ABSTRACT
Background: Return-to-sport (RTS) following anterior cruciate ligament reconstruction (ACLR) is influenced by multiple physical and psychological variables. Psychological readiness has been associated with improved patient reported outcomes as well as RTS rates in young athletes. The COVID-19 pandemic may have altered the typical recovery process for patients undergoing ACLR. Hypothesis/Purpose: To compare 6-month postoperative levels of psychological readiness to RTS in ACLR patients before and during the pandemic. Methods: Patients were prospectively enrolled 6 months after primary ACLR at a single academic sports medicine practice, from December 2018 until May 2021. Patients were categorized into pre-COVID (enrollment prior to March 13, 2020) and COVID groups (March 13, 2020 - May 26, 2021). Demographic information, outcomes scores including the ACL-Return to Sport after Injury Scale (RSI) and PROMIS Psychological Stress Experiences (PROMIS-PSE), and physician RTS clearance were obtained and compared for both groups. Comparisons were performed utilizing Chi-square, Student's t-tests and linear regression. A matched analysis was conducted between groups controlling for age, sex, and graft type. Results: 231 patients were included in the present study (89 males, 142 females;mean age 16.9 years), with 76% (176/231) in the pre-COVID group and 24% (55/231) in the COVID group. There were no significant differences in age and sex between the two population cohorts. There was a significant difference in time from surgery to enrollment in the COVID group compared to the pre- COVID group (7.1 vs 6.2 months, p<0.001). In the matched cohort (n=126, 37/126 COVID group), the COVID group was cleared earlier by their physician to RTS compared to the pre-COVID group (6.9 months vs 8.5 months, p<0.001). While there was no significant difference between groups in 6 month ACL-RSI scores (63.8 pre-COVID vs 66.6 COVID, p=0.48), both groups yielded globally low scores. There were no significant associations between matched groups in PROMIS-PSE (p=0.71), IKDC (p=0.55), Pedi-IKDC (p=0.15), and Pedi-FABS (p=0.77) scores (Table 1). Conclusion: Young athletes demonstrated similar levels of psychological readiness to RTS at 6 months following ACLR prior to and during the COVID-19 pandemic. Patient-reported outcome scores were similar in pre-COVID and COVID ACLR patients, suggesting that the pandemic may not have played a detrimental role in perceptions of recovery. Psychological readiness may not be fully optimized at 6 months post-ACLR and young athletes may benefit from additional time and training for progressive confidence, muscle strength, and performance.
ABSTRACT
Background: Psychological skills training has been shown to improve performance in athletes. However, few studies have looked at the efficacy of mental skills training programs in young athletes. Hypothesis/Purpose: The purpose of this study was to evaluate satisfaction of collegiate athletes with a 6-session mental skills course, and to assess changes in mental toughness and coping skills before and after the course. Methods: We conducted a 6-session mental skills training program with Division I female collegiate athletes during the fall of 2020. Athletes completed pre-course, post-course, and 4-month questionnaires to assess efficacy of the course, as well as their satisfaction. Due to the COVID-19 pandemic, none of the athletes were actively competing at the time of the course or during follow-up surveys. Demographic information was collected and the Athletic Coping Skills Inventory (ACSI, range=0-84) and Mental Toughness Inventory (MTI, range=8-56) were used to assess coping skills and mental toughness at all time points. Satisfaction was assessed on a ten-point scale, with 10 being most satisfied. Results: Fifty-four Division I female athletes participated in the program. Mean age was 19.8 years, 61% reported training in their sport for 8 or more months a year, 26% reported history of mental health conditions, and 22% reported being injured or recovering from injury at the time of participation. For participants with paired pre- and post-course data (n=37, 68.5%), MTI scores improved by a mean 2.6 points (95% CI=1.1-4.1;p=0.001) and ASCI scores improved by a mean 4.0 points (95% CI=0.6-7.4;p=0.02) from pre- to postcourse. For participants with paired data for pre-course and four-month follow-up (n=25, 46.2%), no change was detected in mean MTI score (p=0.72). There was, however, a mean increase of 3.4 points in mean ASCI from pre-course to four-month follow-up (95% CI=0.4-6.4;p=0.03). Overall satisfaction had a median score of 9/10 at the post-course assessment, and eighteen participants (18/37, 48.6%) shared positive free-text comments regarding course delivery, content, and impact. No negative feedback was reported. Conclusion: Following a 6-session mental skills course in collegiate female athletes, mental toughness and coping skills scores significantly improved at post-course assessment. Athletes reported being highly satisfied with the content of the course and reported overall positive experiences.