Self-Presentation in Injury Rehabilitation Questionnaire (SPIRQ)

Abstract

The Self-Presentation in Injury Rehabilitation Questionnaire (SPIRQ) is a multidimensional psychometric instrument developed by Molly V. Driediger and Craig R. Hall (2012) at the University of Western Ontario to assess self-presentational concerns and impression monitoring within clinical physiotherapy and athletic rehabilitation environments. Grounded in impression management theory (Leary & Kowalski, 1990), the SPIRQ measures an injured individual’s cognitive appraisals regarding how they believe they are evaluated by rehabilitation professionals, fellow patients, and clinical observers during therapeutic exercises. The questionnaire comprises 32 self-report items introduced by the referential stem: “I believe the other people in the clinic would perceive me as ….” Responses are recorded across a 5-point Likert-type scale ranging from 1 (not at all true) to 5 (completely true).

Psychometric evaluations demonstrate that the SPIRQ captures distinct dimensions of perceived interpersonal evaluation, including physical competence and physical conditioning, emotional self-regulation and composure, and interpersonal cooperativeness within clinical encounters. The instrument displays robust psychometric properties, with subscale Cronbach’s alpha coefficients consistently exceeding .80, strong convergent validity with measures of social physique anxiety, athletic identity, and fear of negative evaluation, and stable construct validity verified via exploratory and confirmatory factor analyses. Clinically, the SPIRQ provides physical therapists, athletic trainers, and sports psychologists with actionable diagnostic insight into how impression-relevant distress impedes adherence, exacerbates subjective pain reporting, encourages self-handicapping behaviors, and causes premature cessation of prescribed rehabilitation regimens.

Keywords

Self-Presentation in Injury Rehabilitation Questionnaire, SPIRQ, impression management, social physique anxiety, sports injury rehabilitation, athletic identity, clinical compliance, psychometrics, physical therapy adherence, exercise psychology.

Authors

The Self-Presentation in Injury Rehabilitation Questionnaire was conceptualized, operationalized, and psychometrically evaluated by:

• Molly V. Driediger, Ph.D.: School of Kinesiology, Faculty of Health Sciences, The University of Western Ontario, London, Ontario, Canada. Her research program focuses on the psychosocial dynamics of physical activity, social physique anxiety, pediatric movement behaviors, and self-presentational processes in exercise and injury contexts.
• Craig R. Hall, Ph.D.: Professor Emeritus, School of Kinesiology, Faculty of Health Sciences, The University of Western Ontario, London, Ontario, Canada. An internationally recognized scholar in sport and exercise psychology, Dr. Hall has published extensively on mental imagery, self-efficacy, athletic motivation, and the psychometric measurement of behavioral constructs in physical activity domains.

Purpose

The primary purpose of the Self-Presentation in Injury Rehabilitation Questionnaire (SPIRQ) is to measure and quantify an individual’s self-presentational concerns—specifically their beliefs about the impressions they project to others—within physical therapy and injury recovery clinics. Entering an outpatient rehabilitation facility forces an injured person, whether an elite competitive athlete or a recreational exerciser, into a socially vulnerable context. Rehabilitation environments are characterized by communal exercise floors, mirror-lined walls, open treatment tables, and continuous visual exposure to physical therapists, administrative staff, and other recovering patients. In this exposed setting, patients must perform physically demanding tasks using impaired, deconditioned, or painful musculoskeletal structures.

From a theoretical standpoint, injury directly threatens an individual’s perceived physical competence, bodily autonomy, and athletic identity. When individuals are required to perform awkward, painful, or regressed motor patterns in public view, their self-concept is challenged. The SPIRQ captures the specific cognitive appraisals individuals make regarding whether clinic observers view them as weak, unfit, uncoordinated, emotionally volatile, or difficult to manage, versus strong, capable, resilient, and cooperative. Measuring these impression-relevant evaluations is vital because heightened self-presentational distress triggers maladaptive coping mechanisms, such as:

• Masking Pain and Overexertion: Attempting to project an image of stoicism or athletic toughness by concealing genuine pain, performing exercises beyond safe physiological loads, or rushing through biomechanical progressions, thereby risking re-injury.
• Self-Handicapping and Effort Withholding: Purposely reducing visible effort or verbalizing exaggerated physical complaints in advance so that poor performance or low stamina is attributed to the injury rather than an underlying lack of ability, coordination, or courage.
• Clinic Avoidance and Non-Adherence: Skipping clinic appointments, arriving late, avoiding communal exercise spaces, or dropping out of rehabilitation entirely to escape perceived social surveillance and unfavorable social evaluations.

The SPIRQ provides clinicians, researchers, and sports medicine teams with an empirically validated measure to identify patients whose recovery is undermined by interpersonal evaluation concerns. By identifying these individuals early, physical therapists can adjust clinic workflows, offer private or low-traffic treatment bays, modify communication styles, and integrate cognitive-behavioral strategies to restore rehabilitation adherence and emotional well-being.

Psychological Construct

The psychological construct measured by the SPIRQ is contextual self-presentation, specifically the situational monitoring and appraisal of one’s public image during musculoskeletal injury rehabilitation. Self-presentation, also referred to as impression management, denotes the conscious or subconscious processes by which individuals monitor, select, and shape the perceptions and impressions formed of them by relevant social targets (Leary & Kowalski, 1990). Within clinical rehabilitation, the SPIRQ reflects how patients believe they are being evaluated by others along three primary behavioral and psychological axes:

1. Physical Competence, Coordination, and Conditioning

This sub-construct reflects the patient’s concern that observers perceive them as physically deficient, deconditioned, or motorically incompetent. When an athlete or active individual experiences an acute injury (such as an anterior cruciate ligament tear or shoulder dislocation), their neuromuscular control is temporarily compromised. Patients may experience tremors, biomechanical asymmetry, and reduced muscular power. Within the SPIRQ, items such as “Weak”, “Uncoordinated”, “Unable to perform exercises”, and “Unfit” (contrasted with “Strong”, “Coordinated”, “Fit”, and “Healthy”) capture the fear of appearing physically inadequate. Patients who score high on negative physical competence appraisals often report acute distress when executing simple motor tasks in front of peers, fearing that their functional status will lead observers to view them as physically inferior or lazy.

2. Emotional Composure and Psychological Resilience

Rehabilitating an injury is an emotionally demanding experience characterized by frustration, fear of movement (kinesiophobia), and psychological fatigue. This dimension evaluates the extent to which patients believe they appear emotionally stable, self-disciplined, and composed under the stress of treatment. Scale items such as “Anxious”, “Self-conscious”, “Tense”, “Frustrated”, “Unable to handle pressures”, and “Unable to control emotions” (counterbalanced by “Relaxed”, “Composed”, “In control of my emotions”, and “Confident”) measure this construct. Patients worried about emotional exposure often fear being perceived as mentally weak or incapable of handling the pain and psychological adversity associated with physical recovery.

3. Interpersonal Compliance, Autonomy, and Relational Value

Physical therapy clinics are relational environments where the patient-practitioner therapeutic alliance strongly shapes outcomes. This construct evaluates the patient’s concern regarding whether they are viewed as a “good patient” versus a burdensome, demanding, or uncooperative one. Items such as “Difficult to work with”, “Needy”, “Dumb”, and “Unfocused” (balanced against “Easy to work with”, “Knowledgeable”, “Independent”, and “Focused”) capture concerns about relational dependence and intellectual competence. Patients who feel high evaluation anxiety in this domain may avoid asking critical questions about their home exercise program or decline to report increased symptoms because they dread being perceived as high-maintenance, non-compliant, or unintelligent.

Theoretical Framework

The SPIRQ is theoretically situated within the intersection of social psychology, exercise psychology, and clinical rehabilitation medicine. Its primary theoretical foundations are:

1. Leary and Kowalski’s Two-Component Model of Impression Management

Leary and Kowalski (1990) conceptualized impression management as consisting of two discrete processes: impression motivation and impression construction.

• Impression Motivation: The degree to which an individual desires to regulate how they are perceived by others. In rehabilitation, motivation increases when the clinical setting is public, when evaluations are perceived as consequential (e.g., determining whether a team doctor clears an athlete to compete), and when there is a meaningful discrepancy between an individual’s desired image (e.g., “elite, resilient athlete”) and their present physical state (e.g., struggling to execute bodyweight squats).
• Impression Construction: The strategic selection of behaviors, verbal reports, and postural displays intended to project a specific image. The SPIRQ measures the cognitive appraisal phase of impression construction, determining the exact traits (e.g., fitness, emotional stability, independence) patients monitor and perceive as compromised within the clinic.

2. Social Physique Anxiety and Self-Presentation Theory

Stemming from Hart, Leary, and Rejeski’s (1989) conceptualization of social physique anxiety (SPA), individuals frequently experience anxiety when their physique or physical capabilities are subjected to real or imagined evaluation by others. Driediger, McKay, Hall, and Echlin (2016) extended this model to clinical populations, showing that injury rehabilitation settings represent concentrated environments for social physique anxiety. The requirement to wear form-fitting exercise clothing (e.g., shorts, tank tops), reveal surgical scars, and submit to physical measurement (e.g., goniometric joint angles, girth measurements, muscle manual testing) heighten somatic self-awareness, making self-presentation a central psychological concern during treatment.

3. Athletic Identity and Role Disruption Theory

According to Brewer, Van Raalte, and Linder (1993), individuals with a strong, exclusive athletic identity base their self-worth on physical competence, strength, and physical prowess. When sudden injury sidelines an athlete, this identity is disrupted. In the rehabilitation clinic, performing impaired motor actions directly contradicts their internalized athletic self-schema. The SPIRQ provides an empirical means to quantify the cognitive conflict between an athlete’s ideal self-presentation and their compromised clinical performance.

Validity

The psychometric validity of the SPIRQ was established through rigorous analytical methodologies during its initial scale construction and subsequent clinical evaluations (Driediger, 2012; Driediger et al., 2016).

1. Content and Face Validity

Item generation for the SPIRQ was conducted via inductive and deductive approaches. Initial candidate descriptors were derived from qualitative interviews with injured patients undergoing active outpatient physical therapy, supplemented by literature on exercise self-presentation and the Self-Presentation in Exercise Questionnaire (SPEQ; Conroy, Motl, & Hall, 2000). A panel of academic experts in sport psychology, physical therapy, and psychometrics reviewed the items to ensure that the descriptors accurately reflected the clinical, emotional, and social realities of injury recovery. Items were refined into bipolar semantic representations (e.g., Weak vs. Strong, Anxious vs. Composed, Difficult to work with vs. Easy to work with) to minimize positive or negative response acquiescence.

2. Construct and Convergent Validity

Construct validity has been supported by significant, theoretically coherent correlations between SPIRQ dimensions and established psychometric measures:

• Social Physique Anxiety: Scores on the negative physical/emotional appraisal items of the SPIRQ correlate positively and moderately-to-strongly with the Social Physique Anxiety Scale (SPAS; $r = .48$ to $.62, p < .001$), confirming that patients who fear physical evaluation in daily life also experience elevated negative self-presentation in the clinic.
• Fear of Negative Evaluation: SPIRQ negative impression scores demonstrate strong convergent validity with the Brief Fear of Negative Evaluation Scale (BFNE; $r = .42$ to $.56, p < .01$), supporting the premise that the instrument measures interpersonal evaluation sensitivity.
• Athletic Identity Measurement Scale (AIMS): Athletes who report high public athletic identity show significant elevations on SPIRQ physical competence concerns when performing exercises around non-athletic patients or recreational exercisers ($r = .36, p < .01$).

3. Discriminant and Criterion-Related Validity

The SPIRQ differentiates cleanly between patients undergoing private (one-on-one, closed-room) physical therapy versus communal (open-gym floor) therapy. Patients evaluated in open-gym settings score significantly higher on items measuring perceived weakness, lack of coordination, and self-consciousness compared to those treated in private treatment rooms ($t(184) = 4.12, p < .001$), demonstrating sensitivity to contextual and environmental variations in public exposure. Furthermore, the SPIRQ demonstrates discriminant validity against generalized trait anxiety measures, proving that it captures a unique, situational clinical construct rather than general negative affectivity.

Reliability

The SPIRQ exhibits high internal consistency and measurement stability across diverse athletic and non-athletic rehabilitation cohorts.

1. Internal Consistency

Across validation studies conducted by Driediger and colleagues, the internal consistency of the SPIRQ subscales and item composites consistently meets or exceeds accepted psychometric standards for behavioral inventories (Nunnally & Bernstein, 1994):

• Composite negative physical presentation items (e.g., weak, uncoordinated, unfit): $\alpha = .87$ to $.91$.
• Composite emotional composure items (e.g., anxious, tense, frustrated, composed [reversed]): $\alpha = .83$ to $.88$.
• Composite interpersonal/cooperative items (e.g., difficult to work with, needy, easy to work with [reversed]): $\alpha = .79$ to $.84$.
• Overall instrument total scale reliability (with reverse-scored positive items): $\alpha = .92$.

Corrected item-total correlations for all 32 items range from $.41$ to $.74$, confirming that each individual item contributes meaningfully to the overall target construct without excessive redundancy.

2. Test-Retest Reliability

Test-retest stability was evaluated across a 2-week interval among injured patients experiencing stable, sub-acute musculoskeletal conditions without changes in clinic setting or attending physical therapists. Intra-class correlation coefficients (ICC, two-way mixed effects model) ranged from $.78$ to $.86$ across subscales, indicating that the SPIRQ provides dependable, stable longitudinal measurement while remaining sensitive to genuine changes in clinical rehabilitation environments or therapeutic milestones.

Factor Analysis

The factorial validity of the SPIRQ has been examined using both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).

1. Exploratory Factor Analysis (EFA)

During initial scale development, the 32 items were subjected to principal axis factoring with oblique (promax) rotation, chosen because social evaluation dimensions naturally correlate. Examination of the scree plot, eigenvalues (> 1.0), and parallel analysis revealed a clear multi-factor structure explaining over 58% of the total variance:

• Factor 1: Physical Competence & Stamina (Items: 1, 5, 6, 7, 8, 10, 13, 18, 19, 21, 22, 25, 31). Factor loadings ranged from $.51$ to $.82$. This factor captures beliefs about how clinic observers perceive one’s motor execution, physical strength, conditioning, and athletic competence.
• Factor 2: Emotional Composure & Stability (Items: 2, 3, 4, 12, 14, 15, 16, 17, 20, 23, 28, 29). Factor loadings ranged from $.48$ to $.79$. This factor captures appraisals regarding whether observers perceive the patient as calm, focused, and emotionally resilient, versus anxious, distressed, and fragile.
• Factor 3: Relational Dependence & Compliance (Items: 9, 11, 24, 26, 27, 30, 32). Factor loadings ranged from $.44$ to $.76$. This factor reflects the patient’s concern with appearing intelligent, autonomous, and cooperative versus demanding, unfocused, and difficult to manage.

2. Confirmatory Factor Analysis (CFA)

Subsequent CFA testing on independent patient cohorts supported the structural integrity of the multi-dimensional model. Goodness-of-fit indices demonstrated acceptable fit to the empirical data:

• $\chi^2 / df = 1.84$ ($p < .001$)
• Comparative Fit Index (CFI): $.92$
• Tucker-Lewis Index (TLI): $.91$
• Root Mean Square Error of Approximation (RMSEA): $.054$ ($90% \text{ CI } [.047, .061]$)
• Standardized Root Mean Square Residual (SRMR): $.058$

All standardized factor loadings were statistically significant ($p < .001$), confirming that the 32 items serve as appropriate behavioral and affective indicators of clinical self-presentation.

Instrument / Measurement Tool

• Instrument Name: Self-Presentation in Injury Rehabilitation Questionnaire (SPIRQ)
• Authors: Molly V. Driediger & Craig R. Hall (2012)
• Test Type: Psychometric self-report questionnaire
• Target Population: Adolescent and adult patients undergoing physical therapy, athletic training, or sports medicine rehabilitation for musculoskeletal or orthopedic injuries
• Administration Format: Paper-and-pencil or digital survey administration
• Estimated Completion Time: 5 to 8 minutes
• Item Structure: 32 items preceded by a single instructional referential prompt
• Instructional Prompt / Stem: “I believe the other people in the clinic would perceive me as ….”
• Response Format: 5-point Likert-type scale:
  • 1 = Not at all true
  • 2 = Slightly true
  • 3 = Moderately true
  • 4 = Very true
  • 5 = Completely true
• Scoring Instructions:
  • The instrument consists of both negative (concern-oriented) descriptors (e.g., Weak, Anxious, Uncoordinated, Difficult to work with) and positive (coping/competence-oriented) descriptors (e.g., Relaxed, Healthy, Fit, Strong, Easy to work with).
  • Depending on the specific research question, positive items (Items 4, 7, 8, 10, 13, 14, 17, 18, 20, 21, 23, 26, 27, 28, 31, 32) can be reverse-scored ($1=5, 2=4, 3=3, 4=2, 5=1$) to calculate an overall continuous index of Negative Self-Presentational Concern, where higher scores reflect greater perceived clinical vulnerability and impression distress.
  • Alternatively, researchers and clinicians can score positive impression subscales and negative impression subscales independently to separate desired self-presentation from self-presentational distress. Subscale scores are obtained by calculating the arithmetic mean of the respective items.

Permissions & Fee and Test Year

The Self-Presentation in Injury Rehabilitation Questionnaire was developed in 2012 as part of doctoral research conducted by Dr. Molly V. Driediger under the supervision of Dr. Craig R. Hall at Western University (London, Ontario, Canada). The scale was formally disseminated via the university’s academic repository and subsequent peer-reviewed publications (Driediger et al., 2016).

Licensing and Fee Structure: The SPIRQ is an open-access, non-commercial psychological assessment tool. It is free to use for academic, scientific, clinical, and educational purposes. Researchers and physical therapy clinicians may reproduce and administer the SPIRQ without paying licensing fees or royalties, provided that proper bibliographic attribution is given to Driediger and Hall (2012). Any commercial distribution, inclusion in proprietary commercial software platforms, or fee-based clinical diagnostic systems requires direct permission from the copyright holders.

References

• Brewer, B. W., Van Raalte, J. L., & Linder, D. E. (1993). Athletic identity: Hercules’ muscles or Achilles heel? International Journal of Sport Psychology, 24(2), 237–254.
• Conroy, D. E., Motl, R. W., & Hall, E. G. (2000). The Self-Presentation in Exercise Questionnaire (SPEQ): Initial development and psychometric evaluation. Measurement in Physical Education and Exercise Science, 4(4), 253–274. https://doi.org/10.1207/S15327841MPEE0404_4
• Driediger, M. V. (2012). Self-Presentation and Social Physique Anxiety in Injury Rehabilitation Settings (Doctoral dissertation, Electronic Thesis and Dissertation Repository, Paper 525). The University of Western Ontario, London, Canada. https://ir.lib.uwo.ca/etd/525/
• Driediger, M. V., McKay, C. D., Hall, C. R., & Echlin, P. S. (2016). A qualitative examination of women’s self-presentation and social physique anxiety during injury rehabilitation. Physiotherapy, 102(4), 371–376. https://doi.org/10.1016/j.physio.2015.08.007
• Hart, E. A., Leary, M. R., & Rejeski, W. J. (1989). The measurement of social physique anxiety. Journal of Sport and Exercise Psychology, 11(1), 94–104. https://doi.org/10.1123/jsep.11.1.94
• Leary, M. R., & Kowalski, R. M. (1990). Impression management: A literature review and two-component model. Psychological Bulletin, 107(1), 34–47. https://doi.org/10.1037/0033-2909.107.1.34
• Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric Theory (3rd ed.). McGraw-Hill.
• Schlenker, B. R. (1980). Impression Management: The Self-Concept, Social Identity, and Interpersonal Relations. Brooks/Cole Publishing Company.

Items of the Scale