RTS Reactive-Readiness Checklist

Physical tests clear the body. This checklist adds the reactive criteria that hop tests miss.
Chmielewski et al. (IJSPT 2024) found that ACL patients gained less on QuickBoard reaction tests than on hop tests after return-to-sport training. It was independent research from TRIA Orthopedic Center. Physical readiness and reactive readiness are two different things. This checklist covers both.

Part 1: Physical Readiness

Check these off before moving to Part 2.

Single-leg hop series (single, triple, crossover, 6-meter timed) meets your protocol's symmetry target (often 90% or more)
Quadriceps and hamstring strength symmetry meets your protocol's target vs. contralateral limb
Full, pain-free ROM vs. contralateral side
No effusion
Functional movement screens completed per protocol
Time since surgery meets your protocol's minimum
Psychological readiness measure (such as the ACL-RSI) completed per protocol
Physician or supervising clinician sign-off per your protocol

If any box in Part 1 is unchecked, address physical deficits before proceeding to Part 2.

Part 2: Reactive Readiness

What hop tests do not measure: reaction time, decision speed, and left-right reaction symmetry.

2a. Baseline established

Pre-injury baseline on file, or the uninvolved limb's results as the reference
Bilateral reaction time and accuracy recorded at start of rehab episode

2b. Reaction time symmetry

Involved limb reaction time within the range your clinic defines vs. the uninvolved limb
No gross asymmetry in left-vs.-right contact time or accuracy data

2c. Performance under cognitive load

Go/No-Go or Stroop-based protocol completed at or above pre-injury accuracy (or your clinic's threshold)
Performance stable (not declining) across repeated sessions in the weeks before RTS
Correct movement demonstrated under dual-task conditions (cognitive demand plus motor output simultaneously)

2d. Assessment documentation

Agility Rating score on file for the discharge record
PDF report generated and attached to the patient note

If any box in Part 2 is unchecked, reactive readiness is not yet documented. Return-to-sport decisions stay with the treating clinician.

Why This Gap Matters

The finding. ACL patients improved on hop tests but improved less on QuickBoard reaction tests after return-to-sport training (Chmielewski et al., IJSPT 2024).

The recommendation. Leading clinical guidance on neurocognitive and neuromuscular rehabilitation recommends adding neurocognitive training to ACL rehabilitation. This checklist covers the assessment side: it documents reactive performance so you can see whether training is working.

The practical problem. Many clinics do not have an objective way to assess and document reactive readiness at RTS. The criteria in Part 2 require a system that measures bilateral reaction time, runs cognitive load protocols, and generates documentation.

How to Use This Checklist

For new ACL patients: Establish the Part 2 baseline at the start of the rehab episode, not at discharge. That gives you a trend line, not just a snapshot.
For late-stage rehab (months 4+): Run Part 2 at each RTS evaluation alongside your standard hop test battery. Use the same thresholds each time so scores stay comparable.
For the discharge note: Attach the Agility Rating Report PDF. It includes pre-filled CPT 97750 documentation.
For multi-clinician practices: Use this as a shared standard so every clinician applies the same criteria before RTS, regardless of who was primary.
For performance coaches: The physician and PT make the return-to-sport call. Log an Agility Rating baseline for an athlete back from injury, then retest each block. Reaction time also tracks in-season fatigue (Martin, University of Louisville 2012).

QuickBoard measures the reactive criteria in Part 2. The sensor board and iPad and iPhone app run reaction time protocols, capture bilateral symmetry data to the millisecond, and auto-generate PDF reports, with CPT 97750 documentation for the Agility Rating. thequickboard.com/demo → See it in 15 minutes

Clinicians at Johns Hopkins,
Baylor Scott and White,
Select Medical, and Banner Health.
NBA, NFL, and MLB teams.

Recommended technology for
neurocognitive and neuromuscular
rehabilitation.