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Russell HC, Arendt EA, Wiese-Bjornstal DM. Psychological Responses During Latter Rehabilitation and Return to Sport After Anterior Cruciate Ligament Reconstruction Surgery. J Athl Train 2024; 59:627-632. [PMID: 38446462 PMCID: PMC11220769 DOI: 10.4085/1062-6050-0058.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
CONTEXT Despite positive physical outcomes of anterior cruciate ligament reconstruction (ACLR), many athletes do not return to sport afterward. OBJECTIVE To determine if there were differences between athletes who returned to play and those who did not return to sport after ACLR in patterns of psychological responses to injury over the latter course of rehabilitation and return to sport. DESIGN Case-control study. SETTING Comprehensive orthopedic medical center referrals. PATIENTS OR OTHER PARTICIPANTS Thirty-nine recreational and competitive athletes (13 to 58 years, 21 males) with a first ACL tear were observed over the course of the study. MAIN OUTCOME MEASURE(S) Return to sport. RESULTS Fifty-two percent of participants returned to play by 9 months post-ACLR. Those who returned showed a linear decrease in reinjury anxiety from 4 to 9 months post-ACLR, whereas those who did not return showed a linear decrease from 4 to 6 months post-ACLR and then a leveling off from 6 to 9 months. Those who returned showed linear and quadratic effects on perceived limitations of ability with a decrease from 4 to 9 months post-ACLR that accelerated over time, whereas nonreturners showed a linear decrease over time. No significant differences were found between returners and nonreturners in knee self-efficacy, perceived percent recovery, and psychological distress. CONCLUSIONS Our results suggest that reinjury anxiety and perceived limitations of ability are psychological constructs on which returners and nonreturners differ and therefore may be points of intervention to increase the likelihood of return to sport.
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Affiliation(s)
- Hayley C. Russell
- Department of Health and Exercise Science, Gustavus Adolphus College, Saint Peter, MN
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2
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Herring SA, Putukian M, Kibler WB, LeClere L, Boyajian-O'Neill L, Day MA, Franks RR, Indelicato P, Matuszak J, Miller TL, O'Connor F, Poddar S, Svoboda SJ, Zaremski JL. Team Physician Consensus Statement: Return to Sport/Return to Play and the Team Physician: A Team Physician Consensus Statement-2023 Update. Curr Sports Med Rep 2024; 23:183-191. [PMID: 38709944 DOI: 10.1249/jsr.0000000000001169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Affiliation(s)
- Stanley A Herring
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | | | - W Ben Kibler
- Shoulder Center of Kentucky, Lexington Clinic, Lexington KY
| | - Lance LeClere
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | - Peter Indelicato
- Department of Orthopedic Surgery and Sports Medicine, College of Medicine, University of Florida, Gainesville, FL
| | | | - Timothy L Miller
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Fran O'Connor
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Sourav Poddar
- Primary Sports Medicine, University of Colorado School of Medicine, Denver, CO
| | | | - Jason L Zaremski
- Department of Physical Medicine & Rehabilitation, University of Florida Health, Gainesville, FL
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3
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Herring SA, Putukian M, Kibler WB, Leclere L, Boyajian-O'Neill L, Day MA, Franks RR, Indelicato P, Matuszak J, Miller TL, O'Connor F, Poddar S, Svoboda SJ, Zaremski JL. Team Physician Consensus Statement: Return to Sport/Return to Play and the Team Physician: A Team Physician Consensus Statement-2023 Update. Med Sci Sports Exerc 2024; 56:767-775. [PMID: 38616326 DOI: 10.1249/mss.0000000000003371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Affiliation(s)
- Stanley A Herring
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | | | - W Ben Kibler
- Shoulder Center of Kentucky, Lexington Clinic, Lexington KY
| | - Lance Leclere
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | - Peter Indelicato
- Department of Orthopedic Surgery and Sports Medicine, College of Medicine, University of Florida, Gainesville, FL
| | | | - Timothy L Miller
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Fran O'Connor
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Sourav Poddar
- Primary Sports Medicine, University of Colorado School of Medicine, Denver, CO
| | | | - Jason L Zaremski
- Department of Physical Medicine & Rehabilitation, University of Florida Health, Gainesville, FL
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Turkeri-Bozkurt H, Yıldırım S, Brewer BW, Bayrakcı Tunay V, Koruç Z. Translation and Adaptation of the Reinjury Anxiety Inventory, the Sport Injury Rehabilitation Adherence Scale, and the Athletic Injury Self-Efficacy Questionnaire Into Turkish. J Sport Rehabil 2024; 33:231-236. [PMID: 38423008 DOI: 10.1123/jsr.2023-0273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/17/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024]
Abstract
CONTEXT Psychological difficulties can adversely affect rehabilitation outcomes and make return to sport more difficult. Identifying psychological difficulties is possible with valid and reliable measurement tools. The purpose of this study is to translate and culturally adapt the Reinjury Anxiety Inventory (RIAI), the Sport Injury Rehabilitation Adherence Scale (SIRAS), and the Athletic Injury Self-Efficacy Questionnaire (AISEQ) into Turkish and evaluate the psychometric properties of the Turkish versions. DESIGN Cross-sectional study. METHODS The instruments were forward- and back-translated, culturally adapted, and validated on 248 athletes and 34 physical therapists. The physical therapists of the athletes completed the SIRAS to evaluate the athletes. Statistical analysis included reliability tests (Cronbach alpha and test-retest), exploratory factor analysis, confirmatory factor analysis, and correlational analysis. Floor and ceiling effects (<15%) were also assessed. RESULTS Confirmatory factor analyses revealed a satisfactory model fit for the RIAI and the AISEQ, and exploratory factor analysis revealed the 1-factor structure for the SIRAS as in the original. All 3 instruments displayed adequate internal consistency (Cronbach alpha coefficients ranged from .84 to .88) and test-retest reliability (coefficients ranged from .81 to .93). Convergent validity of the instruments was supported by significant correlations between the AISEQ and both the RIAI and the SIRAS. CONCLUSIONS Our results suggest that the Turkish versions of the instruments were valid, consistent, and reliable in athletes who have serious injuries. Scores on these instruments could be useful for evaluating the contributions of psychological factors to return to sport following serious injuries. Clinicians are encouraged to use RIAI-Turkish (RIAI-TR), SIRAS-Turkish (SIRAS-TR), and AISEQ-Turkish (AISEQ-TR) together to make decisions about the treatment and rehabilitation plans of injured athletes.
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Affiliation(s)
| | - Sinan Yıldırım
- Faculty of Sport Sciences, Pamukkale University, Denizli, Turkey
| | - Britton W Brewer
- Department of Psychology, Springfield College, Springfield, MA, USA
| | - Volga Bayrakcı Tunay
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ziya Koruç
- Faculty of Sport Sciences, Hacettepe University, Ankara, Turkey
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Caumeil B, Laboute E, Verhaeghe E, Pérez S, Décamps G. Reinjury Anxiety and Return to Sport After Anterior Cruciate Ligament Reconstruction: A Cluster Analysis and Prospective Study Among 162 Athletes. Am J Sports Med 2024; 52:1189-1198. [PMID: 38520139 DOI: 10.1177/03635465241234887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
BACKGROUND Recent studies have investigated the effect of psychological factors on return to sport (RTS), but none has tested the existence of psychological profiles linked to reinjury anxiety and its links with RTS and reinjury. PURPOSE To assess the effect of different psychological profiles on RTS and reinjury. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS The study screened patients who were involved in all types of sports for anterior cruciate ligament (ACL) reconstruction (hamstring and patellar tendon autografts). All participants were included during the RTS phase (90-180 days after ACL reconstruction). Reinjury anxiety, fear of reinjury, kinesiophobia, perceived stress, anxiety, depression, knee confidence, self-esteem, optimism, coping, and pain were measured. Hierarchical cluster analysis (Ward method) and analysis of variance were performed. In the second year after surgery, patients were recontacted by telephone to follow-up. RTS and reinjury were compared by profile type. RESULTS A total of 162 athletes were initially included, of whom 123 responded regarding RTS and reinjury. Cluster analysis showed a 4-cluster solution (χ2[21] = 428.59; λ = .064; P < .001). Profile 1 (27.8%) was characterized by moderate reinjury anxiety and no depression. Profile 2 (22.8%) was characterized by moderate reinjury anxiety and minor anxious-depressive reaction. Profile 3 (30.9%) was characterized by no reinjury anxiety, no depression, and high confidence. Profile 4 (18.5%) was characterized by high anxiety, high depression, and low confidence. Profile 4 had the lowest self-esteem and optimism scores compared with profile 3 (P < .001). In addition, a higher percentage of men was found in profile 3 as opposed to profile 4 (χ2[3] = 11.35; P < .01). Profile 4 had the highest rate of non-RTS with 54.2% (profile 1: 14.3%, P = .001; profile 2: 25.0%, P = .031; profile 3: 22.2%, P = .011). Finally, patients with profile 3 had a higher risk of reinjury (13.9%) than those with profile 4 (0%) (P = .047), who had an extremely conservative RTS. CONCLUSION The different profiles will affect RTS, but also the risk of reinjury exclusively for profiles 3 and 4. Rehabilitation management will probably require all stakeholders to understand psychological profiles of athletes to develop an on-demand rehabilitation plan.
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Affiliation(s)
- Benjamin Caumeil
- Management Sport Cancer Laboratory (UR 20122035V), Faculty of Sport Sciences, Aix-Marseille University, Marseille, France
| | - Eric Laboute
- Centre Européen de Rééducation du Sportifs, CERS, Groupe Ramsay Santé, Capbreton, France
| | - Emmanuel Verhaeghe
- Centre Européen de Rééducation du Sportifs, CERS, Groupe Ramsay Santé, Capbreton, France
| | - Sébastien Pérez
- Centre Européen de Rééducation du Sportifs, CERS, Groupe Ramsay Santé, Capbreton, France
| | - Greg Décamps
- University of Bordeaux, Laboratory of Psychology EA4139, Bordeaux, France
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Schilaty ND, McPherson AL, Nagai T, Bates NA. Differences in psychological readiness for return to sport after anterior cruciate ligament injury is evident in thigh musculature motor unit characteristics. BMJ Open Sport Exerc Med 2023; 9:e001609. [PMID: 37440978 PMCID: PMC10335479 DOI: 10.1136/bmjsem-2023-001609] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Background Following anterior cruciate ligament (ACL) injury, many athletes that undergo surgery and 6-9 months of rehabilitation struggle to return to sport. Evidence suggests that psychological factors contribute to this failure to return-to-sport. Objective Determine the motor control relationship between thigh musculature motor unit characteristics and psychological readiness to return to sport between ACL-injured and healthy controls. Study design A longitudinal cohort study. Methods Athletes longitudinally completed the ACL Return to Sport after Injury (ACL-RSI) survey and isometric strength measures with a measurement of electromyography (EMG) of the vastus lateralis, vastus medialis, biceps femoris, and semitendinosus. A score cut-off of 61 on the ACL-RSI was used to divide ACL-injured groups. EMG was decomposed to provide each identified motor unit's characteristics (amplitude, average firing rate, etc). Results Data demonstrated increased average firing rate for hamstrings (p<0.001), decreased average firing rate for vastus lateralis (p<0.001) and decreased motor unit size for both the quadriceps and hamstrings at return-to-sport post-ACL reconstruction compared with sex-matched and age-matched healthy controls (p<0.001). Furthermore, there were marked differences in disparate ACL-RSI scores between ACL-injured athletes. Conclusions At return to sport, ACL-injured athletes have major alterations of thigh musculature motor control, with smaller motor units used by those with low ACL-RSI scores. This study uniquely demonstrates objective thigh muscle motor unit characteristics that coincide with subjective reports of psychological readiness. This information will be important to address psychomotor complexes of injury for future rehabilitation protocols.
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Affiliation(s)
- Nathan D Schilaty
- Department of Neurosurgery & Brain Repair, University of South Florida Tampa Campus, Tampa, Florida, USA
- Medical Engineering, University of South Florida, Tampa, Florida, USA
- Center for Neuromusculoskeletal Research, University of South Florida, Tampa, Florida, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - April L McPherson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
- Emory Sports Performance and Research Center, Emory University, Atlanta, Georgia, USA
| | - Takashi Nagai
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Military Performance, USARIEM, Natick, Massachusetts, USA
| | - Nathaniel A Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
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Davies E, Steel L. The psychological responses of British amateur point-to-point jockeys to personal injury. COMPARATIVE EXERCISE PHYSIOLOGY 2022. [DOI: 10.3920/cep220028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Previous research has reported significant psychological consequences of injury on rehabilitation success, performance, and wellbeing in athletes, although little is known within horse-based sports. There is a high prevalence of injury reported in point-to-point (P2P) jockeys, but despite this, comparatively little research exists examining the psychological implications resulting from physical trauma within horseracing. The aim of this study was to investigate the psychological responses to personal injury in British amateur P2P jockeys. Five amateur P2P jockeys (two male, three female, x- age 25 years old) were interviewed about their experiences post an injury sustained during racing in the preceding 12 months. Interview questions explored their pre-injury career, the rehabilitation phase, pre-return to racing phase issues and coping strategies used by jockeys. Thematic analysis revealed three higher order themes: emotional responses, coping strategies, and factors affecting recovery. Subjects universally cited negative emotional responses following injury, including grief, a sense of loss, and frustration, and all experienced denial at the onset of injury. Typical coping strategies included strong support networks of family, friends and racing staff, and goal setting. Fear of reinjury was identified by all athletes, particularly on return to the saddle, and the attitudes towards injury management, such as denial, seen in this study may provide opportunities to develop targeted education campaigns for P2P jockeys on injury services. Targeted marketing for P2P jockeys on available injury support is recommended, such as seen for professional jockeys, as well as the creation of career development resources to offer alternative routes for P2P jockeys following injury.
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Affiliation(s)
- E. Davies
- Hartpury University, Hartpury House, Hartpury, Gloucestershire, GL19 3BE, United Kingdom
| | - L. Steel
- Hartpury University, Hartpury House, Hartpury, Gloucestershire, GL19 3BE, United Kingdom
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Gomez-Espejo V, Olmedilla A, Abenza-Cano L, Garcia-Mas A, Ortega E. Psychological readiness to return to sports practice and risk of recurrence: Case studies. Front Psychol 2022; 13:905816. [PMID: 36211933 PMCID: PMC9540195 DOI: 10.3389/fpsyg.2022.905816] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/22/2022] [Indexed: 11/29/2022] Open
Abstract
Returning to sport after the sports injury is a difficult decision because it's multicausal and the fact that a rash decision can result in numerous negative consequences. Given the importance of psychological variables for the correct rehabilitation of the injured athlete and his or her optimal return to sports practice, there seems to be little information on this subject. In this sense, the objective is to determine the relationship between the subjective psychological disposition of the athlete in the process of Return to Play (RTP) with the type of mood profile and his mental health. This is based on the fact that each athlete evaluates his or her recovery differently and has different levels of anxiety, depression, and stress. For this purpose, four athletes participated in the study. Two males and two females from the sports of indoor soccer and soccer, who had just returned to sports after a moderate or severe injury. The average age was 24.25 years. Various measurements were taken after practices and after matches, to assess mood, psychological readiness, anxiety, stress, and depression. The results confirm Morgan's iceberg profile and the influence that subjective psychological perceptions and assessed emotional states have on athletes' incorporation into their sports practice with a guarantee of success.
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Affiliation(s)
| | - Aurelio Olmedilla
- Department of Personality, Evaluation and Psychological Treatment, University of Murcia, Murcia, Spain
| | | | - Alejandro Garcia-Mas
- Grupo de Investigación en Ciencias de la Actividad Fisica (GICAFE) (Research Group of Sports Sciences), University of the Balearic Islands, Palma de Mallorca, Spain
| | - Enrique Ortega
- Department of Physical Activity and Sport, Campus of Excellence Mare Nostrum, University of Murcia, Murcia, Spain
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Perceived Social Support, Reinjury Anxiety, and Psychological Readiness to Return to Sport in Soccer Players. J Sport Rehabil 2022; 31:749-755. [DOI: 10.1123/jsr.2021-0181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 02/13/2022] [Accepted: 02/15/2022] [Indexed: 11/18/2022]
Abstract
The burden of sports injury in soccer is high, and return to sport outcomes following injury are often poor. This is compounded by a current lack of understanding surrounding the factors that may optimize psychological readiness to return to sport. Consequently, in the present study, we aim to further our understanding of these issues by examining the role of perceived social support in predicting psychological readiness to return to sport. In doing so, we extend previous research by examining whether reinjury anxiety is a mediating factor in this relationship. A sample of 150 previously injured soccer players (mean age = 25.32 y) completed measures of perceived social support, reinjury anxiety during rehabilitation, and psychological readiness to return to sport. Mediation analyses showed that reinjury anxiety partly accounted for the positive relationship between perceived social support and psychological readiness to return to sport. These findings suggest that injured soccer players with higher perceptions of social support will experience less reinjury anxiety during rehabilitation and, as a consequence, will be more psychologically ready upon return to sport.
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Hegedus EJ, Ickes L, Jakobs F, Ford KR, Smoliga JM. Comprehensive Return to Competitive Distance Running: A Clinical Commentary. Sports Med 2021; 51:2507-2523. [PMID: 34478108 DOI: 10.1007/s40279-021-01547-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2021] [Indexed: 01/02/2023]
Abstract
Running injuries are very common, and there are well-established protocols for clinicians to manage specific musculoskeletal conditions in runners. However, competitive and elite runners may experience different injuries than the average recreational runner, due to differences in training load, biomechanics, and running experience. Additionally, injury-specific rehabilitation protocols do not consider the broader goal of return to competitive running, including the unique psychosocial and cardiorespiratory fitness needs of elite athletes. This review aims to suggest a guideline for running-specific progression as part of a comprehensive rehabilitation program for injured competitive runners. Tools to evaluate an athlete's psychosocial preparedness to return to competition are presented. Recommendations are also provided for monitoring cardiorespiratory fitness of injured runners, including the nuances of interpreting these data. Finally, a six-phase training paradigm is proposed to guide clinicians as they help competitive runners transition from the early stages of injury through a full return to competition.
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Affiliation(s)
- Eric J Hegedus
- Department of Physical Therapy, One University Parkway, High Point University, High Point, NC, 27268, USA. .,Physical Therapy Program, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA.
| | - Lindsey Ickes
- Department of Exercise Science, One University Parkway, High Point University, High Point, NC, 27268, USA
| | - Franziska Jakobs
- Department of Exercise Science, One University Parkway, High Point University, High Point, NC, 27268, USA
| | - Kevin R Ford
- Department of Physical Therapy, One University Parkway, High Point University, High Point, NC, 27268, USA
| | - James M Smoliga
- Department of Physical Therapy, One University Parkway, High Point University, High Point, NC, 27268, USA
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The Influence of Kinesiophobia on Perceived Disability in Patients With an Upper-Extremity Injury: A Critically Appraised Topic. J Sport Rehabil 2021; 30:818-823. [PMID: 33662934 DOI: 10.1123/jsr.2020-0179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 12/12/2020] [Accepted: 12/21/2020] [Indexed: 11/18/2022]
Abstract
Clinical Scenario: Kinesiophobia is a common psychological phenomenon that occurs following injury involving fear of movement. These psychological factors contribute to the variability among patients' perceived disability scores following injury. In addition, the psychophysiological, behavioral, and cognitive factors of kinesiophobia have been shown to be predictive of a patient's self-reported disability and pain. Previous kinesiophobia research has mostly focused on lower-extremity injuries. There are fewer studies that investigate upper-extremity injuries despite the influence that upper-extremity injuries can have on an individual's activities of daily living and, therefore, disability scores. The lack of research calls for a critical evaluation and appraisal of available evidence regarding kinesiophobia and its contribution to perceived disability for the upper-extremity. Focused Clinical Question: How does kinesiophobia in patients with upper-extremity injuries influence perceptions of disability and quality of life measurements? Summary of Key Findings: Two cross-sectional studies and one cohort study were included. The first study found a positive relationship between kinesiophobia and a high degree of perceived disability. Another study found that kinesiophobia and catastrophic thinking scores were the most important predictors of perceived upper-extremity disability. The third study found that kinesiophobia contributes to self-reported disability in the shoulder. Clinical Bottom Line: There is moderate evidence that supports the relationship between kinesiophobia and perceived disability, and the relationship between elevated perceptions of disability and increased kinesiophobia scores in patients with an upper-extremity injury. Clinicians should evaluate and monitor kinesiophobia in patients following injury, a condition that can enhance perceptions of disability. An elevated perception of disability can create a cycle of fear that leads to hypervigilance and fear-avoidance behavior. Strength of Recommendation: Consistent findings from reviewed studies suggest there is grade B evidence to support that kinesiophobia is related to an increased perceived disability following upper-extremity injuries.
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Christakou A, Stavrou NA, Psychountaki M, Zervas Y. Re-injury worry, confidence and attention as predictors of a sport re-injury during a competitive season. Res Sports Med 2020; 30:19-29. [PMID: 33256461 DOI: 10.1080/15438627.2020.1853542] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Rehabilitation from sport injury involves not only physical, but also psychological considerations. Re-injury worry, confidence and attention are characteristics that may affect athletes' returning to competition after a sport injury. The study aimed to describe the predictive ability of the re-injury worry, confidence, and attention to the total of re-injuries at the new competitive season. The sample was 80 male athletes with at least three years of competitive experience who had a sport musculoskeletal injury in the last 8 months and had followed properly their physiotherapy program. They were ready for re-entry into competitive sport. They completed on returning to competition: (a) the Causes of the Re-Injury Worry Questionnaire, (b) the Sport Confidence Questionnaire of Rehabilitated Athletes Returning to Competition and (c) the Attention Questionnaire of Rehabilitated Athletes Returning to Competition. The three valid and reliable instruments predict the total of re-injuries at the beginning and at the middle of the competitive season. Future research should be conducted to examine the relationship between the physical and psychological characteristics in re-injury's prediction from different contact sports.
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Affiliation(s)
- Anna Christakou
- Department of Physiotherapy, University of West Attica, Athens, Greece.,Department of Physiotherapy, General Hospital of Evagelismos, Athens, Greece
| | - Nektarios A Stavrou
- Department of Physical Education and Sports Science, University of Athens, Athens, Greece.,Sport Psychology Laboratory, Hellenic Sports Research Institute, Olympic Athletic Center of Athens "Spyros Louis", Maroussi, Greece
| | - Maria Psychountaki
- Department of Physical Education and Sports Science, University of Athens, Athens, Greece
| | - Yannis Zervas
- Department of Physical Education and Sports Science, University of Athens, Athens, Greece
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D’Astous E, Podlog L, Burns R, Newton M, Fawver B. Perceived Competence, Achievement Goals, and Return-To-Sport Outcomes: A Mediation Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2980. [PMID: 32344846 PMCID: PMC7246734 DOI: 10.3390/ijerph17092980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to explore the potential mediating effect of achievement goals on perceived competence and return-to-sport outcomes among college athletes sustaining a sport injury. Altogether, 75 male and female college athletes from the United States who returned to sport after having missed competition for an average of 3 weeks due to injury, completed valid and reliable inventories measuring perceived competence, achievement goals, and return-to-sport outcomes. Results indicated that task-approach goals significantly mediated the relationship between perceived competence and a renewed sport perspective. These data suggest the importance of promoting competence beliefs and a task-oriented focus among athletes returning to sport following athletic injury. From a practical standpoint, clinicians can foster competence perceptions by integrating progressive physical tests assessing functionality and sport-specific skills/abilities. Furthermore, these data suggest that coaches, physical therapists, and significant others may do well to use language that orients injured athletes towards attaining success as opposed to avoiding failure, to emphasize effort, task completion, and correct form, and to avoid comments that compare athletes to others or to their preinjury standards of performance. From a theoretical standpoint, our mediation findings extend previous achievement goal research into the sport injury domain, further highlighting the importance of task-approach goals.
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Affiliation(s)
- Elyse D’Astous
- College of Health, Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, UT 84101, USA; (E.D.); (L.P.); (R.B.); (M.N.)
| | - Leslie Podlog
- College of Health, Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, UT 84101, USA; (E.D.); (L.P.); (R.B.); (M.N.)
| | - Ryan Burns
- College of Health, Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, UT 84101, USA; (E.D.); (L.P.); (R.B.); (M.N.)
| | - Maria Newton
- College of Health, Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, UT 84101, USA; (E.D.); (L.P.); (R.B.); (M.N.)
| | - Bradley Fawver
- School of Medicine, Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT 84101, USA
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Psychometric Analysis and Effectiveness of the Psychological Readiness of Injured Athlete to Return to Sport (PRIA-RS) Questionnaire on Injured Soccer Players. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051536. [PMID: 32120951 PMCID: PMC7084929 DOI: 10.3390/ijerph17051536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/21/2020] [Accepted: 02/23/2020] [Indexed: 11/23/2022]
Abstract
The decision-making process about when an athlete may safely return to training and competition after an injury is a difficult decision. Safe return to training and competition is characterised by physical and psychological readiness to return to the sport. The objectives of this study are (1) to assess the measurement properties of the Psychological Readiness of Injured Athlete to Return to Sport questionnaire (PRIA-RS), and (2) to analyse the effectiveness which the PRIA-RS questionnaire possesses when applied during four consecutive seasons on professional soccer players. One hundred and nine male soccer players from the Albacete Soccer Club (Spain) were involved during four consecutive seasons for the current study: 2012–2013, 2013–2014, 2014–2015 and 2015–2016. Psychometric analysis (validity, reliability, internal consistency and effectiveness) and external psychometric analysis (evaluating measures of patient-reported outcomes (EMPRO)) were confirmed and supported. The main results of the study reveal that the psychometric properties of this questionnaire are optimum for their application in a professional sports context.
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16
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Truong LK, Mosewich AD, Holt CJ, Le CY, Miciak M, Whittaker JL. Psychological, social and contextual factors across recovery stages following a sport-related knee injury: a scoping review. Br J Sports Med 2020; 54:1149-1156. [PMID: 32060141 PMCID: PMC7513260 DOI: 10.1136/bjsports-2019-101206] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2020] [Indexed: 12/12/2022]
Abstract
Objective To explore the role of psychological, social and contextual factors across the recovery stages (ie, acute, rehabilitation or return to sport (RTS)) following a traumatic time-loss sport-related knee injury. Material and methods This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews and Arksey and O’Malley framework. Six databases were searched using predetermined search terms. Included studies consisted of original data written in English that identified or described a psychological, social or contextual factor related to recovery after a traumatic time-loss sport-related knee injury. Two authors independently conducted title–abstract and full-text reviews. Study quality was assessed using the Mixed Methods Appraisal Tool. Thematic analysis was undertaken. Results Of 7289 records, 77 studies representing 5540 participants (37% women, 84% anterior cruciate ligament tears, aged 14–60 years) were included. Psychological factors were investigated across all studies, while social and contextual factors were assessed in 39% and 21% of included studies, respectively. A cross-cutting concept of individualisation was present across four psychological (barriers to progress, active coping, independence and recovery expectations), two social (social support and engagement in care) and two contextual (environmental influences and sport culture) themes. Athletes report multiple barriers to recovery and valued their autonomy, having an active role in their recovery and diverse social support. Conclusion Diverse psychological, social and contextual factors are present and influence all stages of recovery following a traumatic sport-related knee injury. A better understanding of these factors at the time of injury and throughout rehabilitation could assist with optimising injury management, promoting RTS, and long-term health-related quality-of-life.
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Affiliation(s)
- Linda K Truong
- Faculty of Medicine, Department of Physical Therapy, #223, 212 Friedman Building 2177 Westbrook Mall, V6T 1Z3, The University of British Columbia, Vancouver, British Columbia, Canada .,Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada.,Glen Sather Sports Medicine Clinic, Edmonton, Alberta, Canada
| | - Amber D Mosewich
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Christopher J Holt
- Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Christina Y Le
- Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada.,Glen Sather Sports Medicine Clinic, Edmonton, Alberta, Canada
| | - Maxi Miciak
- Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada.,Alberta Innovates, Edmonton, Alberta, Canada
| | - Jackie L Whittaker
- Faculty of Medicine, Department of Physical Therapy, #223, 212 Friedman Building 2177 Westbrook Mall, V6T 1Z3, The University of British Columbia, Vancouver, British Columbia, Canada.,Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
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17
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Conti C, di Fronso S, Robazza C, Bertollo M. The Injury-Psychological Readiness to return to sport (I-PRRS) scale and the Sport Confidence Inventory (SCI): A cross-cultural validation. Phys Ther Sport 2019; 40:218-224. [PMID: 31610419 DOI: 10.1016/j.ptsp.2019.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The purpose of this study was to cross-culturally validate in the Italian language the I-PRRS and the SCI. DESIGN Cross-sectional study. SETTING Injured Italian athletes. PARTICIPANTS We recruited male (n = 73) and female (n = 27) athletes who returned to practice after having completed the rehabilitation. MAIN OUTCOME MEASURES The measures comprised the I-PRRS, the SCI, and the Italian Mood Scale (ITAMS). Athletes completed the questionnaires within 1 day before their first official competition following injury. We investigated the construct validity, the internal consistency, and the concurrent validity of the I-PRRS and SCI with the ITAMS. RESULTS Confirmatory Factor Analysis supported the two-factor structure of the I-PRRS (Confidence in performance capability and Confidence in recovery) and the three-factor structure of the SCI (SC-Physical Skills and Training, SC-Cognitive Efficiency, and SC-Resilience). The reliability scores of both I-PRRS and SCI subscales indicated good internal consistency. Correlation between the I-PRRS and the SCI ranged in magnitude from weak to moderately high. A similar trend of correlations was found between the subscales of the I-PRRS and the ITAMS, as well as between the subscales of the SCI and the ITAMS. CONCLUSIONS Study findings showed satisfactory psychometric properties of the Italian version of the I-PRRS and SCI.
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Affiliation(s)
- Cristiana Conti
- BIND-Behavioral Imaging and Neural Dynamics Center, Department of Medicine and Aging Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.
| | - Selenia di Fronso
- BIND-Behavioral Imaging and Neural Dynamics Center, Department of Medicine and Aging Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.
| | - Claudio Robazza
- BIND-Behavioral Imaging and Neural Dynamics Center, Department of Medicine and Aging Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.
| | - Maurizio Bertollo
- BIND-Behavioral Imaging and Neural Dynamics Center, Department of Medicine and Aging Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; School of Science, Technology and Engineering, University of Suffolk, Ipswich, UK.
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18
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Webster KE, Nagelli CV, Hewett TE, Feller JA. Factors Associated With Psychological Readiness to Return to Sport After Anterior Cruciate Ligament Reconstruction Surgery. Am J Sports Med 2018; 46:1545-1550. [PMID: 29718684 PMCID: PMC6598700 DOI: 10.1177/0363546518773757] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury has a significant psychological effect, and a negative psychological state is a commonly cited reason for a reduction or cessation of sports participation after ACL reconstruction (ACLR) surgery. PURPOSE To identify factors that contribute to an athlete's psychological readiness to return to sport (RTS) after ACLR. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A cohort of 635 athletes (389 male, 246 female) who underwent ACLR and had been cleared to RTS completed the Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) scale at an average 12 months (range, 11-24 months) after surgery. Demographics (age, sex), sporting outcomes (preinjury frequency), surgical timing (injury to surgery interval), clinical factors (laxity), functional measures (single-limb hop symmetry), and symptoms of pain and function (International Knee Documentation Committee subjective) were also taken, and univariate and multiple regression models were used to determine the association between these and the psychological readiness of the athlete to RTS (ACL-RSI scores). Data for the entire cohort were initially analyzed; then, patients were grouped according to whether they had returned to competitive sport, and the analysis repeated for each group (return/nonreturn). RESULTS Univariate analysis for the entire group showed that all of the following had a positive effect on psychological readiness: male sex (β = 5.8; 95% CI, 2-10), younger age (β = -0.2; 95% CI, -0.4 to 0.01), a shorter interval between injury and surgery (β = -0.1; 95% CI, -0.1 to -0.02), a higher frequency of preinjury sport participation (β = 5.4; 95% CI, 2-9), greater limb symmetry (β = 0.5; 95% CI, 0.3-0.6), and higher subjective knee scores (β = 1.3; 95% CI, 1.1-1.4). In the multivariate model, subjective knee scores and age significantly accounted for 37% of the variance in psychological readiness ( r2 = 0.37, P < .0001). The only difference between the groups who had and had not returned to sport was that female sex was a significant contributor for the nonreturn group. CONCLUSION Self-reported symptoms and function were most associated with psychological readiness to RTS after ACLR surgery. Male patients who participated frequently in sport before ACL injury had higher psychological readiness. Conversely, female patients had a more negative outlook and may therefore benefit more from interventions designed to facilitate a smooth transition back to sport.
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Affiliation(s)
- Kate E. Webster
- School of Allied Health, La Trobe University, Melbourne, Australia.,Address correspondence to Kate E. Webster, PhD, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Victoria 3086, Australia ()
| | - Christopher V. Nagelli
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy E. Hewett
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA.,Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA.,Mayo Clinic Biomechanics Laboratories and Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
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19
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Caron JG, Bloom GA, Podlog LW. Are athletes psychologically ready for sport following a concussion? Br J Sports Med 2017; 52:1-2. [PMID: 29056597 DOI: 10.1136/bjsports-2017-098319] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Jeffrey G Caron
- Department of Kinesiology and Physical Education, McGill University, Montreal, Canada
| | - Gordon A Bloom
- Department of Kinesiology and Physical Education, McGill University, Montreal, Canada
| | - Leslie W Podlog
- Department of Kinesiology, Health and Recreation, University of Utah, Salt Lake City, Utah, USA
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20
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Ross CA, Clifford A, Louw QA. Factors informing fear of reinjury after anterior cruciate ligament reconstruction. Physiother Theory Pract 2017; 33:103-114. [DOI: 10.1080/09593985.2016.1271847] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Cheryl A. Ross
- Physiotherapy Department, University of Stellenbosch, Stellenbosch, South Africa
| | - Amanda Clifford
- Department of Clinical Therapies, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Quinette A. Louw
- Faculty of Medicine and Health Sciences, University of Stellenbosch Physiotherapy Division/FNB-3D Movement Analysis Laboratory, Tygerberg, South Africa
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Use of Objective Neurocognitive Measures to Assess the Psychological States that Influence Return to Sport Following Injury. Sports Med 2016; 46:299-303. [PMID: 26604099 DOI: 10.1007/s40279-015-0435-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
There is growing interest in the effects of psychological states on human performance, especially with those who have suffered debilitating injury and are attempting to return to sport (RTS). Current research methods measure psychological states through validated questionnaires; however, these outcomes only allow for subjective assessment and may be unintentionally biased. Application of objective neurocognitive measures correlated with psychological states will advance understanding of injury outcomes by identifying human behavior and avoiding vague assumptions from subjective measures.
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22
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Forsdyke D, Gledhill A, Ardern C. Psychological readiness to return to sport: three key elements to help the practitioner decide whether the athlete is REALLY ready? Br J Sports Med 2016; 51:555-556. [DOI: 10.1136/bjsports-2016-096770] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2016] [Indexed: 11/04/2022]
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Abstract
Context: A sports injury has both physical and psychological consequences for the athlete. A common postinjury psychological response is elevated fear of reinjury. Objective: To provide an overview of the implications of fear of reinjury on the rehabilitation of athletes, including clinical methods to measure fear of reinjury; the impact of fear of reinjury on rehabilitation outcomes, including physical impairments, function, and return to sports rate; and potential interventions to address fear of reinjury during rehabilitation. Evidence Acquisition: PubMed was searched for articles published in the past 16 years (1990-2016) relating to fear of reinjury in athletes. The reference lists of the retrieved articles were searched for additionally relevant articles. Study Design: Clinical review. Level of Evidence: Level 3. Results: Fear of reinjury after a sports injury can negatively affect the recovery of physical impairments, reduce self-report function, and prevent a successful return to sport. Athletes with high fear of reinjury might benefit from a psychologically informed practice approach to improve rehabilitation outcomes. The application of psychologically informed practice would be to measure fear of reinjury in the injured athletes and provide interventions to reduce fear of reinjury to optimize rehabilitation outcomes. Conclusion: Fear of reinjury after a sports injury can lead to poor rehabilitation outcomes. Incorporating principles of psychologically informed practice into sports injury rehabilitation could improve rehabilitation outcomes for athletes with high fear of reinjury.
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Affiliation(s)
- Chao-Jung Hsu
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois
| | | | - Steven Z George
- Department of Physical Therapy, University of Florida, Gainesville, Florida.,Brooks Rehabilitation, Jacksonville, Florida
| | - Terese L Chmielewski
- TRIA Orthopaedic Center, Bloomington, Minnesota.,Department of Physical Therapy, University of Florida, Gainesville, Florida
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24
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What is the evidence to support a psychological component to rehabilitation programs after anterior cruciate ligament reconstruction? CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000371] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Ardern CL, Kvist J, Webster KE. Psychological Aspects of Anterior Cruciate Ligament Injuries. OPER TECHN SPORT MED 2016. [DOI: 10.1053/j.otsm.2015.09.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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26
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Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE. Sports participation 2 years after anterior cruciate ligament reconstruction in athletes who had not returned to sport at 1 year: a prospective follow-up of physical function and psychological factors in 122 athletes. Am J Sports Med 2015; 43:848-56. [PMID: 25583757 DOI: 10.1177/0363546514563282] [Citation(s) in RCA: 182] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A return to their preinjury level of sport is frequently expected within 1 year after anterior cruciate ligament (ACL) reconstruction, yet up to two-thirds of athletes may not have achieved this milestone. The subsequent sports participation outcomes of athletes who have not returned to their preinjury level sport by 1 year after surgery have not previously been investigated. PURPOSE To investigate return-to-sport rates at 2 years after surgery in athletes who had not returned to their preinjury level sport at 1 year after ACL reconstruction. STUDY DESIGN Case series; Level of evidence, 4. METHODS A consecutive cohort of competitive- and recreational-level athletes was recruited prospectively before undergoing ACL reconstruction at a private orthopaedic clinic. Participants were followed up at 1 and 2 years after surgery with a sports activity questionnaire that collected information regarding returning to sport, sports participation, and psychological responses. An independent physical therapist evaluated physical function at 1 year using hop tests and the International Knee Documentation Committee knee examination form and subjective knee evaluation. RESULTS A group of 122 competitive- and recreational-level athletes who had not returned to their preinjury level sport at 1 year after ACL reconstruction participated. Ninety-one percent of the athletes returned to some form of sport after surgery. At 2 years after surgery, 66% were playing sport, with 41% playing their preinjury level of sport and 25% playing a lower level of sport. Having a previous ACL reconstruction to either knee, poorer hop-test symmetry and subjective knee function, and more negative psychological responses were associated with not playing the preinjury level sport at 2 years. CONCLUSION Most athletes who were not playing sport at 1 year had returned to some form of sport within 2 years after ACL reconstruction, which may suggest that athletes can take longer than the clinically expected time of 1 year to return to sport. However, only 2 of every 5 athletes were playing their preinjury level of sport at 2 years after surgery. When the results of the current study were combined with the results of athletes who had returned to sport at 1 year, the overall rate of return to the preinjury level sport at 2 years was 60%. Demographics, physical function, and psychological factors were related to playing the preinjury level sport at 2 years after surgery, supporting the notion that returning to sport after surgery is multifactorial.
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Affiliation(s)
- Clare L Ardern
- School of Allied Health, La Trobe University, Melbourne, Australia Division of Physiotherapy, Linköping University, Linköping, Sweden
| | | | - Julian A Feller
- School of Allied Health, La Trobe University, Melbourne, Australia OrthoSport Victoria, Epworth Healthcare, Melbourne, Australia
| | | | - Kate E Webster
- School of Allied Health, La Trobe University, Melbourne, Australia
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27
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Gignac MAM, Cao X, Ramanathan S, White LM, Hurtig M, Kunz M, Marks PH. Perceived personal importance of exercise and fears of re-injury: a longitudinal study of psychological factors related to activity after anterior cruciate ligament reconstruction. BMC Sports Sci Med Rehabil 2015; 7:4. [PMID: 25973208 PMCID: PMC4429315 DOI: 10.1186/2052-1847-7-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 01/09/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Psychological perceptions are increasingly being recognized as important to recovery and rehabilitation post-surgery. This research longitudinally examined perceptions of the personal importance of exercise and fears of re-injury over a three-year period post anterior cruciate ligament (ACL) reconstruction. Stability and change in psychological perceptions was examined, as well as the association of perceptions with time spent in different types of physical activity, including walking, household activities, and lower and higher risk for knee injury activities. METHODS Participants were athletes, 18-40 years old, who underwent ACL reconstruction for first-time ACL injuries. They were recruited from a tertiary care centre in Toronto, Canada. Participants completed interviewer-administered questionnaires pre-surgery and at years one, two and three, postoperatively. Questions assessed demographics, pain, functional limitations, perceived personal importance of exercise, fear of re-injury and physical activities (i.e., walking; household activities; lower risk for knee injury activities; higher risk for knee injury activities). Analyses included fixed-effect longitudinal modeling to examine the association of a fear of re-injury and perceived personal importance of exercise and changes in these perceptions with the total hours spent in the different categories of physical activities, controlling for other factors. RESULTS Baseline participants were 77 men and 44 women (mean age = 27.6 years; SD = 6.2). At year three, 78.5% of participants remained in the study with complete data. Fears of re-injury decreased over time while personal importance of exercise remained relatively stable. Time spent in walking and household activities did not significantly change with ACL injury or surgery. Time spent in lower and higher risk of knee injury physical activity did not return to pre-injury levels at three years, post-surgery. Greater time spent in higher risk of knee injury activities was predicted by decreases in fears of re-injury and by greater personal importance of exercise. CONCLUSIONS This study highlights not only fears of re-injury, which has been documented in previous studies, but also the perceived personal importance of exercise in predicting activity levels following ACL reconstructive surgery. The findings can help in developing interventions to aid individuals make decisions about physical activities post knee injury and surgery.
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Affiliation(s)
- Monique AM Gignac
- />Institute for Work and Health; Division of Health Care & Outcomes Research, Arthritis Community Research and Evaluation Unit, Toronto Western Research Institute; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Xingshan Cao
- />Arthritis Community Research and Evaluation Unit, Toronto Western Research Institute, Toronto, Canada
| | - Subha Ramanathan
- />Postdoctoral Fellow, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Lawrence M White
- />Joint Department of Medical Imaging, Faculty of Medicine, University Health Network, Mount Sinai Hospital, Women’s College Hospital, University of Toronto, Toronto, Canada
| | - Mark Hurtig
- />Ontario Veterinary College, University of Guelph, Guelph, Canada
| | - Monica Kunz
- />Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Paul H Marks
- />Division of Orthopaedic Surgery, Faculty of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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28
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Podlog L, Heil J, Schulte S. Psychosocial Factors in Sports Injury Rehabilitation and Return to Play. Phys Med Rehabil Clin N Am 2014; 25:915-30. [DOI: 10.1016/j.pmr.2014.06.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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29
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Abstract
OBJECTIVE To determine the risk of injury associated with athletic identity, attitudes toward body checking, competitive state anxiety, and reinjury fear in elite youth ice hockey. Also, to determine if there is an elevated risk of subsequent injury associated with return to play before medical clearance. DESIGN Cohort study. SETTING Hockey arenas, Calgary, Alberta. PARTICIPANTS A total of 316 male participants from 18 elite (A, AA, AAA), Bantam (age, 13-14 years), and Midget (age, 15-17 years) teams. ASSESSMENT OF RISK FACTORS At season commencement and postinjury, participants completed the athletic identity measurement scale, competitive state anxiety inventory-2R, body checking questionnaire, and fear of reinjury questions. MAIN OUTCOME MEASURES Hockey injury resulting in medical attention, the inability to complete a hockey session, and/or missing a subsequent hockey session. RESULTS Players scoring below the 25th percentile in athletic identity were at increased risk of a first injury [incidence rate ratios (IRR), 1.53; 95% confidence interval (CI), 1.05-2.22], but scoring above the 25th percentile was associated with subsequent injury (IRR = 2.28; 95% CI, 1.01-6.04). There was no increase in risk associated with return to play before clearance (IRR, 1.58; 95% CI, 0.30-5.42). CONCLUSIONS Athletic identity was implicated as an injury risk factor in this population. Return to play before medical clearance was not a risk factor in this study, but the point estimate warrants additional investigation.
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