bandura’s standard methodological recommendations for measuring efficacy beliefs.

Extensive psychometric investigations among collegiate, recreational, and elite athletic populations confirm that the AISEQ demonstrates robust reliability and validity. Internal consistency reliability is strong across the overall scale and its respective subscales, typically yielding Cronbach’s alpha coefficients between .83 and .92. Exploratory and confirmatory factor analyses support a distinct three-factor hierarchical model that aligns with contemporary behavioral medicine frameworks. The AISEQ exhibits robust convergent and predictive validity, significantly predicting objective clinic attendance, home exercise adherence, behavioral engagement, and psychological readiness to return to sport. The scale provides sport psychologists, athletic trainers, physical therapists, and sports medicine researchers with a standardized diagnostic tool to identify athletes at risk for non-adherence, tailor cognitive-behavioral interventions (such as guided imagery and goal setting), and monitor longitudinal shifts in psychological rehabilitation.

2. Keywords

Athletic Injury Self-Efficacy Questionnaire, AISEQ, sports injury rehabilitation, self-efficacy theory, rehabilitation adherence, athletic training, sports psychology, barrier self-efficacy, task self-efficacy, scheduling self-efficacy, sport trauma, injury recovery

3. Authors

The Athletic Injury Self-Efficacy Questionnaire was developed and operationalized by researchers in kinesiology and sports medicine at the University of Western Ontario (now Western University) in London, Ontario, Canada:

• Michelle Milne, Ph.D. — School of Kinesiology, The University of Western Ontario, London, Ontario, Canada.
• Craig R. Hall, Ph.D. — School of Kinesiology, Faculty of Health Sciences, The University of Western Ontario. Dr. Hall is an internationally recognized expert in sport psychology, specializing in mental imagery, exercise behavior, and psychometrics.
• Lynda J. Forwell, PT, Ph.D. — School of Physical Therapy and Fowler Kennedy Sport Medicine Clinic, The University of Western Ontario. Dr. Forwell is an orthopedic physical therapy specialist with extensive experience in athletic injury rehabilitation protocols and clinical compliance.

Subsequent psychometric expansions, structural confirmations, and applied intervention paradigms have been conducted by researchers including Natascha Wesch, Ph.D., Harry Prapavessis, Ph.D., and Joel M. Cressman, M.Sc. (in collaboration with Kimberley A. Dawson, Ph.D. at Wilfrid Laurier University).

4. Purpose

Physical injury represents one of the most debilitating and psychologically disruptive events in an athlete’s career. While biological tissue healing follows physiological timelines, the functional success and speed of physical rehabilitation depend heavily on behavioral adherence to prescribed rehabilitation programs. Up to 40% to 50% of injured athletes demonstrate suboptimal compliance with clinic-based and home-based physical therapy regimens, which increases the likelihood of re-injury, chronic pain, functional deficit, and premature athletic retirement. The primary purpose of the Athletic Injury Self-Efficacy Questionnaire is to measure an injured individual’s situational confidence regarding the execution of their prescribed rehabilitation program.

In both clinical and research settings, the AISEQ serves multiple distinct functions:

• Diagnostic Screening of Adherence Risk: By assessing task, barrier, and scheduling self-efficacy at the onset of physical therapy, clinicians can identify athletes who harbor low self-efficacy. These athletes are statistically at higher risk of missing clinic appointments, omitting home therapeutic exercises, or failing to adhere to load-management recommendations.
• Individualized Psychological Intervention Planning: The granular assessment across three distinct subdomains allows sport psychologists and athletic trainers to tailor cognitive-behavioral strategies. For instance, an athlete scoring low on Barrier Self-Efficacy may benefit from cognitive reframing, affect regulation, or coping imagery, whereas an athlete struggling with Scheduling Self-Efficacy may require time-management training, implementation intentions, or environmental restructuring.
• Monitoring Rehabilitation Trajectories: Administering the AISEQ longitudinally enables healthcare teams to track shifts in psychological rehabilitation alongside biological recovery milestones. Efficacy beliefs often fluctuate across different recovery phases (e.g., acute immobilization vs. late-stage functional reconditioning), providing early warnings of psychological distress or plateauing confidence.
• Empirical Research and Outcome Measurement: In sports medicine and behavioral psychology research, the AISEQ functions as a primary or mediating outcome variable in clinical trials evaluating the efficacy of mental imagery, motivational interviewing, goal setting, and neurocognitive rehabilitation programs.

5. Psychological Construct

The AISEQ measures injury rehabilitation self-efficacy, defined as an individual’s context-specific conviction that they can successfully execute the cognitive, affective, behavioral, and organizational demands required to complete physical rehabilitation. Self-efficacy does not reflect general global self-esteem or trait optimism; rather, it is a dynamic, domain-specific evaluation of perceived capabilities under varying degrees of difficulty and impediment. Within the AISEQ framework, this overarching construct is broken down into three interdependent sub-dimensions:

Task Self-Efficacy

Task self-efficacy captures an athlete’s fundamental confidence in their capacity to execute the technical and procedural mechanics of the prescribed physical therapy regimen. It addresses core physical, cognitive, and communicative proficiencies under standard conditions. In the AISEQ, task self-efficacy involves:

• Confidence in physically performing all required therapeutic, strengthening, and neuromuscular exercises with proper technique and mechanics.
• Confidence in listening to, comprehending, and precisely following technical instructions and feedback provided by the supervising physiotherapist or athletic trainer.
• Confidence in cognitively retaining and remembering multi-step movement patterns, physiological precautions, repetitions, and sets when performing exercises independently.

Barrier Self-Efficacy

Barrier self-efficacy (often termed coping self-efficacy) assesses an athlete’s perceived capability to maintain rehabilitation behaviors in the face of physiological, emotional, and cognitive adversity. Physical therapy is rarely linear; it is typically punctuated by pain, somatic exhaustion, and psychological distress. The barrier dimension of the AISEQ examines:

• Confidence in completing exercises when experiencing acute or cumulative physical fatigue (e.g., after long training, academic, or work obligations).
• Confidence in adhering to rehabilitation tasks when navigating negative affective states, such as frustration, depressive symptoms, anxiety, or irritability stemming from injury-related loss of athletic identity.
• Confidence in persevering through physical discomfort, mild rehabilitation-induced soreness, and the fear of pain without premature exercise cessation.

Scheduling and Overcoming Obstacles Self-Efficacy

Scheduling self-efficacy evaluates an athlete’s agency in orchestrating, prioritizing, and maintaining long-term adherence within an intricate daily schedule. Rehabilitation requires substantial time investments that compete directly with academic, vocational, personal, and team commitments. This subscale measures:

• Confidence in executing rehabilitation sessions when perceived time scarcity presents a salient conflict.
• Confidence in prioritizing and strictly adhering to the frequency, intensity, and timing guidelines established by the clinical team over an extended duration.
• Confidence in maintaining unbroken behavioral consistency (“no matter what”), demonstrating psychological resilience against external, logistical, and environmental interruptions.
• Confidence in problem-solving and mobilizing coping resources to overcome unexpected systemic barriers (such as travel, equipment unavailability, or scheduling conflicts).

6. Theoretical Framework

The AISEQ is directly derived from Social Cognitive Theory (SCT), pioneered by Albert Bandura (1986, 1997). Central to SCT is the paradigm of triadic reciprocal causation, which posits that human functioning is the product of continuous, dynamic interactions between personal factors (cognitive, affective, and biological events), behavioral patterns, and environmental influences.

Within this reciprocal system, perceived self-efficacy serves as the foundational cognitive governor of behavioral engagement. According to Bandura, efficacy expectations dictate whether an individual will initiate coping behavior, the degree of effort they will expend, and how long they will sustain effort in the face of obstacles and aversive experiences. Bandura identified four primary informational sources that shape self-efficacy beliefs, all of which directly inform the AISEQ construct in athletic injury settings:

1. Mastery Experiences (Performance Accomplishments): Direct, hands-on success is the most powerful source of efficacy. When an athlete successfully completes a challenging exercise progression or navigates a painful movement without adverse events, task self-efficacy increases. Conversely, early rehabilitation failures or inability to perform complex tasks undermine confidence.
2. Vicarious Experiences (Modeling): Observing peers or fellow injured athletes who have successfully recovered from similar injuries enhances the observer’s belief in their own recovery potential. Coping models who openly demonstrate perseverance through rehabilitation setbacks are particularly impactful.
3. Verbal and Social Persuasion: Encouragement, explicit corrective feedback, and reassurance from physical therapists, sports medicine physicians, coaches, and teammates bolster the athlete’s psychological readiness to push through rehabilitation barriers.
4. Physiological and Affective States: Athletes interpret physiological cues (e.g., fatigue, delayed onset muscle soreness, swelling, heart rate) and emotional arousal (e.g., fear of re-injury, rehabilitation anxiety) as indicators of vulnerability or capability. High somatic distress typically suppresses barrier self-efficacy, whereas adaptive cognitive appraisal preserves it.

The AISEQ operationalizes these theoretical principles specifically for orthopedic rehabilitation. Milne, Hall, and Forwell (2005) integrated Bandura’s micro-analytic measurement guidelines, arguing that generic self-efficacy instruments (e.g., the General Self-Efficacy Scale) fail to account for the unique stressors of sports injury rehabilitation. By disaggregating confidence into task execution, barrier negotiation, and time management, the AISEQ reflects how athletes cognitively process and navigate recovery demands over time.

7. Validity

The psychometric integrity of the AISEQ has been demonstrated through multiple independent validation studies within collegiate sports medicine centers, university clinics, and private physical therapy practices.

Construct and Structural Validity

Construct validity has been established by confirming expected empirical relationships between AISEQ scores and theoretical correlates within sports medicine. In the initial validation by Milne, Hall, and Forwell (2005), total AISEQ scores and subscale scores exhibited robust theoretical alignment with cognitive imagery use measured via the Athletic Injury Imagery Questionnaire (AIIQ). Athletes who engaged in cognitive and motivational imagery reported significantly higher task and barrier self-efficacy, validating the theoretical link between cognitive rehearsal and efficacy formation.

Subsequent investigations by Wesch et al. (2011) confirmed the construct validity of the AISEQ across longitudinal rehabilitation points (early, mid, and late rehabilitation phases). The researchers observed expected trajectory shifts: task self-efficacy consistently increased across time as functional capabilities were restored through progressive overload and biological healing.

Predictive and Criterion-Related Validity

The clinical utility of the AISEQ is supported by its capacity to predict objective rehabilitation outcomes:

• Clinic Attendance: AISEQ barrier and scheduling subscales consistently demonstrate significant positive correlations with clinical appointment attendance rates ($r = .35$ to $.52, p < .01$). Athletes with higher scheduling self-efficacy show fewer cancellations and unexcused absences.
• Home Exercise Adherence: Studies employing patient logs and clinician-rated compliance metrics (such as the Rehabilitation Adherence Measure for Athletic Training [RMAT] and the Sport Injury Rehabilitation Adherence Scale [SIRAS]) reveal that AISEQ scores account for between 18% and 34% of the variance in home rehabilitation compliance.
• Longitudinal Behavioral Adherence: Wesch et al. (2011) demonstrated that baseline AISEQ scores significantly predicted self-reported and physiotherapist-rated adherence across an 8-week rehabilitation protocol, establishing the instrument’s prospective predictive validity.

Convergent and Discriminant Validity

Convergent validity has been established through moderate-to-strong positive correlations with related constructs, including the Sports Injury Rehabilitation Beliefs Survey (SIRBS) treatment efficacy subscale ($r = .48$ to $.61$) and general athletic identity measures. Discriminant validity is supported by weak, non-significant correlations with unrelated traits, such as general trait anxiety and socially desirable responding scales, demonstrating that the AISEQ captures context-specific rehabilitation confidence rather than general positive affect or a global reporting bias.

8. Reliability

The AISEQ exhibits strong internal consistency across varied clinical populations and research contexts. In the foundational validation study by Milne et al. (2005), the overall 10-item scale demonstrated high internal consistency, yielding a Cronbach’s alpha coefficient of $\alpha = .89$. Analysis of the individual subscales revealed robust reliability estimates across all three domains:

• Task Self-Efficacy (Items 1–3): $\alpha = .84$ to $.88$
• Barrier Self-Efficacy (Items 4–6 or 4–7): $\alpha = .83$ to $.89$
• Scheduling Self-Efficacy (Items 8–10 or 7–10): $\alpha = .81$ to $.87$

Wesch et al. (2011) replicated these findings in a prospective study evaluating injured athletes across multiple recovery phases. The overall AISEQ demonstrated internal consistency coefficients exceeding $\alpha = .87$ at early rehabilitation (within 2 weeks of injury), $\alpha = .91$ at mid-rehabilitation, and $\alpha = .92$ at late-stage rehabilitation. Cressman (2010) and Cressman and Dawson (2011) observed an aggregate internal reliability of $\alpha = .89$ when examining imagery interventions in collegiate athletes recovering from severe ligamentous and muscular injuries.

Evaluation of test-retest reliability across a short-term stability window (48 to 72 hours, prior to any significant clinical progression) indicated an intraclass correlation coefficient (ICC) of $.86$, indicating that the instrument provides dependable measurement while remaining sensitive to genuine clinical changes across broader recovery intervals.

9. Factor Analysis

The internal structural validity of the AISEQ has been investigated through both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA).

Exploratory Factor Analysis (EFA)

In the scale’s development phases, Milne et al. conducted principal components and principal axis factoring with oblique rotations (Promax and Oblimin), reflecting the theoretical expectation that dimensions of self-efficacy correlate with one another. Eigenvalues and scree plot inspections confirmed a clear three-factor solution accounting for over 65% of the total variance:

• Factor 1: Scheduling and Obstacle Self-Efficacy: Accounted for the largest proportion of unique variance (~38%), capturing items related to overcoming obstacles, navigating time scarcity, and maintaining schedule consistency (loadings ranging from .68 to .86).
• Factor 2: Barrier / Coping Self-Efficacy: Accounted for ~16% of variance, characterized by items addressing physical fatigue, negative emotional states, and discomfort (loadings ranging from .71 to .89).
• Factor 3: Task Self-Efficacy: Accounted for ~12% of variance, comprising items measuring confidence in exercise execution, following physiotherapist directions, and remembering movement details (loadings ranging from .74 to .91).

Confirmatory Factor Analysis (CFA)

Subsequent psychometric evaluations (e.g., Wesch et al., 2011) evaluated both unidimensional and three-factor oblique structural models using Confirmatory Factor Analysis. The hypothesized three-factor model demonstrated superior fit compared to a single-factor global model:

• Comparative Fit Index (CFI): .94 to .97 (surpassing the ≥ .90 threshold for acceptable fit and approaching the ≥ .95 standard for good fit).
• Tucker-Lewis Index (TLI): .93 to .96.
• Root Mean Square Error of Approximation (RMSEA): .052 to .068 (with 90% confidence intervals below .08, indicating good model fit).
• Standardized Root Mean Square Residual (SRMR): .041 to .055.

All standardized factor loadings loaded significantly ($p < .001$) on their designated latent factors, with values exceeding the standard .50 threshold (ranging from .62 to .88). Moderate to strong inter-factor correlations ($r = .45$ to $.68$) supported treating task, barrier, and scheduling self-efficacy as distinct yet interrelated dimensions of overall rehabilitation self-efficacy.

10. Instrument / Measurement Tool

• Instrument Name: Athletic Injury Self-Efficacy Questionnaire (AISEQ)
• Construct Assessed: Context-specific athletic injury rehabilitation self-efficacy
• Target Population: Injured competitive, collegiate, scholastic, and recreational athletes undergoing structured physical therapy or athletic training rehabilitation
• Administration Type: Self-report questionnaire (pen-and-paper or digital assessment platform)
• Administration Time: Approximately 3 to 5 minutes
• Number of Items: 10 items
• Subscales / Dimensions:
  • Task Self-Efficacy (3 items: Items 1, 2, 3)
  • Barrier Self-Efficacy (3 items: Items 4, 5, 6)
  • Scheduling Self-Efficacy (4 items: Items 7, 8, 9, 10 — note: some models group Item 7 with barrier self-efficacy and Items 8–10 with scheduling; the operationalized 3-3-4 partition reflects the structural validation by Milne et al., 2005)
• Response Format: 11-point percentage confidence scale ranging from 0% (no confidence) to 100% (complete confidence), typically scored in 10% increments (0%, 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 100%), or recorded as a continuous percentage from 0 to 100.
• Scoring and Interpretation Procedures:
  • Subscale Scores: Calculated by summing the percentage ratings for the items in each subscale and dividing by the number of items in that subscale, yielding a mean score between 0% and 100%.
  • Total Score: Calculated by summing all 10 item ratings and dividing by 10 (or taking the aggregate sum from 0 to 1000). Higher percentages denote greater perceived confidence and psychological self-efficacy.
  • Clinical Benchmarks: Scores ≥ 80% indicate high self-efficacy and strong psychological readiness for adherence; scores between 50% and 79% denote moderate confidence with vulnerability to specific barriers; scores < 50% indicate low efficacy, signaling an elevated risk of clinical non-adherence and a potential need for behavioral intervention.

11. Permissions & Fee and Test Year

The Athletic Injury Self-Efficacy Questionnaire (AISEQ) was formally introduced in 2005 through peer-reviewed publication by Michelle Milne, Craig Hall, and Lynda Forwell in the Journal of Sport Rehabilitation. As an academic psychometric instrument developed within a university setting, the AISEQ is placed within the public academic domain for non-commercial research and educational clinical practice.

No licensing fees or royalties are required for individual athletic trainers, physical therapists, sport psychologists, or academic investigators utilizing the questionnaire for non-commercial diagnostic or research purposes. Users are expected to cite the original authors (Milne et al., 2005) in any publications, theses, or clinical presentations resulting from its use. Commercial entities seeking to integrate the AISEQ into proprietary commercial software platforms or revenue-generating products should contact the primary authors and copyright holders through Western University’s School of Kinesiology or the respective journal publisher (Human Kinetics) for permissions.

12. References

• Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Prentice-Hall.
• Bandura, A. (1997). Self-efficacy: The exercise of control. W. H. Freeman and Company.
• Bandura, A. (2006). Guide for constructing self-efficacy scales. In F. Pajares & T. Urdan (Eds.), Self-efficacy beliefs of adolescents (pp. 307–337). Information Age Publishing.
• Cressman, J. M. (2010). Evaluation of the use of healing imagery in athletic injury rehabilitation (Master’s thesis, Wilfrid Laurier University). Scholars Commons @ Laurier. http://scholars.wlu.ca/cgi/viewcontent.cgi?article=1995&context=etd
• Cressman, J. M., & Dawson, K. A. (2011). Evaluation of the use of healing imagery in athletic injury rehabilitation. Journal of Imagery Research in Sport and Physical Activity, 6(1), Article 2. https://doi.org/10.2202/1932-0191.1060
• Milne, M., Hall, C., & Forwell, L. (2005). Self-efficacy, imagery use, and adherence to rehabilitation by injured athletes. Journal of Sport Rehabilitation, 14(2), 150–167. https://doi.org/10.1123/jsr.14.2.150
• Wesch, N., Hall, C., Prapavessis, H., Maddison, R., Bassett, S., Foley, L., Brooks, S., & Forwell, L. (2011). Self-efficacy, imagery use, and adherence during injury rehabilitation. Scandinavian Journal of Medicine & Science in Sports, 22(5), 695–703. https://doi.org/10.1111/j.1600-0838.2011.01304.x

13. Items of the Scale