Athletic Trainers' Influence on National Collegiate Athletic Association Division I Athletes' Basic Psychological Needs During Sport Injury Rehabilitation.

CONTEXT: Athletic trainers (ATs) have indicated a desire to better understand the motivations of athletes during rehabilitation. Self-determination theory offers an ideal lens for conceptualizing the antecedents, mediators, and consequences of motivated behavior. OBJECTIVE: To explore athletes' perceptions of ATs' influence on their basic psychological needs as well as their motivation during sport injury rehabilitation. DESIGN: Qualitative study. SETTING: National Collegiate Athletic Association Division I universities in the northwestern and southeastern United States. PATIENTS OR OTHER PARTICIPANTS: A total of 10 injured and previously injured athletes (7 women, 3 men; mean age = 20.9 ± 2.0 years) active in a variety of sports. DATA COLLECTION AND ANALYSIS: Participants completed semistructured interviews, which were transcribed verbatim. The data were analyzed using consensual qualitative research methods. Trustworthiness techniques (eg, bracketing interview, discussion of biases, member checking, external auditor) were used throughout the process. RESULTS: Four domains were constructed: (a) athletes' concerns about injury and rehabilitation, (b) ATs' feedback and athletes' perceptions of competence, (c) a person-centered approach from ATs and athletes' perceptions of autonomy, and (d) a connection between ATs' and athletes' perceptions of relatedness. Athletes' experiences were largely influenced by the degree to which they perceived that ATs satisfied their 3 basic psychological needs, which, in turn, was determined by the presence or absence of particular AT behaviors, such as providing encouragement (competence), soliciting input (autonomy), and building rapport (relatedness). Furthermore, the degree to which they perceived these basic psychological needs were fulfilled (or thwarted) affected their overall motivation during sport injury rehabilitation. CONCLUSIONS: Self-determination theory is a promising framework for ATs to consider when addressing motivational challenges among injured athletes.

Stages of psychological impact after diagnosis with serious or potentially lethal cardiac disease in young competitive athletes: a new model.

IMPORTANCE: Sudden cardiac death (SCD) in sports is a tragic event. Pre-participation cardiovascular screening is required before participation in high school and college athletic programs and is universally endorsed by major medical societies. The medical impact of a diagnosis may be life-saving; however, the detection of disease should not be the sole endpoint of care. Physicians have an obligation to attend to both the medical and psychological well-being of their patients. OBJECTIVE: To determine the psychological impact of being diagnosed with cardiac disease in young competitive athletes. DESIGN: Athletes diagnosed with cardiac conditions were recruited to participate in a semi-structured interview, which was analyzed by sport psychology experts using qualitative research. Individuals shared reactions and experiences regarding diagnosis, lifestyle implications, coping strategies, major concerns, and overall impact on psychosocial functioning. SETTING: Young competitive athletes from across the United States. PARTICIPANTS: 25 athletes (52% male, 80% Caucasian, median age 17.7) participated. Diagnoses included: 5 hypertrophic cardiomyopathy, 8 Wolff Parkinson White, 4 long QT syndrome, 3 atrial septal defect, 2 supraventricular tachycardia, and 3 other. MAIN OUTCOME MEASURES: Interviews were analyzed using consensual qualitative research (CQR) to identify domains, categories, and core ideas. RESULTS: Athletes progressed through 4 stages of psychological impact including: 1) immediate reactions and challenge to athlete identity, 2) grief/coping, 3) adaptation, and 4) acceptance. Risk factors for increased psychological morbidity included: higher level of competition, permanent disqualification from sports, persistent reminders (e.g. daily medication, monitoring heart rate during activity), and unanticipated outcomes (e.g. failed procedures). Those undergoing simple corrective procedures came to terms with their diagnosis quickly with little impact on daily life. Few athletes described emotional support mechanisms provided by medical programs. Diagnosis often led to new goals such as mentoring or coaching. All athletes diagnosed through advanced cardiovascular screening stated they would repeat the process. CONCLUSIONS AND RELEVANCE: Athletes diagnosed with cardiac disease represent an emotionally vulnerable population and experience 4 stages of psychological adjustment not previously described. This proposed model of psychological impact should be used to develop improved support mechanisms, awareness, and education to assist athletes diagnosed with serious or potentially lethal cardiac disease.