Well-Come Back! Professional Basketball Players Perceptions of Psychosocial and Behavioral Factors Influencing a Return to Pre-injury Levels

Return to Play in the Professional Athlete

The management of any injury in elite athletes poses unique challenges distinct from the general population because the goal is rapid recovery and return to play (RTP) while simultaneously managing residual symptoms and minimizing risk of reinjury. The time required for treatment, recovery, and return to peak performance can have consequences for both the athlete and his or her team: financial implications, psychological stressors, team dynamics, and future performance. RTP after an injury in the professional athlete requires a complex decision-making process with many stakeholders. Several factors influence this decision, not the least of which is the type and mechanism of injury. This article provides an overview of the RTP process including nonmedical factors that may influence this decision, common injuries seen in professional athletes, injury patterns particular to certain popular sports, and imaging guidelines for such injuries.

Psychosocial experiences of competitive rugby players on the "long, long journey" to recovery following ACL ruptures and reconstruction

Anterior Cruciate Ligament (ACL) injuries are serious and potentially career-ending. Reconstruction surgery and extended rehabilitation typically follow, but some athletes never attain the same level of sport performance. The psychosocial experiences of athletes who sustain ACL injuries and their cognitive appraisal, emotional and behavioral responses to the injury, and reconstruction require further attention during the different recovery phases. The aim is to explore these psychosocial experiences, social support needs and sources thereof of competitive athletes who sustained unilateral ACL ruptures and underwent reconstruction surgery. Semi-structured interviews with six competitive rugby players (M age: 22.3 ± 2.92 years), elicited information at seven time-points. We analyzed the qualitative information through thematic analysis. Five common themes emerged: (1) cognitive appraisal, (2) emotional responses (negative and positive affective responses), (3) behavioral responses, (4) social support needs and sources thereof, and (5) adversity-induced identity expansion (athletic and person-centered identities). In-vivo quotes gave a rich description of the athletes' experiences throughout the "long, long journey" to return-to-sport. These findings may sensitize and assist sports healthcare professionals, coaches, teammates, family, and friends to explore various psychosocial experiences throughout the injury and recovery period. Phase-appropriate psychosocial support or referral to sport psychology services is recommended to enhance the recovery process, improve long-term physical and mental health, and subsequent performance.

The Impact of Wrist Fractures on Long-Term Basketball Performance

Background

Wrist joint fractures may present challenging obstacles for the rehabilitating athlete upon return to play. Although current literature has examined the effects of specific injuries to the upper extremity for basketball athletes, little is known about long-term performance outcomes following wrist joint fractures.

Methods

Review of all National Basketball Association players who sustained wrist joint fractures was conducted. Player characteristics, preinjury and postinjury performance, and overall efficiency were analyzed.

Results

A total of 31 players were deemed appropriate for inclusion, with an average age of 26.2 ± 4.3 years and a mean of 5.2 ± 3.6 years played before injury and 4.1 ± 3.1 years played upon return. Operative management was pursued in 48.4% of players. Players demonstrated a significant decrease in win shares before injury (mean: 24.3 ± 31.5) compared to after return from injury (mean: 9.6 ± 19.6) (p < 0.032). Multivariate regression demonstrated that increased points per game before injury (standardized β: 0.71; 95% confidence interval [CI]: 1.2-8.5, p < 0.011) and increased win shares before injury (β: 1.0; 95% CI: 1.4-9.5, p < 0.001) were both independently predictive with increased win shares after return to play. Player position, age, management type, and all other statistics were not significantly associated with any other findings upon return.

Conclusion

Overall efficiency following return to play in the setting of basketball-associated wrist joint fractures appears to be decreased in athletes. However, preinjury performance as captured through win share efficiency and points per game appears to be predictive of increased productivity after successful return.

Social support and therapeutic relationships intertwine to influence exercise behavior in people with sport-related knee injuries

OBJECTIVE

Explore how social support influences exercise therapy participation and adherence before and after enrolling in an education and exercise therapy intervention (Stop OsteoARthritis, SOAR).

METHODS

Study design: Interpretative description. We sampled participants with sport-related knee injuries from the SOAR randomized controlled trial. SOAR is a virtual, physiotherapist-guided, education and exercise therapy-based knee health program that targets individuals at risk of early osteoarthritis. One-on-one semi-structured interviews were completed, and an inductive approach was guided by Braun & Clarke's reflexive thematic analysis.

RESULTS

Fifteen participants (67% female, median age 26 [19-35] years) were interviewed. Three themes were generated that encapsulated participants' social support experiences that fostered exercise participation: 1) Treat me as a whole person represented the value of social support that went beyond participants' physical needs, 2) Work with me highlighted the working partnership between the clinician and the participant, and 3) Journey with me indicated a need for on-going support is necessary for the long-term management of participants' knee health. A theme of the therapeutic relationship was evident across the findings.

CONCLUSIONS

Insight was gained into how and why perceived support may be linked to exercise behavior, with the therapeutic relationship being potentially linked to perceived support. Social support strategies embedded within an education and exercise therapy program may boost exercise adherence after sport-related knee injuries.

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.

Effects of Mindfulness on Obligatory Exercise During the Return of Injured Athletes to Sports: The Mediating Roles of Self-Criticism and Competitive State Anxiety

Purpose

Despite the Advances in sports training methods and medicine, they have not reduced the recurrence rate of athletes' injuries significantly, and obligatory exercise may be an important reason for their re-injury. The purpose of this study was to investigate the effects of mindfulness on obligatory exercise behavior, self-criticism, and competitive state anxiety in athletes recovering from injury, and explain their interactions.

Patients and Methods

The study adopted the snowball and convenience sampling methods. From November to December 2022, a total of 265 high-level sports players in South China were selected, and ultimately, 208 valid data samples were obtained. Maximum likelihood estimation was used to analyze the data and test the hypotheses proposed using 5000 bootstrap samples to test the mediating effects of the structural equation model.

Results

The results demonstrated that there were positive correlations between self-criticism and obligatory exercise (standardized coefficients = 0.38, p < 0.001), as well as competitive state anxiety and self-criticism (standardized coefficients = 0.45, p < 0.001). Mindfulness and obligatory exercise were correlated negatively (standardized coefficients = -0.31, p < 0.001), but there was no significant relation between competitive state anxiety and obligatory exercise (standardized coefficients = 0.05, p > 0.01). Self-criticism and competitive state anxiety mediated mindfulness's positive effects on obligatory exercise in part (standardized indirect effect = -0.16, p < 0.01), and this explanatory power was higher than in any previous study (R2 = 0.37).

Conclusion

The irrational beliefs in Activating events-Beliefs-Consequence (ABC) theory play an important role in explaining athletes' obligatory exercise, and mindfulness has a positive effect on reducing obligatory exercise behavior.

London International Consensus and Delphi study on hamstring injuries part 3: rehabilitation, running and return to sport

Hamstring injuries (HSIs) are the most common athletic injury in running and pivoting sports, but despite large amounts of research, injury rates have not declined in the last 2 decades. HSI often recur and many areas are lacking evidence and guidance for optimal rehabilitation. This study aimed to develop an international expert consensus for the management of HSI. A modified Delphi methodology and consensus process was used with an international expert panel, involving two rounds of online questionnaires and an intermediate round involving a consensus meeting. The initial information gathering round questionnaire was sent to 46 international experts, which comprised open-ended questions covering decision-making domains in HSI. Thematic analysis of responses outlined key domains, which were evaluated by a smaller international subgroup (n=15), comprising clinical academic sports medicine physicians, physiotherapists and orthopaedic surgeons in a consensus meeting. After group discussion around each domain, a series of consensus statements were prepared, debated and refined. A round 2 questionnaire was sent to 112 international hamstring experts to vote on these statements and determine level of agreement. Consensus threshold was set a priori at 70%. Expert response rates were 35/46 (76%) (first round), 15/35 (attendees/invitees to meeting day) and 99/112 (88.2%) for final survey round. Statements on rehabilitation reaching consensus centred around: exercise selection and dosage (78.8%-96.3% agreement), impact of the kinetic chain (95%), criteria to progress exercise (73%-92.7%), running and sprinting (83%-100%) in rehabilitation and criteria for return to sport (RTS) (78.3%-98.3%). Benchmarks for flexibility (40%) and strength (66.1%) and adjuncts to rehabilitation (68.9%) did not reach agreement. This consensus panel recommends individualised rehabilitation based on the athlete, sporting demands, involved muscle(s) and injury type and severity (89.8%). Early-stage rehab should avoid high strain loads and rates. Loading is important but with less consensus on optimum progression and dosage. This panel recommends rehabilitation progress based on capacity and symptoms, with pain thresholds dependent on activity, except pain-free criteria supported for sprinting (85.5%). Experts focus on the demands and capacity required for match play when deciding the rehabilitation end goal and timing of RTS (89.8%). The expert panellists in this study followed evidence on aspects of rehabilitation after HSI, suggesting rehabilitation prescription should be individualised, but clarified areas where evidence was lacking. Additional research is required to determine the optimal load dose, timing and criteria for HSI rehabilitation and the monitoring and testing metrics to determine safe rapid progression in rehabilitation and safe RTS. Further research would benefit optimising: prescription of running and sprinting, the application of adjuncts in rehabilitation and treatment of kinetic chain HSI factors.

Factors That Affect Return to Sports After an Achilles Tendon Rupture: A Qualitative Content Analysis

Background

Achilles tendon rupture is common among physically active individuals, yet a high percentage fail to return to their former activity after the injury. Quantifiable factors such as type of treatment, hours of rehabilitation, and age have not been associated with return-to-play rates. A factor that influences recovery is the participant's experience before and throughout the rehabilitation process, which can be explored using a qualitative content analysis.

Purpose

To explore and describe what influences the participant to return to physical activity after an Achilles tendon rupture.

Study Design

Cross-sectional study; Level of evidence, 3.

Methods

Twenty participants (14 men; mean age, 46 years) were interviewed as part of this study. All participants had ruptured their Achilles tendon 4 to 6 years before the interviews. From the interviews, codes were extracted that evolved into 19 subcategories, 6 categories, and 1 theme.

Results

The overarching theme that emerged was "Help me and then I can fix this." The 6 categories were (1) one's own drive to succeed, (2) having a supportive social network, (3) trusting the support from the health and social systems, (4) receiving and adapting information from others drives persistence in returning to activity, (5) impact of the injury on psychological factors; and (6) influence of physiological aspects.

Conclusion

To be able to recover properly from an Achilles tendon rupture and return to activity, the study participants described the importance of obtaining the support needed to be able to gain optimal rehabilitation. In the participants' opinion, for a greater chance of successful treatment and rehabilitation, it was vital to be provided with good support.

Pain and Psychological Readiness to Return to Sport in Elite Volleyball Players: A Cross-Sectional Study

Pain is modulated by multiple factors. A relevant psychological process peculiar to athletes and which could be associated with pain is Psychological Readiness to Return to Sport (PRRS). The analysis of this association in competition context is particularly important.

OBJECTIVE

To determine the correlation between the PRRS and pain intensity in elite volleyball players during their participation in a continental sporting event.

METHODS

A cross-sectional study was conducted. Data from 107 male volleyball players (23.50 ± 4.08 years of age) participating in the South American Volleyball Championship were used. The athletes answered a self-report questionnaire on the day the championship began regarding their history of injuries in the previous six months. The athletes who declared injuries were asked about the current pain intensity using the Pain Numeric Rating Scale (NRS) and Psychological Readiness to Return to Sport using the Injury-Psychological Readiness to Return to Sport scale (I-PRRS).

RESULTS

43.93% (n = 47) of the athletes (23.70 ± 3.54 years) reported an injury in the six months prior to the championship. They presented a median on the NRS of three (interquartile range (IQR), 2-5), and 54 (IQR, 46-58) on the I-PRRS. The Spearman's Rho correlation test showed an inversely and moderate correlation (r_s = -0.36; p = 0.011; CI: -0.64--0.08) between pain intensity and PRRS.

CONCLUSIONS

In male elite volleyball players who participate in a Continental Championship in South America, higher levels of PRRS was correlated to lower pain intensity.

Psychological readiness to return to sports practice and risk of recurrence: Case studies

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.

A Psychological Support Intervention to Help Injured Athletes “Get Back in the Game”: Design and Development Study

Background

After a serious knee injury, up to half of athletes do not return to competitive sport, despite recovering sufficient physical function. Athletes often desire psychological support for the return to sport, but rehabilitation clinicians feel ill-equipped to deliver adequate support.

Objective

We aimed to design and develop an internet-delivered psychological support program for athletes recovering from knee ligament surgery.

Methods

Our work for developing and designing the Back in the Game intervention was guided by a blend of theory-, evidence-, and target population–based strategies for developing complex interventions. We systematically searched for qualitative evidence related to athletes’ experiences with, perspectives on, and needs for recovery and return to sport after anterior cruciate ligament (ACL) injury. Two reviewers coded and synthesized the results via thematic meta-synthesis. We systematically searched for randomized controlled trials reporting on psychological support interventions for improving ACL rehabilitation outcomes in athletes. One reviewer extracted the data, including effect estimates; a second reviewer checked the data for accuracy. The results were synthesized descriptively. We conducted feasibility testing in two phases—(1) technical assessment and (2) feasibility and usability testing. For phase 1, we recruited clinicians and people with lived experience of ACL injury. For phase 2, we recruited patients aged between 15 and 30 years who were within 8 weeks of ACL reconstruction surgery. Participants completed a 10-week version of the intervention and semistructured interviews for evaluating acceptability, demand, practicality, and integration. This project was approved by the Swedish Ethical Review Authority (approval number: 2018/45-31).

Results

The following three analytic themes emerged from the meta-synthesis (studies: n=16; participants: n=164): (1) tools or strategies for supporting rehabilitation progress, (2) barriers and facilitators for the physical readiness to return to sport, and (3) barriers and facilitators for the psychological readiness to return to sport. Coping strategies, relaxation, and goal setting may have a positive effect on rehabilitation outcomes after ACL reconstruction (randomized controlled trials: n=7; participants: n=430). There were no trials of psychological support interventions for improving the return to sport. Eleven people completed phase 1 of feasibility testing (technical assessment) and identified 4 types of software errors, which we fixed. Six participants completed the feasibility and usability testing phase. Their feedback suggested that the intervention was easy to access and addressed the needs of athletes who want to return to sport after ACL reconstruction. We refined the intervention to include more multimedia content and support access to and the use of the intervention features.

Conclusions

The Back in the Game intervention is a 24-week, internet-delivered, self-guided program that comprises 7 modules that complement usual rehabilitation, changes focus as rehabilitation progresses, is easy to access and use, and includes different psychological support strategies.

Development and Initial Validation of an Acute Readiness Monitoring Scale in Military Personnel

Personnel in many professions must remain “ready” to perform diverse activities. Managing individual and collective capability is a common concern for leadership and decision makers. Typical existing approaches for monitoring readiness involve keeping detailed records of training, health and equipment maintenance, or – less commonly – data from wearable devices that can be difficult to interpret as well as raising privacy concerns. A widely applicable, simple psychometric measure of perceived readiness would be invaluable in generating rapid evaluations of current capability directly from personnel. To develop this measure, we conducted exploratory factor analysis and confirmatory factor analysis with a sample of 770 Australian military personnel. The 32-item Acute Readiness Monitoring Scale (ARMS) demonstrated good model fit, and comprised nine factors: overall readiness; physical readiness; physical fatigue; cognitive readiness; cognitive fatigue; threat-challenge (i.e., emotional/coping) readiness; skills-and-training readiness; group-team readiness, and equipment readiness. Readiness factors were negatively correlated with recent stress, current negative affect and distress, and positively correlated with resilience, wellbeing, current positive affect and a supervisor’s rating of solider readiness. The development of the ARMS facilitates a range of new research opportunities: enabling quick, simple and easily interpreted assessment of individual and group readiness.

Rebooting in sport training and competitions: Athletes' perceived stress levels and the role of interoceptive awareness

The psychological consequences of the lockdown in the sport context have been well studied. However, few studies investigated athletes' perceived stress during the rebooting in sport training and competitions; moreover, no investigations examined the relationship between perceived stress and interoceptive awareness. To mind this gap and support the enactment of appropriate behaviours for practising sports in a unique situation, we compared athletes' perceived stress data collected during the rebooting in sport activities with normative data and with those collected during the first Italian lockdown. Furthermore, we examined the impact of interoceptive awareness towards positive and negative stress by means of regression analyses. The IPSS-10 and the MAIA questionnaire were administered to 220 athletes. Findings suggest that athletes were experiencing a detrimental situation despite the resumption of sport activities but when comparing rebooting phase with the lockdown, female athletes began to feel greater financial security thereby reducing their perceived stress. Athletes who scored high especially for body trusting - the experience of one's body as safe and trustworthy - could regulate their perceived stress levels by increasing positive and reducing negative stress. Athletes could engage in mindful activities related to the body to reduce their perceived stress levels and better deal with an unprecedented situation.

Physical activity on mental wellbeing in senior English Premier League soccer players during the COVID-19 pandemic and the lockdown

The COVID-19 pandemic and the subsequent lockdown created new stressors that could potentially attenuate mental wellbeing (MW) in athletes, who are already susceptible to poor MW. This study aims to describe fluctuations to MW during "lockdown" and subsequent "return to sport" protocols, in comparison to the normal "in-season" in professional soccer. Twenty-five English Premier League (EPL) soccer players completed the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) every two weeks, during the 2019/2020 season, and every week during "lockdown" and "return to training" for 28 weeks. The duration of each physical activity (PA) session completed was recorded. No significant differences were found for MW between time points (In-season, lockdown, return to training and the restart) (51.5 ± 5.6 vs. 50.7 ± 4.8 vs. 50.8 ± 5.7 vs. 50.7 ± 5.6 (p > 0.05)) respectively. Individually, differences were identified; in-season weekly session duration (243 ± 38 min) was higher than during lockdown (180 ± 62 min) (p < 0.05). During lockdown, weekly MW scores were related to the previous 7-day number of sessions (r = 0.151) and active min (r = 0.142) (p < 0.05). Furthermore, participants that exercised >250 min in lockdown, had higher MW scores (52.46 ± 4.65) than <250 min (50.35 ± 6.55) (p < 0.05). MW responses to lockdown were best understood on an individual basis. Additionally, PA only had a measurable effect on MW when >250 min. Further, stressors imposed upon players during an EPL season, are potentially greater than those inflicted by the lockdown. Implications for monitoring MW in EPL soccer players and the potential inclusion of an in-season break are discussed.Highlights Mental Wellbeing Responses, as measured by the Warwick-Edinburgh Mental Wellbeing scale did not change significantly at a group level across the four phases of the season. However, on an individual level changes were evident.There was a decline in the trend of wellbeing scores during in-season, return to training and the restart, but an increase in wellbeing scores during lockdown.Physical Activity had a measurable effect on wellbeing, when physical activity was >250 min during lockdown.These findings highlight the need for individual monitoring of wellbeing and longitudinal monitoring in sport to identify decline in wellbeing and implement intervention. In addition, the prescription of physical activity >250 min per week during lockdown in trained athletes may promote positive mental health.

Is Perceived Autonomy Support Provided by a Coach Related to the Intention of Injury Preventative Behavior Among National and International Level Golfers?

The successful implementation of injury prevention programs is reliant on athletes and coaches accepting, adopting, and complying with behaviors that reduce injury risk. Exploring factors, such as motivation and planned behavior, that might increase the frequency of these behaviors warrants investigation. The aim of the study was to investigate the complex interaction between perceived autonomy support, self-determined motivation, planned behavior, and how this relates to golfers self-reported intention injury preventative behavior. A total of 60 golfers completed questions on psychological measures of perceived autonomy support from coaches, autonomous motivation, and intentions of injury preventative behavior. A neural network model analysis was performed to investigate the strength of connection between covariates and construct a network structure. Analysis of results was performed by assessing edge strengths and node centrality to guide inference of the network topology. The most central node was autonomous regulation and the results showed one cluster comprising positive interactions between perceived autonomy support, effort of injury preventative behavior, and frequency of injury preventative behavior. When aiming to encourage injury preventative behavior, coaches should consider giving feedback that supports autonomous motivation since it is positively associated with effort and frequency of injury preventative behavior among high-level golfers. Injury prevention programs should include strategies to improve the athlete's autonomous motivation to carry out preventive activities.

No Fans, No Problem: An Investigation of Audience Effects on Shooting Performance in Professional Basketball

Sports, along with nearly all facets of life, have been impacted by the COVID-19 pandemic. The National Basketball Association quickly adopted a unique method to finish the 2019–2020 regular season and playoffs. The entire league quarantined for months in what was known as the “NBA bubble” where games were played in spectator-less arenas. During this time, increases in shooting accuracy were reported, suggesting that free throws and field goals were made at record-breaking levels. This study examined differences in free throw shooting accuracy with and without spectators. Archival data were retrieved and analyzed to evaluate the potential differences. Free throw shooting accuracy with and without spectators were examined in multiple analyses. Our examination revealed free throw percentages were significantly greater in spectator-less arenas compared with the 2018 and 2019 seasons with spectators. Changes of the environmental characteristics, due to spectator-less arenas, were likely contributors to the improved free throw phenomenon reported in this study.

A qualitative assessment of return to sport following Achilles tendon repair

Studies have demonstrated successful return to sport rates following Achilles tendon rupture and repair. The purpose of this study is to understand the subjective intrinsic and extrinsic motivational factors influencing an athlete's return to pre-injury level of sport following Achilles tendon repair. Qualitative, semi-structured interviews of 23 athletes who had undergone Achilles tendon repair were conducted and analyzed to derive codes, categories, and themes. Three major themes affecting return to sport were elucidated from the interviews: personal motivation, shift in focus, and confidence in healthcare team. These findings can direct healthcare teams on how to better guide patients post-operatively.

Anxiety and Motivation to Return to Sport During the French COVID-19 Lockdown

Feeling anxious and presenting self-determined motivations about returning to sport after a break may impair sport performance and increase the risk of sustaining an injury. Hence, the aim of this study is to explore differences in anxiety and motivation to return to sport according to gender, expertise, training status before and during the lockdown, and athletes' availability (i.e., injury status) at the time of the lockdown. A total of 759 competitive athletes (49% female; mean age: 27 ± 10 years old) completed the cross-sectional study. Participants were invited to state their expertise, training status before and during the lockdown (did they have a training program), and whether they were injured at the start of the lockdown. Additionally, participants filled out psychometric self-report measures of anxiety (TFAI-return) and motivation (SMS-return) to return to sport. Due to non-normal distributions in the TFAI and SMS scores, non-parametric group comparisons were performed to compare participants for each categorical variable: non-parametric correlation tests were also performed to test the associations between continuous variables. Group comparisons showed higher scores of anxiety for females, younger athletes, athletes practicing and competing at the highest level, and athletes without a training program during the lockdown. Moreover, results suggested lower motivation scores (i.e., autonomous and controlled) for older athletes, experts (practicing for more than 10 years), athletes practicing and competing at a lower level, and athletes without a training program during the lockdown. Additionally, participants who were injured at the start of the lockdown reported higher scores of cognitive anxiety to return to sport than non-injured participants. The results of this study suggest that elite athletes may have suffered from external pressures to return to sport during the lockdown. Additionally, participants with a training program during the lockdown seemed to be less anxious and more self-determined to return to sport after the lockdown. Future studies may focus on the impact of cognitive behavioral interventions on anxiety and motivation to return to sport.

Re-injury worry, confidence and attention as predictors of a sport re-injury during a competitive season

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.

Competence and Benevolence as Dimensions of Trust: Lecturers' Trustworthiness in the Words of Italian Students

Trustworthiness includes at least two dimensions: one dimension captures the authority's benevolence; the other captures authority's competence. This qualitative study explores the representation of the two dimensions of authority trustworthiness: competence and benevolence. We collected free-associations about what lecturers' competence and benevolence actually mean for Italian psychology students (n = 125). The data corpus was content-analyzed. Text units were categorized according to meaning using both a bottom-up strategy, with some categories stemming from the data (inductive reasoning), and a top-down strategy, with some categories following from the analysis of the relevant literature (deductive reasoning). Qualitative content analysis showed that these two dimensions overlapped. Students listed theoretically-defined competence characteristics as indications of both benevolence and competence. The same applied to benevolence. Overall, associations were grouped into two main dimensions: (1) the "can-do" dimension, describing a lecturer's competence and social skill; (2) the "will-do" dimension, describing a lecturer's good intentions, integrity, and personal motivation. In conclusion, the two conceptually distinct dimensions of trust are indistinguishable in the students' words. These preliminary results are in line with scholars debating the multifactorial or mono-factorial nature of trust.

Athletes and adversities: athletic identity and emotional regulation in time of COVID-19

Background

The COVID-19 pandemic impacted on the sporting field, with athletes constrained in home isolation without the possibility to train and compete in their usual environments. This situation has been investigated within the theoretical frameworks of athletic identity and cognitive emotion regulation.

Objectives

The objectives of our investigation were to: (a) validate the athletic identity measurement scale (AIMS) for use in Italian language; and (b) explore differences by gender, typology of sport (individual vs. team), and competitive level (elite vs. non-elite) in athletic identity and in cognitive emotion regulation during the Covid-19 lockdown period.

Methods

To achieve these objectives, the reliability and construct validity of the Italian version of the AIMS have been tested in Study 1. Multivariate and univariate analyses were run to evaluate differences between different groups of athletes in Study 2.

Results

Results from Study 1 suggest a 3-factor higher order model of athletic identity. Results from Study 2 highlight that, during this lockdown period, elite athletes and team sports athletes show higher athletic identity. Cognitive emotion regulation strategies are different for gender and for competitive level. Finally, athletes with higher athletic identity tend to ruminate and catastrophize more.

Conclusions

The present multi-study paper contributes to the theoretical field with a validated measure of athletic identity in Italian language. It also provides some practical implications that could apply in this situation of isolation and can be extended to cases such as those of injury or illness.

BAck iN the Game (BANG) - a smartphone application to help athletes return to sport following anterior cruciate ligament reconstruction: protocol for a multi-centre, randomised controlled trial

Background

Sustaining injury is a common consequence of playing sport. At least one in every three recreational athletes with anterior cruciate ligament (ACL) reconstruction do not return to their preinjury sport following treatment. Psychological factors including confidence and fear of new injury exert large effects on returning to sport. The primary aim of this trial is to test whether a custom smartphone application delivering cognitive-behavioural therapy is effective for improving the number of people who return to their preinjury sport and level following ACL reconstruction.

Methods

Participants scheduled for primary ACL reconstruction are recruited prior to surgery from one of six trial sites in Sweden. We aim to recruit 222 participants (111 in each group) for the BANG trial. Participants are randomly allocated to receive either usual rehabilitation care alone or usual rehabilitation care plus the Back in the Game smartphone application intervention. Back in the Game is a 24-week Internet-delivered programme, based on cognitive-behavioural therapy. The primary outcome is return to the preinjury sport and level at 12 months follow-up. The secondary outcomes assess physical activity participation, new knee injuries, psychological factors, quality of life and physical function. Physical activity participation and new injuries are self-reported every two weeks for 12 months, then every 4 weeks to 24 months follow-up. Psychological readiness to return to sport, knee self-efficacy, motivation to participate in leisure time physical activity, knee-related quality of life, and self-reported knee function are also assessed at 3, 6, 9, 12 and 24 months after surgery. A clinical assessment of strength, knee range of motion, effusion and hopping performance is completed by a blinded assessor at 12 months to assess physical function.

Discussion

This protocol outlines how we plan to assess the efficacy of a custom smartphone application, delivering cognitive-behavioural therapy to address fear, confidence and recovery expectations, for improving return to sport following serious sports-related musculoskeletal injury. The BANG trial employs a pragmatic design to best reflect the reality of, and inform, clinical practice.

Trial registration

ClinicalTrials.gov, NCT03959215. Registered 22 May 2019.

A cross-cultural validation of the Attention Questionnaire of Rehabilitated Athletes Returning to competition

OBJECTIVES

To culturally adapt the Attention Questionnaire of Rehabilitated Athletes Returning to Competition (AQ-RARC) in the Italian language.

DESIGN

Cross-sectional study.

SETTING

Italian athletes.

PARTICIPANTS

We recruited 324 athletes (215 men, 109 women) divided in two samples: 101 injured athletes returning to their first competition following injury, 223 non-injured athletes making their first competition of the regular season.

MAIN OUTCOME MEASURES

The AQ-RARC-IT, the Psychobiosocial States Scale (PBS-ST), and a Concentration Disruption scale. Athletes completed the questionnaires at the end of their first competition. We investigated the construct validity, the internal consistency, and the concurrent validity of all measures.

RESULTS

A confirmatory factor analysis (CFA) supported the two-factor structure of the AQ-RARC-IT yielding acceptable fit indices, CFI = 0.930, TLI = 0.912, RMSEA (90% CI) = 0.100 (.076-.123), and SRMR = 0.082. Concurrent validity was evaluated through Pearson's correlation coefficients between measures. Correlations ranged in magnitude from weak to moderately high.

CONCLUSIONS

Study findings showed satisfactory psychometric properties of the AQ-RARC-IT. The questionnaire can be used for clinical and research purposes.

A qualitative assessment of return to sport following ulnar collateral ligament reconstruction in baseball players

Background

The rate of ulnar collateral ligament (UCL) reconstruction has been increasing at all levels of play. With excellent outcomes, primary UCL reconstruction has allowed many overhead athletes to return to their pre-injury sport. However, the subjective factors influencing this decision to return to sport have yet to be studied. The aim of this study is to understand the factors influencing an athlete's decision to return to pre-injury level of sport after primary UCL reconstruction.

Methods

An experienced interviewer conducted qualitative, semi-structured interviews of patients aged 18-35 years who had undergone primary UCL reconstruction by one fellowship-trained, Major League Baseball (MLB) team orthopaedic surgeon. All subjects were throwing athletes prior to injury and had a minimum two-year follow-up without revisions. Qualitative analysis was then performed to derive codes, categories, and themes. Patients were surveyed to assess familiarity with UCL reconstruction as well as to obtain Kerlan-Jobe Orthopaedic Clinic (KJOC) Overhead Athlete Shoulder and Elbow score, American Shoulder and Elbow Surgeons Shoulder (ASES) score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) highlighting current activity and function levels along with sport participation.

Results

Twenty-two athletes were interviewed to elucidate four predominant themes influencing their return to sport: trust in surgeon and care team, innate drive and optimism, misconceptions regarding post-operative athletic ability, and life priorities. A significant difference was noted between patients that returned and those that did not in the KJOC survey and for the statement that UCL reconstruction surgery would improve throwing ability relative to patients' peak performance three years prior to the surgery. Athletes who did not return to sport cited lifestyle changes and age as limiting factors.

Conclusion

Patients' decision to return to their pre-injury level of sport after primary UCL reconstruction was based on trust in their care team's reputation, intrinsic personality traits, anecdotal evidence about post-operative outcomes, and lifestyle. This study emphasizes the importance for health care providers to educate patients toward realistic expectations upon return to sport. On a larger scale, this study illustrates the effects the media and anecdotal experiences of a growing population of players undergoing UCL reconstruction have had on the game of baseball and players' decisions to return to sport.

Level of evidence

Level IV.

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.