Psychological interventions used to reduce sports injuries: a systematic review of real-world effectiveness

50 Years of Research on the Psychology of Sport Injury: A Consensus Statement

Factors influencing sport injury risk, rehabilitation outcomes, and return to sport processes have been the focus in various research disciplines (sports medicine, psychology and sociology). One discipline, with over 50 years of scholarship, is the psychology of sport injury. Despite the research in this field, there is no evidence-based consensus to inform professional practice. The aim of this original and timely consensus statement is to summarise psychological sport injury research and provide consensus recommendations for sport practitioners seeking to implement psychological principles into clinical practice. A total of seven experts with extensive experience outlined the consensus objectives and identified three psychology of sport injury sub-domains: risk, rehabilitation and return to sport. The researchers, grouped in pairs, prepared initial drafts of assigned sub-domains. The group met in Stockholm, and the three texts were merged into a draft and revised in an iterative process. Stress responses are the strongest psychological risk factor for acute injuries. Intra- and interpersonal factors, as well as sociocultural factors, are demonstrated psychosocial risk factors for overuse injuries. Stress management and mindfulness interventions to prevent injuries have been successfully implemented. The rehabilitation process may influence athlete's cognitive, emotional, and behavioural responses. Social support, mindfulness, acceptance-based practices, and cognitive-behavioural based intervention programs reduce negative reactions. Return to sport includes various stages and different trajectories. Returning athletes typically experience concerns regarding competence, autonomy, and relatedness. It is recommended that athletes focus on the physical, technical, and psychological demands of their sport as they progress to increasingly intense activities. Interdisciplinary collaboration (e.g., sports medicine and psychology) would be beneficial in enhancing clinical practice and improving athlete outcomes.

Association between greenspace exposure and suicide-related outcomes across the lifespan: A systematic review

A growing number of studies have linked greenspace exposure to suicide, but findings are inconsistent. We conducted a systematic review on the associations between greenspace exposure and suicide-related outcomes (namely, suicide mortality, self-harm, and suicidal ideation) up until January 6, 2023. We used the Mixed Methods Appraisal Tool (or MMAT) to assess the quality of the included studies. In total, 23 studies met our inclusion criteria, consisting of 14 ecological, four cross-sectional, three longitudinal, and two experimental studies. Most studies were published in 2022 and conducted in Europe (n = 10), Asia (n = 7), and North America (n = 5), with one worldwide analysis. Various indicators were used to assess greenspace exposure including objective measures (e.g., level of surrounding greenness, quantity, structural features, tree canopy coverage), and greenspace use (e.g., duration and frequency). Suicide mortality was the most studied outcome (n = 14). Quality assessment showed that most (87 %) of the included observational studies used representative samples. Protective associations of exposure to greenspace were reported for suicide mortality (9/14 or 64 %), self-harm (n = 3/5 or 60 %) and suicidal ideation (n = 4/6 or 67 %), with nine or 36 % studies reporting no association. Most of the included studies adjusted for key covariates such as age, sex, and socioeconomic status at various aggregate levels (e.g., household, city). For greenspace exposure and suicide mortality, studies stratified by sex (n = 10) showed larger protective associations for females (n = 7) than for males (n = 4). However, the included studies showed high heterogeneity in terms of exposure indicators and greenspace definitions. Experimental studies and studies using youth samples were rare. While more research is warranted, preliminary findings suggest protective associations between greenspace exposure and suicide-related outcomes.

Evidence Review for Preventing Osteoarthritis After an Anterior Cruciate Ligament Injury: An Osteoarthritis Action Alliance Consensus Statement

CONTEXT

The Osteoarthritis Action Alliance formed a secondary prevention task group to develop a consensus on secondary prevention recommendations to reduce the risk of osteoarthritis after a knee injury.

OBJECTIVE

Our goal was to provide clinicians with secondary prevention recommendations that are intended to reduce the risk of osteoarthritis after a person has sustained an anterior cruciate ligament injury. Specifically, this manuscript describes our methods, literature reviews, and dissenting opinions to elaborate on the rationale for our recommendations and to identify critical gaps.

DESIGN

Consensus process.

SETTING

Virtual video conference calls and online voting.

PATIENTS OR OTHER PARTICIPANTS

The Secondary Prevention Task Group consisted of 29 members from various clinical backgrounds.

MAIN OUTCOME MEASURE(S)

The group initially convened online in August 2020 to discuss the target population, goals, and key topics. After a second call, the task group divided into 9 subgroups to draft the recommendations and supportive text for crucial content areas. Twenty-one members completed 2 rounds of voting and revising the recommendations and supportive text between February and April 2021. A virtual meeting was held to review the wording of the recommendations and obtain final votes. We defined consensus as >80% of voting members supporting a proposed recommendation.

RESULTS

The group achieved consensus on 15 of 16 recommendations. The recommendations address patient education, exercise and rehabilitation, psychological skills training, graded-exposure therapy, cognitive-behavioral counseling (lacked consensus), outcomes to monitor, secondary injury prevention, system-level social support, leveraging technology, and coordinated care models.

CONCLUSIONS

This consensus statement reflects information synthesized from an interdisciplinary group of experts based on the best available evidence from the literature or personal experience. We hope this document raises awareness among clinicians and researchers to take steps to mitigate the risk of osteoarthritis after an anterior cruciate ligament injury.

The psychological responses of British amateur point-to-point jockeys to personal injury

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.

Current concepts and practical applications for recovery, growth, and peak performance following significant athletic injury

For decades, physicians, athletic trainers, and other health care professionals have worked to standardize the recovery process following injury to enhance patient outcomes and to help set appropriate goals for return to competition. Traditionally, these efforts have focused primarily on physical and/or physiological aspects of healing with little consideration for psychological aspects. Concurrently, mental health professionals who work with athletes have developed strategies to enhance performance and minimize negative influences of mental aspects of recovery while promoting approaches that include mental as well as physical recovery. Several strategies have emerged that further encourage a multi-faceted and interdisciplinary approach when helping injured patients return to participation. While important in a healthy population, the practical applications of these strategies are likely more critical for an athlete working through the recovery process with an ultimate goal of returning to competition. Despite these realities, both practical experience and a dearth of literature point to the traditional athletic healthcare providers’ common focus on physical aspects of recovery and psychological professionals’ focus primarily on mental aspects has resulted in sub-optimal outcomes compared to the likely benefits of an integrated approach. This article is intended to characterize current concepts in the fields of sport psychology and mental health concerning the importance of mental aspects of recovery in returning to play. Next, the authors will examine how modern theories can influence practice and discuss how these strategies can be effectively integrated and leveraged to enhance recovery and the athlete’s enjoyment of the rehabilitation and ultimately restoration process.

Cocreating injury prevention training for youth team handball: bridging theory and practice

Although it is advocated that end-users are engaged in developing evidence-based injury prevention training to enhance the implementation, this rarely happens. The ‘Implementing injury Prevention training ROutines in TEams and Clubs in youth Team handball (I-PROTECT)’ uses an ecological participatory design incorporating the perspectives of multiple stakeholders throughout the project. Within the I-PROTECT project, the current study aimed to describe the development of holistic injury prevention training specifically for youth handball players through using knowledge from both end-users (coaches and players) and researchers/handball experts. Employing action evaluation within participatory action research, the cyclical development process included three phases: research team preparation, handball expert-based preparation and end-user evaluation to develop injury prevention training incorporating both physical and psychological perspectives. To grow the knowledge of the interdisciplinary research team, rethinking was conducted within and between phases based on participants’ contributions. Researchers and end-users cocreated examples of handball-specific exercises, including injury prevention physical principles (movement technique for upper and lower extremities, respectively, and muscle strength) combined with psychological aspects (increase end-user motivation, task focus and body awareness) to integrate into warm-up and skills training within handball practice. A cyclical development process that engaged researchers/handball experts and end-users to cocreate evidence-based, theory-informed and context-specific injury prevention training specifically for youth handball players generated a first pilot version of exercises including physical principles combined with psychological aspects to be integrated within handball practice.

Maximising individualisation of sports injury risk reduction approach to reach success

•To individualise injury risk reduction measures could help to better match athlete's individual characteristics and should thus improve their effectiveness. •To individualise injury risk reduction measures could help to improve athlete adherence into such measures and consequently their effectiveness. •This maximised individualised approach is proposed to be used whatever the sport (i.e., individual and teams sports) in both scientific studies and real-world settings, with an end-user centred approach (especially athlete-centred approach) and a co-construction of the injury risk reduction measures with all stakeholders.

Resilience in sports: a multidisciplinary, dynamic, and personalized perspective

Athletes are exposed to various psychological and physiological stressors, such as losing matches and high training loads. Understanding and improving the resilience of athletes is therefore crucial to prevent performance decrements and psychological or physical problems. In this review, resilience is conceptualized as a dynamic process of bouncing back to normal functioning following stressors. This process has been of wide interest in psychology, but also in the physiology and sports science literature (e.g. load and recovery). To improve our understanding of the process of resilience, we argue for a collaborative synthesis of knowledge from the domains of psychology, physiology, sports science, and data science. Accordingly, we propose a multidisciplinary, dynamic, and personalized research agenda on resilience. We explain how new technologies and data science applications are important future trends (1) to detect warning signals for resilience losses in (combinations of) psychological and physiological changes, and (2) to provide athletes and their coaches with personalized feedback about athletes' resilience.

Gamifying App-Based Low-Intensity Psychological Interventions to Prevent Sports Injuries in Young Athletes: A Review and Some Guidelines

Sports injuries have become a real health concern. Particularly noticeable is the increasing number of severe sports injuries among young people. Sports injury (SI) is a multifactorial event where many internal and external, proximal and remote factors play a role in a recursive way, including physical and psychological variables. Accordingly, many voices expressing the need of tackling that and several prevention programs have arisen. Nevertheless, different barriers and limitations prevent a wide extension of well-controlled programs, closely monitored by highly specialized professionals in ordinary sports grass-root organizations. These have helped flourishing different low intensity (LI)-interventions and e-Health apps focusing on both physical warmup, training and fitness, and mental skills aimed at reducing athlete's vulnerability to SIs. This kind of intervention usually uses self-administered techniques and/or non-specialized staff that can effectively monitoring the program. In fact, LI-interventions have shown to be effective coping with different health and psychological issues. However, these interventions face an important challenge: the lack of engagement people usually show. The current paper proposes how gamification can contribute to the engagement to such interventions. Based on the mechanics-dynamics-aesthetics framework to analyze game design, the paper suggests a set of guidelines app- and web-LI interventions aimed at preventing SIs should include to foster motivation and reduce attrition.

Determinants of the adoption of injury risk reduction programmes in athletics (track and field): an online survey of 7715 French athletes

OBJECTIVES

To identify individual characteristics associated with the adoption of injury risk reduction programmes (IRRP) and to investigate the variations in sociocognitive determinants (ie, attitudes, subjective norms, perceived behavioural control and intentions) of IRRP adoption in athletics (track and field) athletes.

METHODS

We conducted a cross-sectional study using an online survey sent to athletes licensed with the French Federation of Athletics to investigate their habits and sociocognitive determinants of IRRP adoption. Sociodemographic characteristics, sports practice and history of previous injuries were also recorded. Logistic regression analyses and group comparisons were performed.

RESULTS

The final sample was composed of 7715 athletes. From the multivariable analysis, competing at the highest level was positively associated with IRRP adoption (adjusted OR (AOR)=1.66; 99.9% CI 1.39 to 1.99 and AOR=1.48; 99.9% CI 1.22 to 1.80) and presenting a low number of past injuries was negatively associated with IRRP adoption (AOR=0.48; 99.9% CI 0.35 to 0.65 and AOR=0.61; 99.9% CI 0.44 to 0.84), both during their lifetime and the current season, respectively. These results were supported by higher scores of sociocognitive determinants among athletes who reported IRRP adoption compared with other athletes.

CONCLUSION

Some characteristics of athletes seem to be associated with IRRP adoption either positively (competing at the highest level) or negatively (presenting a lower number of past injuries), whereas all the sociocognitive determinants tested appear to be linked to IRRP adoption. Since many athlete characteristics are difficult or impossible to change, IRRP promotion may be enhanced by targeting athletes' beliefs and intentions to adopt an IRRP.

A Comprehensive Summary of Systematic Reviews on Sports Injury Prevention Strategies

Background

A large volume of systematic reviews and meta-analyses has been published on the effectiveness of sports injury prevention programs.

Purpose

To provide a qualitative summary of published systematic reviews and meta-analyses that have examined the effectiveness of sports injury prevention programs on reducing musculoskeletal injuries.

Study Design

Systematic review; Level of evidence, 4.

Methods

We searched the PubMed, CINAHL, EMBASE, and the Cochrane databases for systematic reviews and meta-analyses that evaluated the effectiveness of sports injury prevention programs. We excluded published abstracts, narrative reviews, articles not published in English, commentaries, studies that described sports injury prevention strategies but did not assess their effectiveness, studies that did not assess musculoskeletal injuries, and studies that did not assess sports-related injuries. The most relevant results were extracted and summarized. Levels of evidence were determined per the Oxford Centre for Evidence-Based Medicine, and methodological quality was assessed using the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews, revised version).

Results

A total of 507 articles were retrieved, and 129 were included. Articles pertaining to all injuries were divided into 9 topics: sports and exercise in general (n = 20), soccer (n = 13), ice hockey (n = 1), dance (n = 1), volleyball (n = 1), basketball (n = 1), tackle collision sports (n = 1), climbing (n = 1), and youth athletes (n = 4). Articles on injuries by anatomic site were divided into 11 topics: general knee (n = 8), anterior cruciate ligament (n = 34), ankle (n = 14), hamstring (n = 11), lower extremity (n = 10), foot (n = 6), groin (n = 2), shoulder (n = 1), wrist (n = 2), and elbow (n = 1). Of the 129 studies, 45.7% were ranked as evidence level 1, and 55.0% were evidence level 2. Based on the AMSTAR-2, 58.9% of the reviews reported a priori review methods, 96.1% performed a comprehensive literature search, 47.3% thoroughly described excluded articles, 79.1% assessed risk of bias for individual studies, 48.8% reported a valid method for statistical combination of data (ie, meta-analysis), 45.0% examined the effect of risk of bias on pooled study results, and 19.4% examined the risk for publication bias.

Conclusion

This comprehensive review provides sports medicine providers with a single source of the most up-to-date publications in the literature on sports injury prevention.

Nature and Children's Health: A Systematic Review

CONTEXT

Daily outdoor play is encouraged by the American Academy of Pediatrics. Existing evidence is unclear on the independent effect of nature exposures on child health.

OBJECTIVE

We systematically evaluated evidence regarding the relationship between nature contact and children's health.

DATA SOURCES

The database search was conducted by using PubMed, Cumulative Index to Nursing and Allied Health Literature, PsychInfo, ERIC, Scopus, and Web of Science in February 2021.

STUDY SELECTION

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In all searches, the first element included nature terms; the second included child health outcome terms.

DATA EXTRACTION

Of the 10 940 studies identified, 296 were included. Study quality and risk of bias were assessed.

RESULTS

The strongest evidence for type of nature exposure was residential green space studies (n = 147, 50%). The strongest evidence for the beneficial health effects of nature was for physical activity (n = 108, 32%) and cognitive, behavioral, or mental health (n = 85, 25%). Physical activity was objectively measured in 55% of studies, and 41% of the cognitive, behavioral, or mental health studies were experimental in design.

LIMITATIONS

Types of nature exposures and health outcomes and behaviors were heterogenous. Risk of selection bias was moderate to high for all studies. Most studies were cross-sectional (n = 204, 69%), limiting our ability to assess causality.

CONCLUSIONS

Current literature supports a positive relationship between nature contact and children's health, especially for physical activity and mental health, both public health priorities. The evidence supports pediatricians in advocating for equitable nature contact for children in places where they live, play, and learn.

Psychological Interventions Can Reduce Injury Risk in Athletes: A Critically Appraised Topic

Clinical Scenario: Injury prevention programs are becoming standard practice for reducing sports-related injuries, but most programs focus on musculoskeletal elements. Psychological factors can be strong predictors of sports-related injuries and there is recent evidence that suggests psychological interventions can be effective at reducing injury risk. It is unclear if injury prevention programs that focus on psychological factors are an important inclusion for athletic trainers/therapists. Athletes can be exposed to different psychological factors based on sport type including team or individual sports, which can increase their risk of injury. While psychological interventions can reduce injuries by addressing psychological symptoms, it is unclear if the interventions are effective for at-risk athletes in addition to athletes who are not suffering from any psychological factors. Currently, there are no guidelines or recommendations for athletic trainers/therapists to address psychological factors with the purpose of injury prevention. Clinical Question: Are psychological intervention programs effective in reducing sports-related injury risk and are they clinically relevant to athletic trainers/therapists for implementation in all settings? Summary of Findings: The authors searched the literature for studies investigating the use of psychological intervention programs to reduce sports-related injuries in an athletic population. The search returned 6 possible papers (2 systematic reviews without meta-analysis, 1 systematic review with a meta-analysis, 2 meta-analyses, and 1 randomized control trial not included in the systematic reviews). The authors narrowed our appraisal to one systematic review and one randomized controlled trial. The review contained all the studies from the previous review papers including 3 studies which performed screening procedures. The collection of evidence demonstrates positive effects associated with implementing psychological intervention techniques to reduce sports injury rates in all athletes; at-risk athletes, not at-risk athletes, and individual and team-sport athletes. Bottom Line: There is sufficient evidence supporting the use of a psychological-based intervention by athletic trainers/therapists to effectively reduce the number of injury occurrences in the athletic population. Direct comparisons of effectiveness between team and individual sports was not conducted in the research, but a substantial representation of both sport types existed. The current evidence includes a variety of athletic populations, at-risk and not at-risk, different sport types, and competition levels. Athletic trainers/therapists should consider the integration of psychological disciplines in current injury prevention practices to address the psychological concerns which put athletes at additional risk for injury. Strength of Recommendation: Grade B evidence exists to support the use of psychological intervention strategies in a well-developed injury prevention plan. Sports medicine practitioners can help athletes reduce stress, increase mindfulness, and be more aware of mental health practices which helps reduce injury risk.

A narrative review of the risk factors and psychological consequences of injury in horseracing stable staff

Horseracing stable staff have a multifaceted role, acting as care givers, skilled athletes and equine experts, resulting in inherent high emotional, physical and mental demands. Despite these demands, and reports of significant injury risk to those working in racing at ground level, there has been no research investigating the psychological risk factors for injury in UK racing stable staff and how psychological responses to injury may affect long term mental health and wellbeing. With mental health at the forefront of industry consideration, this narrative review aimed to reflect on the current literature to propose occupational, life and social stressors that may be increasing the risk of injury in racing staff. In addition, this review aims to apply current injury theory to propose whether stable staff are at heightened risk of injury mismanagement. A literature search was undertaken to investigate the psychological aspects of injury, using five search engines and the following key words: injury, psychological responses, occupational, sport and/or athlete, equestrian, horseracing, jockey, risk of injury, rehabilitation, and injury minimisalisation. Articles were selected based on relevance to review aims, and research findings were synthesised under two primary areas: predictors of injury (working hours, job security, job control, life stressors, mental health and drug misuse) and responses to injury (positive and negative responses to injury, the role of social support, rehabilitation adherence, and injury minimalisation). Whilst there are limitations to narrative reviews, this study provides a novel interpretation of injury risk and responses specific to staff working in horseracing, where injury-related challenges are currently a key focus for sector employees, managerial staff and racing organisations. Recommendations for further research have been made to direct the advancement of knowledge in the field.

An Interactive Cognitive-Behavioural Multimedia Program Favourably Affects Pain and Kinesiophobia During Rehabilitation After Anterior Cruciate Ligament Surgery: An Effectiveness Trial

Psychological interventions have been found effective in helping athletes cope with the challenges associated with knee surgery. In this investigation, an interactive cognitive-behavioural multimedia program was evaluated as a means of delivering psychological interventions to individuals experiencing anterior cruciate ligament (ACL) surgery in a field trial with 69 ACL surgery patients (30 women and 39 men; 24 competitive athletes, 41 recreational athletes, and 4 nonathletes; M _age = 35.01, SD = 11.98 years). Results indicated that compared to participants who received standard care, participants who received the multimedia program reported greater preoperative confidence in ability to cope, lower postoperative pain and kinesiophobia, and greater use and perceived utility of patient education materials. The findings suggest that the multimedia program has promise as an economical and effective means of educating and delivering psychological interventions to people experiencing ACL surgery and rehabilitation.

Youth sport injury research: a narrative review and the potential of interdisciplinarity

To prevent sports injuries, researchers have aimed to understand injury aetiology from both the natural and social sciences and through applying different methodologies. This research has produced strong disciplinary knowledge and a number of injury prevention programmes. Yet, the injury rate continues to be high, especially in youth sport and youth football. A key reason for the continued high injury rate is the development of injury prevention programmes based on monodisciplinary knowledge that does not account for the complex nature of sport injury aetiology. The purpose of this paper is to consider and outline an interdisciplinary research process to research the complex nature of sport injury aetiology. To support our proposition, we first present a narrative review of existing youth football and youth sport injury research demonstrating an absence of paradigmatic integration across the research areas’ main disciplines of biomedicine, psychology and sociology. We then demonstrate how interdisciplinary research can address the complexity of youth sport injury aetiology. Finally, we introduce the interdisciplinary process we have recently followed in a youth football injury research project. While further research is necessary, particularly regarding the integration of qualitative and quantitative sport injury data, we propose that the pragmatic interdisciplinary research process can be useful for researchers who aim to work across disciplines and paradigms and aim to employ methodological pluralism in their research.

Effect of motor imagery on enjoyment in knee-injury prevention and rehabilitation training: A randomized crossover study

OBJECTIVES

The novel MOTor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS) model takes a uniquely holistic approach by integrating mental and physical aspects into current training programs. The aim of this trial was to evaluate enjoyment of MOTIFS training as compared to Care-as-Usual (CaU) knee injury and/or rehabilitation training. The primary hypothesis was that enjoyment would be greater following MOTIFS training than CaU training.

DESIGN

Block-randomized 2×2 cross-over trial.

METHODS

Thirty athletes (18-31years, 50% women) currently or previously active in team ball sports, with no pain or injury preventing jump and/or directional changes. MOTIFS training integrates sport-specific experiences and equipment into physical exercises to increase individualized realism and meaning. The CaU condition included solely physical exercise. The main outcome was the Physical Activity Enjoyment Scale (PACES). Secondary outcomes included Self-Assessment Manikin (SAM; subscales Valence, Arousal, Dominance), Perceived exertion, pulse, duration, and movement quality.

RESULTS

PACES scores were better following MOTIFS training than CaU (point estimate 24.67; 95% CI: 19.0; 30.3). Between-groups differences in SAM Valence (median 2, quartiles 1;3), Arousal (median 1, quartiles 0;2.25), and Dominance (median 0.5, quartiles 0;2), and RPE (median 1, quartiles -0.3;2), training duration (mean 5.34, 95% CI: -0.17; -0.73), and pulse (median 7.50, quartiles 0.25;16.75) were higher following MOTIFS training than CaU training.

CONCLUSIONS

Results suggest that the MOTIFS model, which integrates simultaneous physical and psychological interventions, is a clinically plausible method of influencing enjoyment and other psychological outcomes. Further studies may explore effects of the MOTIFS principles on injury prevention and rehabilitation training.

Effects of Psychological Interventions on the Prevention of Sports Injuries: A Meta-analysis

Background:

Studies have shown that preventive psychological interventions can reduce the occurrence of sports injuries.

Purpose:

To systematically evaluate the published literature on the effects of psychological interventions on rates of sports injuries and propose a set of psychological interventions to reduce such injuries.

Study Design:

Systematic review; Level of evidence, 1.

Methods:

A total of 11 randomized controlled trials and intervention control trials involving 1287 participants were included. A random-effects model was used to analyze the data. Pooled results were expressed as effect sizes and 95% CIs. Bias and heterogeneity among the studies were assessed, and sensitivity and subgroup analyses were performed.

Results:

Meta-analysis suggested that preventive psychological interventions effectively prevented the occurrence of sports injuries (effect size = –0.55; P < .001), although the studies showed substantial heterogeneity (I² = 94.2%; P < .001), which could not be attributed to specific variables. Nevertheless, sensitivity analysis suggested that overall results were reliable. No significant risk of publication bias was found.

Conclusion:

Preventive psychological interventions moderately reduced the risk of sports injuries. Risk screening also significantly reduced the risk of sports injuries. These interventions should focus on cognitive behavior and be administered in 1 to 6 sessions over 7 to 12 weeks for 60 minutes per session.

Effect of a mindfulness programme training to prevent the sport injury and improve the performance of semi-professional soccer players

OBJECTIVE

Mindfulness improves psychological outcomes. We examined whether greater mindfulness scores were associated with reduced injury rates in soccer players, as well as improved performance at both the individual and team level.

METHOD

This was a parallel-group, pre- and post-test, randomised controlled pilot trial. Forty-five male amateur soccer players from Tehran, Iran, were randomly assigned into experimental (n=23) and control groups (n=22). Outcomes were scores on the mindfulness sport inventory, as well as injury rates and recovery as assessed by a physiotherapist using standardised criteria. Expert observers assessed the effect on individual and team performance. Data were analysed using mixed analysis of variance and, where indicated, its non-parametric alternative, the Friedman test.

RESULTS

Significantly greater mindfulness scores in the intervention group were associated with both reduced injury and improved performance.

CONCLUSION

Mindfulness training shows promise in preventing injury and improving performance. The intervention could be applied to other sports and be helpful in clinical settings given the importance of exercise in promoting psychological well-being.