Translation, cross-cultural adaptation, validity, reliability and stability of the Dutch Injury - Psychological Readiness to Return to Sport (I-PRRS-NL) scale

Psychological readiness for injury recovery: evaluating psychometric properties of the IPRRS and assessing group differences in injured physically active individuals

Objectives

The primary purpose of the study was to assess the one-factor and two-factor structure of the Injury Psychological Readiness to Return to Sport Scale (IPRRS) in an injured physically active population using confirmatory factor analysis (CFA) procedures and assess group (ie, sex, age, injury type, athlete status) and longitudinal differences using structural equation modelling (eg, invariance testing).

Methods

The non-experimental study included a sample of 629 physically active individuals who suffered a musculoskeletal injury who sought treatment at an outpatient integrated sport medicine and rehabilitation therapy clinic. Participants filled out a questionnaire packet at three time points. Data analysis included a CFA and multigroup and longitudinal invariance.

Results

Sample mean age was 26.3 years, with females comprising 49.5%. Chronic injuries represented 29.6% of the sample and 35.0% were classified as competitive athletes. A six-item, one-factor model was confirmed in the sample with factor loadings ranging from 0.67 to 0.86. Multigroup and longitudinal invariance were established. Multigroup invariance demonstrated null differences between sex and injury type, and statistical differences between age and athlete status subgroups. Longitudinal invariance demonstrated a statistically significant increase in psychological readiness over time.

Conclusions

The findings support the use of the IPRRS as a tool to measure aspects of psychological readiness. Clinicians and researchers can use the IPRRS to assess interventions in future research.

Effectiveness of an On-Field Rehabilitation framework for return to sports in injured male professional football players: a single-blinded, prospective, randomised controlled trial

Objectives

In football, on-field rehabilitation (OFR) is critical during injury recovery for a player's safe return to sports (RTS). The study aimed to evaluate the effectiveness of an OFR framework for RTS in injured male professional football players.

Trial design

A prospective block-randomised controlled-parallel trial was conducted (level of evidence 1b).

Methods

Male professional football players (mean age, 26.3±3.6 years) from Greece diagnosed with an acute, lower limb musculoskeletal (MSK) injury (confirmed clinically and through imaging) participated in the study. During rehabilitation, the participants' OFR was guided by either the On-Field Rehabilitation (On FI.RE.) accelerated framework (experimental group) or a traditional OFR framework for a late injury recovery phase (comparison group). Between July 2021 and January 2022, 76 players were randomly allocated to the experimental group (n=38) and the comparison group (n=38). Participants were blinded during the study regarding intervention therapeutic protocols. The primary outcome measure was the effect of On FI.RE. framework on the time needed to return to team training (RTT) participation. The correlation between the time needed to return to on-field activity and RTT was calculated. Subsequent injuries were registered for a 12-month follow-up period.

Results

The intervention protocol, On FI.RE. framework, had a statistically significant effect on the time needed to RTT (F(1) = 49 626, p<0.001) with a large effect size (ES; η2=0.422) and fewer days (mean=23.8±9.1 days) needed than the comparison group (mean=30.3±9.8 days). There was a strong correlation between return to on-field activity and the time needed to RTT (r(76) = 0.901, p<0001) with a large ES (r>0.5). Six subsequent injuries were registered in the traditional OFR framework group, and one subsequent injury in the On FI.RE. framework group after a follow-up period of 12 months.

Conclusion

The On FI.RE., an accelerated OFR framework during injury recovery, is more effective than a traditional OFR framework, reducing the time a player needs to RTS. It entails a very low risk of reinjury.

Trial registration number

NCT05163470.

Examination of the validity of the Injury-Psychological Readiness to Return to Sport (I-PRRS) scale in male professional football players: A worldwide study of 29 professional teams

Perceived confidence is an important dimension of an athlete's psychological readiness to return-to-play. However, there is no established and validated tool to evaluate confidence in professional football. This study aimed to provide preliminary evaluation of the internal structure of the Injury-Psychological Readiness to Return-to-Sport scale (I-PRRS) in a cohort of injured male professional footballers. Over an 18-month period, 29 teams from 17 leagues participated. Players sustaining injuries eliciting ≥ 3 weeks' time-loss were recruited. Cross culturally adapted to 4 further languages, the I-PRRS was administered on two occasions: 1) day before returning-to-training and 2) day before returning-to-match-play. In total, 113 injuries were recorded with 96 completed I-PRRS data sets collected. Confirmatory factor analysis indicated the I-PRRS was a unidimensional scale, with all items measuring the same construct. The scale demonstrated good internal consistency (ω = .88). When examining longitudinal invariance of the I-PRRS across administration time-points, indices of model fit supported scalar invariance. There was preliminary evidence of good internal structure for the I-PRRS in professional male footballers. However, before further research involving the I-PRRS can be endorsed, efforts to confirm or refute empirical developments pertaining to psychological readiness are necessary.

Post-injury fear-avoidance and confidence in readiness to return to sport in Irish collegiate athletes

Fear avoidance and low confidence in their ability to return to sport can impede athletes' subsequent recovery and return to sport. This study aimed to identify fear avoidance and confidence in readiness to return to sport following injury in Irish collegiate athletes. Male (416) and female (256) athletes from 24 field-sport teams at one university were prospectively followed for one season. The Athlete Fear Avoidance Questionnaire (AFAQ) and pain on the Visual Analogue Scale was completed following a time-loss injury. Prior to return to sport, participants completed the AFAQ and the Injury Psychological Readiness to Return to Sport (I-PRRS). We recorded 179 injuries. Fear avoidance was evident post-injury (21.8 ± 6.7), and the mean total I-PRRS score was 48.4 ± 8.9. Those with severe injuries presented with higher fear avoidance and lower confidence. Higher pain was associated with greater fear avoidance following injury (r = 0.32, p < 0.0001), prior to return to sport (r = 0.38, p < 0.0001), and with lower confidence (r = -0.27, p < 0.0001).   Low confidence and fear avoidance was identified, particularly in those with a severe injury or high pain levels. Identifying, and providing psychosocial support to athletes experiencing, these issues is recommended.

Psychological Factors Change During the Rehabilitation of an Achilles Tendon Rupture: A Multicenter Prospective Cohort Study

OBJECTIVE

The authors sought to gain insight into the changes in psychological factors during rehabilitation after Achilles tendon rupture (ATR) and to explore the association between psychological factors during rehabilitation and functional outcome 12 months after ATR.

METHODS

Fifty patients clinically diagnosed with ATR were invited to visit the hospital 3, 6, and 12 months after injury for data collection. They completed questionnaires assessing psychological factors: psychological readiness to return to sport (Injury Psychological Readiness to Return to Sport Questionnaire); kinesiophobia (Tampa Scale for Kinesiophobia); expectations, motivation, and outcome measures related to symptoms and physical activity (Achilles Tendon Total Rupture Score); and sports participation and performance (Oslo Sports Trauma Research Centre Overuse Injury Questionnaire). To determine whether psychological factors changed over time, generalized estimating equation analyses were performed. Multivariate regression analyses were used to study the association between psychological factors at 3, 6, and 12 months and outcome measures at 12 months after ATR.

RESULTS

Psychological readiness to return to sport improved, and kinesiophobia decreased significantly during rehabilitation. Psychological readiness at 6 and 12 months showed significant associations with sports participation and performance. Kinesiophobia at 6 months was significantly associated with symptoms and physical activity. Motivation remained high during rehabilitation and was highly associated with symptoms and physical activity, sports participation, and performance.

CONCLUSION

Psychological factors change during rehabilitation after ATR. Patients with lower motivation levels during rehabilitation, low psychological readiness to return to sports, and/or high levels of kinesiophobia at 6 months after ATR need to be identified.

IMPACT

According to these results, psychological factors can affect the rehabilitation of patients with ATR. Physical therapists can play an important role in recognizing patients with low motivation levels and low psychological readiness for return to sport and patients with high levels of kinesiophobia at 6 months post-ATR. Physical therapist interventions to enhance motivation and psychological readiness to return to sport and to reduce kinesiophobia need to be developed and studied in the post-ATR population.

LAY SUMMARY

With Achilles tendon rupture, level of motivation, psychological readiness for return to sport, and fear of movement can affect rehabilitation outcome. A physical therapist can help recognize these factors.

Confidence to Return to Play After ACL Reconstruction: An Evaluation of Quadriceps Strength Symmetry and Injury Mechanism in Male Athletes

BACKGROUND

After anterior cruciate ligament reconstruction (ACLR), diminished quadriceps strength symmetry and reduced psychological readiness to return to play (RTP) increase the risk for subsequent injury. Although the relationship between quadriceps strength symmetry and psychological readiness to RTP has been reported to be influenced by injury mechanism in female athletes, it is unclear whether such a relationship exists in male athletes.

HYPOTHESIS

Quadriceps strength symmetry would be positively associated with greater psychological readiness to RTP after ACLR, regardless of injury mechanism.

STUDY DESIGN

Retrospective cohort.

LEVEL OF EVIDENCE

Level 3 (cohort study).

METHODS

Sixty male patients completed strength testing and the Injury-Psychological Readiness to Return to Sport Scale (I-PRRS) at an outpatient clinical facility as part of return to sport testing after ACLR. Linear regression analysis was used to assess the relationship between the I-PRRS and the independent variables of interest (quadriceps strength symmetry and injury mechanism).

RESULTS

For all patients combined, no symmetry × mechanism interaction was found (P = 0.11). A significant positive relationship was found between quadriceps strength symmetry and the I-PRRS score (P < 0.001, R² = 0.31), after adjusting for time post-ACLR and injury mechanism.

CONCLUSION

Greater quadriceps strength symmetry was associated with greater psychological readiness to RTP after ACLR in male athletes. In contrast to what has been reported in female athletes, this relationship was independent of injury mechanism.

CLINICAL RELEVANCE

Given the potential negative consequences of quadriceps strength deficits on one's confidence to RTP, the need to restore quadriceps symmetry during the postoperative period is readily apparent. Low confidence or low psychological readiness to RTP may be indicative of quadriceps strength asymmetry or poor physical function in general.

Psychological factors during rehabilitation of patients with Achilles or patellar tendinopathy: a cross-sectional study

OBJECTIVE

to examine psychological factors during rehabilitation of patients with Achilles or patellar tendinopathy as well as the association between psychological factors and tendinopathy severity, sport participation, and satisfaction with activity level and tendon function.

DESIGN

cross-sectional study.

SETTING

online survey platform.

PARTICIPANTS

119 patients (mean age: 44 years (SD 14)) diagnosed with Achilles or patellar tendinopathy.

MAIN OUTCOME MEASURES

A range of patient-reported psychological and outcome measures were recorded. Multivariate regression analyses were performed to establish the association between each psychological factor and outcome measures, adjusted for relevant confounders.

RESULTS

Psychological readiness and confidence to return to sports (I-PRRS) and pain catastrophizing (PCS) were significantly associated with tendinopathy severity (modified VISA), sport participation(OSTRC-O), and satisfaction. Kinesiophobia (TSK) and the importance to patients of returning to pre-injury activity level were significantly associated with sports participation and satisfaction.

CONCLUSION

The current study provides evidence of impairments in psychological factors during rehabilitation of patients with Achilles and patellar tendinopathy. Most investigated psychological factors were associated with tendinopathy severity, function, participation, and satisfaction. Physical therapists should recognize patients with lack of psychological readiness to return to sports and also patients with kinesiophobia or catastrophizing thoughts when experiencing pain.

Confidence to Return to Play After Anterior Cruciate Ligament Reconstruction Is Influenced by Quadriceps Strength Symmetry and Injury Mechanism

BACKGROUND

Although the restoration of quadriceps strength symmetry is a primary rehabilitation goal after anterior cruciate ligament reconstruction (ACLR), little is known about the potential relationship between quadriceps strength symmetry and psychological readiness to return to play (RTP).

HYPOTHESIS

Quadriceps strength symmetry will be associated with psychological readiness to RTP after ACLR. Secondarily, injury mechanism will influence the association between quadriceps strength and psychological readiness to RTP.

STUDY DESIGN

Retrospective cohort.

LEVEL OF EVIDENCE

Level 3 (cohort study).

METHODS

A total of 78 female patients completed strength testing and the Injury-Psychological Readiness to Return to Sport (I-PRRS) scale at an outpatient clinical facility as part of return to sport testing after ACLR. Linear regression analysis was used to assess the relationship between the I-PRRS and the independent variables of interest (quadriceps strength symmetry and injury mechanism).

RESULTS

For all patients combined, a significant symmetry × mechanism interaction was found. When split by injury mechanism, a significant linear relationship was found between quadriceps strength symmetry and the I-PRRS score in patients who experienced a noncontact injury (n = 55; P = 0.01; R² = 0.24). No such relationship was found for those who experienced a contact injury (n = 23; P = 0.97; R² = 0.01).

CONCLUSION

Greater quadriceps strength symmetry was associated with greater psychological readiness to RTP in female athletes after ACLR. This relationship, however, was present only in those who experienced a noncontact injury.

CLINICAL RELEVANCE

Clinicians should consider both the physical and the psychological factors in assessing a patient's readiness to RTP. This may be particularly important for those who have experienced an ACL tear through a noncontact mechanism.

The Injury-Psychological Readiness to return to sport (I-PRRS) scale and the Sport Confidence Inventory (SCI): A cross-cultural validation

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.

The recovery after Achilles tendon rupture: a protocol for a multicenter prospective cohort study

BACKGROUND

Achilles tendon rupture (ATR) is a common sports injury, with a rising incidence and significant impairments. Due to the lack of treatment guidelines, there is no consensus about diagnostic methods, primary treatment (non-surgical or surgical) and rehabilitation. It is hypothesized that this lack of consensus and guidelines leads to sub-optimal recovery and higher societal costs. The primary aim of this study is to give a broad insight into the recovery after ATR. Secondarily this study aims to explore factors contributing to recovery and gain insight into the cost-effectiveness of ATR management.

METHODS

This multicenter prospective cohort study will include all adult (≥ 18 years) patients with an ATR treated at the three main hospitals in the Northern Netherlands: University Medical Center Groningen, Martini Hospital Groningen and Medical Center Leeuwarden. All subjects will be invited for three visits at 3, 6 and 12 months post-injury. The following data will be collected: patient-reported outcome measures (PROMs), physical tests, imaging and economic questionnaires. At 3 months post-injury personal, injury, and treatment data will be collected through a baseline questionnaire and assessment of the medical file. The PROMs concern the Dutch version of the Achilles Tendon Total Rupture Score, EQ-5D-5 L, Oslo Sport Trauma Research Center Overuse Injury Questionnaire, Injury Psychological Readiness Return to Sport Scale, Tampa Scale of Kinesiophobia, Expectations, Motivation and Satisfaction questionnaire and a ranking of reasons for not returning to sport. The administered physical tests are the heel-rise test, standing dorsiflexion range of motion, resting tendon length and single leg hop for distance. Ultrasound Tissue Characterization will be used for imaging. Finally, economic data will be collected using the Productivity Cost Questionnaire and Medical Consumption Questionnaire.

DISCUSSION

This prospective cohort study will contribute to optimal decision making in the primary treatment and rehabilitation of ATRs by providing insight into (1) ATR recovery (2) novel imaging for monitoring recovery (3) (barriers to) return to sport and (4) cost-effectiveness of management. The analysis of these data strives to give a broad insight into the recovery after ATR as well as provide data on novel imaging and costs, contributing to individualized ATR management.

TRIAL REGISTRATION

Trialregister.nl. NTR6484 . 20/06/2017. 20/07/2017.