Self-Presentation in Injury Rehabilitation Questionnaire (SPIRQ)

1. Abstract

The Self-Presentation in Injury Rehabilitation Questionnaire (SPIRQ) is a multidimensional psychometric instrument developed to assess the self-presentational concerns, impression monitoring, and impression construction processes of individuals undergoing physical therapy and athletic injury rehabilitation. Grounded in the self-presentation framework of social psychology and physical rehabilitation research (Goffman, 1959; Leary & Kowalski, 1990), the SPIRQ measures the degree to which injured individuals are concerned with how clinic staff, physiotherapists, and other patients perceive their physical capabilities, emotional resilience, compliance, and interpersonal qualities. Composed of 32 items evaluated on a 5-point Likert scale ranging from 1 (not at all true) to 5 (completely true), the scale prompts respondents using the standardized stem: “I believe the other people in the clinic would perceive me as…”. Factor-analytic investigations reveal dimensions encompassing Physical Competence and Stamina, Emotional Composure and Coping, Compliance and Interpersonal Amenability, and Physical/Cognitive Vulnerability. The SPIRQ exhibits robust psychometric properties, including high internal consistency reliability (Cronbach’s alpha coefficients typically ranging from .81 to .92 across subscales), robust convergent validity with measures of social physique anxiety, rehabilitative adherence, and fear of reinjury, as well as distinct discriminant validity from generalized trait anxiety. As an assessment tool, the SPIRQ provides physical therapists, athletic trainers, and clinical sports psychologists with deep empirical insight into the psychological barriers that impede exercise execution, attendance, and open communication in outpatient clinical rehabilitation environments.

2. Keywords

Self-presentation, impression management, injury rehabilitation, physical therapy, social physique anxiety, psychometrics, rehabilitation psychology, athletic injuries, physical competence, clinical assessment

3. Authors

The Self-Presentation in Injury Rehabilitation Questionnaire (SPIRQ) was conceptualized, developed, and validated through the research of Molly V. Driediger and her colleagues at the School of Kinesiology, Faculty of Health Sciences, Western University (London, Ontario, Canada):

• Molly V. Driediger, Ph.D. — School of Kinesiology, Western University, London, Ontario, Canada. Research focuses on sport and exercise psychology, self-presentation, social physique anxiety, and the psychological dimensions of orthopaedic and sports injury rehabilitation.
• Craig R. Hall, Ph.D. — Professor, School of Kinesiology, Western University, London, Ontario, Canada. Internationally recognized scholar in imagery use, exercise behavior, and self-presentational dynamics in physical activity contexts.
• Carly D. McKay, Ph.D. — Department for Health, University of Bath, Bath, United Kingdom. Specialist in sport injury prevention, rehabilitation adherence, and implementation science.
• Paul S. Echlin, M.D. — Primary Care Sports Medicine Physician, The Centre for Restorative Medicine, Midland, Ontario, Canada. Expert on traumatic brain injury, sports-related concussion, and holistic clinical rehabilitation.

4. Purpose

Physical injury and subsequent rehabilitation represent not only a physiological trauma but also a profound psychological disruption. When individuals enter an outpatient rehabilitation clinic or physical therapy center, they are frequently placed in open, communal spaces surrounded by specialized equipment, clinical professionals, and other recovering patients. In this highly visible public environment, patients are required to perform unfamiliar, painful, or biomechanically awkward motor tasks, often exposing physical limitations, altered body mechanics, and reduced physical conditioning. The primary purpose of the Self-Presentation in Injury Rehabilitation Questionnaire (SPIRQ) is to systematically measure the specific impressions that patients believe they project to others within these clinical environments.

From an applied clinical perspective, self-presentational concerns can severely compromise rehabilitation adherence and clinical outcomes. Patients who anticipate being viewed as “weak,” “uncoordinated,” “unfit,” or “unable to perform exercises” frequently experience elevated social evaluative anxiety. This psychological distress may manifest as avoidance behaviors, including missing physical therapy appointments, exerting submaximal effort during prescribed exercises to conceal functional deficits, or prematurely terminating therapeutic sets. Conversely, patients who are intensely motivated to appear “strong,” “fit,” or “able to handle pressures” may engage in compensatory overexertion, masking severe pain, exceeding prescribed range-of-motion parameters, or refusing necessary assistive devices, thereby dramatically increasing the risk of reinjury or chronic tissue irritation.

In research contexts, the SPIRQ serves as an empirical instrument to quantify the underlying cognitive appraisals that mediate the relationship between injury severity, physical self-efficacy, clinic environmental design, and long-term recovery metrics. By identifying the multidimensional facets of impression monitoring—ranging from perceived physical incompetence to concerns over being judged as emotionally volatile or uncooperative—the SPIRQ enables researchers and healthcare professionals to design targeted psychosocial interventions, foster supportive clinical climates, and personalize therapeutic communication.

5. Psychological Construct

The central construct measured by the SPIRQ is contextual self-presentation (also termed impression management) within clinical healthcare and sports rehabilitation settings. Grounded in social cognitive psychology, self-presentation refers to the ubiquitous process by which individuals attempt to monitor, control, and manipulate the impressions that other people form of them. In the specific context of injury rehabilitation, this construct captures the subjective perceptions, expectations, and cognitive appraisals a patient holds regarding how their physical stamina, motor coordination, emotional resilience, and interpersonal demeanors are evaluated by observers in the clinic.

The SPIRQ delineates self-presentation along several critical psychological dimensions:

• Perceived Physical and Functional Competence: This dimension assesses an individual’s appraisals of their bodily strength, fitness, motor control, and functional execution under observation. Exemplified by items such as Strong, Fit, Coordinated, and Perform exercises well, contrasted with feared evaluations such as Weak, Unfit, Uncoordinated, and Unable to perform exercises. Individuals with high evaluative distress in this domain experience acute vulnerability when their injured physical state fails to reflect their pre-injury identity or perceived normative standards of physical prowess.
• Emotional Regulation and Composure: Rehabilitation involves navigating pain, frustration, and uncertainty. This dimension evaluates how patients believe observers perceive their psychological fortitude and affect regulation. It contrasts positive, desirable impressions—such as Composed, In control of my emotions, Relaxed, and Able to handle pressures—with negative, distressing impressions including Anxious, Tense, Frustrated, and Unable to control emotions. Patients often fear that displaying visible signs of distress will lead clinicians and peers to view them as mentally brittle or unable to cope with therapeutic rehabilitation stress.
• Interpersonal Amenability and Autonomy: The patient-therapist working alliance depends heavily on interpersonal dynamics. This facet captures impressions concerning social friction, compliance, and dependence. It includes evaluations such as Easy to work with, Independent, and Knowledgeable versus negative labels such as Difficult to work with, Needy, and Dumb. Fear of being perceived as demanding or cognitively incapable can deter patients from asking clarifying questions about home exercise programs or reporting adverse symptoms.
• Vigorous Engagement versus Fatigue: This dimension taps into how observers perceive the patient’s attentional focus, energy reserves, and overall commitment to the rehabilitation session, captured through items such as Energized and Focused versus Tired, Unfocused, and Self-conscious. Patients often report profound concern that fatigue or cognitive distraction will be misattributed to laziness, lack of motivation, or lack of dedication to their recovery.

6. Theoretical Framework

The theoretical architecture of the SPIRQ is anchored primarily in the Two-Component Model of Self-Presentation formulated by Mark R. Leary and Robin M. Kowalski (1990), synthesized with Erving Goffman’s (1959) pioneering sociological treatise on dramatic impression management and Barry Schlenker’s (1980) social psychological conceptualization of human identity regulation.

According to Leary and Kowalski (1990), self-presentation operates via two distinct processes:

1. Impression Motivation: The degree to which an individual is motivated to control the impressions others form of them. Impression motivation is elevated when the impressions are perceived as instrumental to achieving valued goals (e.g., gaining approval from a clinician, maintaining an athletic identity, avoiding pity or condescension), when the public visibility of the behavior is high, and when the evaluators possess high social status or hold power over valued outcomes (such as clearance to return to sport or work).
2. Impression Construction: The specific tactics, behavioral adjustments, and expressive styles an individual chooses to project specific identities. This involves determining the desired impression (e.g., “competent, tough athlete” or “compliant, cooperative patient”) and actively regulating one’s verbal self-reports, emotional displays, and physical performance to match that ideal.

In injury rehabilitation contexts, this theoretical paradigm intersects with the literature on Social Physique Anxiety (SPA) (Hart, Leary, & Rejeski, 1989). When an athlete or active individual sustains an orthopaedic injury, their bodily appearance, movement patterns, and physical capabilities undergo sudden involuntary alterations. In communal clinical settings—often lined with floor-to-ceiling mirrors, open treatment plinths, and active gym zones—patients experience heightened objective self-awareness. Goffman’s conceptualization of “spoiled identity” and social stigma illuminates how patients may view their injured state as an undesirable social identity marked by vulnerability and reduced bodily agency. The SPIRQ operationalizes these theoretical dynamics by systematically evaluating the subjective semantic space across which patients project their public identities during clinical encounters.

7. Validity

Empirical evaluations of the SPIRQ have established solid evidence supporting its construct, convergent, discriminant, and predictive validity across competitive athletic populations, recreational exercisers, and clinical patient cohorts:

• Construct Validity: Construct validity was established through sequential stages of item generation, cognitive interviews with injured athletes, expert panel evaluations in exercise psychology, and exploratory and confirmatory factor analyses. The scale demonstrated distinct factor structures separating positive, agentic impression goals (e.g., physical competence, cooperativeness) from negative, vulnerability-oriented impression concerns (e.g., perceived incompetence, emotional volatility).
• Convergent Validity: Statistically significant correlations have been documented between SPIRQ subscales and validated psychological instruments measuring evaluative body anxiety. Specifically, negative self-presentational appraisals (e.g., feeling that others view one as Weak, Uncoordinated, Unfit, or Self-conscious) correlate positively and moderately-to-strongly with the Social Physique Anxiety Scale (SPAS) (r values typically ranging between .42 and .61, p < .001). Furthermore, negative impression subscales correlate significantly with the State-Trait Anxiety Inventory (STAI) state subscale during clinical visits (r = .38 to .52) and with indices of kinesiophobia measured via the Tampa Scale for Kinesiophobia (TSK).
• Discriminant Validity: The SPIRQ exhibits adequate discriminant validity against generalized self-esteem (e.g., Rosenberg Self-Esteem Scale) and non-evaluative physical pain intensity (measured via Visual Analog Scales). While acute pain intensity is related to physical limitation, its shared variance with the SPIRQ items remains low to moderate (r < .30), confirming that the SPIRQ assesses social-evaluative cognitive appraisals rather than raw sensory pain or global self-worth.
• Predictive / Criterion Validity: Research investigating behavioral compliance in rehabilitation demonstrates that high scores on negative self-presentation subscales predict poorer clinic attendance, lower home-exercise completion rates, and heightened self-reported avoidance of clinic gym spaces (Driediger et al., 2016). Conversely, extreme scores on positive self-presentation (e.g., an overwhelming desire to be seen as Strong and Able to handle pressures) predict dangerous over-compliance, such as withholding pain feedback from physical therapists.

8. Reliability

The SPIRQ exhibits strong internal consistency reliability across varied clinical and athletic samples undergoing orthopaedic and musculoskeletal rehabilitation:

• Internal Consistency: In foundational validation studies conducted by Driediger (2012) and subsequent empirical evaluations, Cronbach’s alpha (α) coefficients for the SPIRQ subscales consistently met or exceeded the established threshold of .80 recommended for clinical and psychological research instruments. The composite reliability across the overall instrument generally exceeds α = .88. Specifically:
• Physical Competence / Fitness subscale: α = .87 to .92
• Emotional Control / Composure subscale: α = .82 to .88
• Interpersonal Amenability / Relatability subscale: α = .78 to .84
• Physical & Emotional Vulnerability subscale: α = .84 to .89
• Test-Retest Reliability: Intraclass correlation coefficients (ICCs) evaluated across a 7- to 10-day test-retest interval among stable, non-acute rehabilitation patients demonstrated substantial temporal stability (ICC values ranging from .76 to .85), indicating that while the instrument captures dynamic state appraisals influenced by clinical progress, baseline impression tendencies remain reliable over short therapeutic windows.

9. Factor Analysis

The dimensional structure of the SPIRQ was originally examined through exploratory factor analysis (EFA) utilizing principal axis factoring with oblique (Promax/Oblimin) rotations to accommodate the theoretical intercorrelations among social evaluative dimensions. Subsequent confirmatory factor analytic (CFA) investigations have evaluated both higher-order and multi-factor correlated models to determine structural fit.

The analyses consistently isolate a stable multidimensional architecture, characterized by:

• Factor 1: Physical Incompetence / Vulnerability (Items loading heavily: Weak, Uncoordinated, Unable to perform exercises, Unfit, Unhealthy). Factor loadings for these items typically range between .62 and .84, explaining the largest proportion of unique variance in clinical populations.
• Factor 2: Emotional Composure and Coping (Items loading heavily: Composed, In control of my emotions, Able to handle pressures, Relaxed, contrasted inversely with Anxious, Tense, Frustrated, and Unable to control emotions). Loadings consistently range from .55 to .79.
• Factor 3: Physical Stamina and Capability (Items loading heavily: Strong, Fit, Healthy, Energized, Perform exercises well, Coordinated). Standardized loadings range from .58 to .81.
• Factor 4: Interpersonal Compliance and Autonomy (Items loading heavily: Easy to work with, Independent, Knowledgeable, vs. Difficult to work with, Needy, Dumb). Standardized loadings range between .48 and .74.

Confirmatory factor analytic fit indices for the four-factor correlated model have demonstrated adequate to excellent fit with the empirical data across clinical cohorts: Comparative Fit Index (CFI) > .91, Tucker-Lewis Index (TLI) > .90, Root Mean Square Error of Approximation (RMSEA) ≤ .058 (90% CI [.047, .068]), and Standardized Root Mean Square Residual (SRMR) ≤ .061, confirming that the 32-item instrument operates as an empirically coherent psychometric tool.

10. Instrument / Measurement Tool

• Instrument Name: Self-Presentation in Injury Rehabilitation Questionnaire (SPIRQ)
• Format: Self-administered paper-and-pencil questionnaire or secure digital electronic inventory
• Item Count: 32 single-word or short-phrase evaluative descriptors
• Target Population: Injured athletes, outpatient physical therapy patients, orthopaedic rehabilitation patients, and clinical exercise participants aged 16 years and older
• Prompt Stem: “I believe the other people in the clinic would perceive me as ….”
• Response Scale: 5-point Likert scale formatted as:
• 1 = Not at all true
• 2 = Slightly true
• 3 = Moderately true
• 4 = Substantially true
• 5 = Completely true
• Administration Time: Approximately 5 to 8 minutes
• Scoring Procedures:
• Items are grouped into positive (desired) and negative (feared/undesired) self-presentation dimensions, or organized into subscales reflecting Physical Competence, Emotional Composure, Compliance/Autonomy, and Vulnerability.
• Subscale scores are calculated by summing or averaging the items corresponding to each dimension. Higher scores on negative items (e.g., Weak, Anxious, Uncoordinated) reflect greater apprehension and fear of negative evaluation in the clinic. Higher scores on positive items (e.g., Strong, Independent, Easy to work with) reflect confidence in projecting a positive, competent clinical impression.

11. Permissions & Fee and Test Year

• Year of Development: 2012 (formalized in doctoral dissertation research; validated in peer-reviewed clinical literature in 2016).
• Copyright & Permissions: The SPIRQ was developed by Molly V. Driediger and colleagues at Western University. The questionnaire is published in academic theses and peer-reviewed journals for scientific and educational advancement.
• Access and Fees: The SPIRQ is an open-access psychometric instrument available free of charge for non-commercial academic, research, and non-profit clinical evaluative purposes. Researchers and healthcare practitioners wishing to use the instrument are encouraged to appropriately cite the original dissertation and subsequent peer-reviewed validation papers. Commercial deployment or digital proprietary platform integration requires direct permission from the copyright holders.

12. References

• Driediger, M. V. (2012). Self-presentation and social physique anxiety in injury rehabilitation settings (Electronic Thesis and Dissertation Repository, Paper 525). Western University. http://ir.lib.uwo.ca/cgi/viewcontent.cgi?article=1649&context=etd
• 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.2015.09.001
• Goffman, E. (1959). The Presentation of Self in Everyday Life. Anchor Books.
• 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
• Schlenker, B. R. (1980). Impression Management: The Self-Concept, Social Identity, and Interpersonal Relations. Brooks/Cole Publishing Company.

13. Items of the Scale