Profiles of psychosocial factors: Can they be used to predict injury risk?

The creation of risk profiles using the model of stress and athletic injury (J Appl Sport Psychol. 1998;10(1):5) represents a proposed shift from the reductionism paradigm to the complex sport approach in an attempt to formulate prevention strategies to combat the increasing number of injuries being reported in sporting populations. As a result, the primary purpose of this study was to: (a) identify different risk profiles based on psychosocial factors associated with the Williams and Andersen's model of stress and athletic injury model; and (b) examine potential differences in the frequency of injuries across these risk profiles. A prospective research design was utilized with a sample of 117 competitive soccer players (81 males and 36 females) from Sweden and the United States of America. Data was collected at two time points over the course of three months. At time 1 (beginning of the season) - a demographic information sheet, the Life Event Survey for Collegiate Athletes (LESCA), Sport Competitive Anxiety Test (SCAT), and Brief Cope were administered. At time two (T2), three months after the initial data collection, participants' traumatic injuries were recorded. Latent profile analysis (LPA) showed that 3 profiles solution showed best fit to data. Players in profile 1 and 2 reported fewer injuries compared to players in profile 3. However, whereas individuals in profile 1 had a lower predictive risk of sustaining an injury when compared to those in profile 3, both profiles had similar anxiety levels and use of coping strategies with differing stress levels. These findings suggest that the interaction between different proposed risk factors might influence injury risk.

An Investigation Into Former High School Athletes' Experiences of a Multidisciplinary Approach to Sport Injury Rehabilitation.

CONTEXT: A multidisciplinary approach is one of the many forms of professional practice that can be utilized by sports medicine professionals to provide care to injured athletes. While this approach has been empirically supported in the health care domain, studies supporting its utilization in the sport injury rehabilitation context-particularly at the high school level-are limited. OBJECTIVE: To investigate former high school athletes' experiences of a multidisciplinary model of care for sport injury rehabilitation. DESIGN: Cross-sectional survey design. SETTING: In-person, in a classroom setting at 2 Division I universities. PATIENTS: A total of 186 former high school athletes. MAIN OUTCOME MEASURE: An author-constructed instrument developed using the multidisciplinary model of care for sport injury rehabilitation as a guide. RESULTS: Family, athletic coaches, and athletic trainers were the closest professionals/individuals that injured athletes reported interacting with during sport injury rehabilitation. The data also revealed that these professionals/individuals had the closest and most direct relationships with the injured athletes. CONCLUSIONS: The findings from the present study provided support for the utilization of the multidisciplinary model of care for sport injury rehabilitation with high school athletes.

The Delivery of a Short-Term Psychological Skills Training Program to College Dance Students: A Pilot Study Examining Coping Skills and Injuries.

Dance makes a number of inherent physical and psychosocial demands that can promote resilience. However, dancers may strive to meet those demands by employing unhealthy coping strategies that can be linked to maladaptive thoughts and behaviors and increased injury risk. The present study utilized a two-group pretest-posttest quasi-experimental design to examine the impact of a psychological skills training program on coping skills and prevalence of injuries over a 6-week period in a convenience sample of college dance students (N = 30). Participants were drawn from the same dance program and were assigned to a control or treatment condition based on their current class schedule. At the end of the study, there were no significant quantitative differences observed between the treatment and control groups. However, mean scores for treatment group participants' coping skills slightly increased over time. A focus group discussion led to several recommendations for future research and programming improvements. Additionally, this study underscores the need for a single operational definition of injury in a college dance context. Best practices for researchers, practitioners, and educators in the context of psychological skills training are also discussed.

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.

A Preliminary Exploration of the Application of Self-Compassion Within the Context of Sport Injury.

In a prospective study of collegiate athletes (N = 117), the application of self-compassion within the context of sport injury was explored. Previous literature indicated that self-compassion enhances adaptive coping and well-being and reduces anxiety in stress-provoking situations. This research suggested that it could potentially reduce the stress response and subsequent injury risk. Findings indicated that self-compassion may buffer the experience of somatic anxiety (rs = -.436, p < .01) and worry (rs = -.351, p < .01), and reduce the engagement of avoidance-focused coping strategies (rs = -.362, p < .01). There were no significant findings related to self-compassion and injury reduction. A challenge with this research is distinguishing the impact of resistance to self-compassion from the potential benefits that it may have on coping and appraisal of stress in sport. This research was a preliminary exploration of self-compassion within the context of responses to stress and subsequent injury risk. Results suggest that further investigation across different athletic populations, sports, and injury situations is warranted.

Preliminary investigation into sport and exercise psychology consultants' views and experiences of an interprofessional care team approach to sport injury rehabilitation.

Sport injury rehabilitation has moved from predominately physical treatment to a more holistic care. However, limited research has explored the views and experiences of those involved in such an approach. The purpose of this study was to preliminarily investigate sport psychology consultants' (SPCs') views and experiences of an interprofessional team approach to sport injury rehabilitation. A cross-sectional online survey previously used with athletic trainers was distributed via a US-based sport/exercise psychology list-serve (N = 1245). A total of 62 (27 men, 35 women, M age 38.2 years, age range: 22-73 years) participants with 10.6 (SD = 9.8) years of experience as an SPC were included in the final analyses. On average, SPCs felt that it was very important (M = 6.6; SD = 0.6) for athletes to have access to an interprofessional care team. Of the sample, 64.5% (n = 40) typically worked as part of an interprofessional care team 44.7% of the time. The SPCs (n = 28; 45.2%) also indicated that the primary treatment providers (e.g., athletic trainer, physical therapist) were typically serving as the primary point person for such teams. Since gaining entry to sport medicine can be an area SPCs struggle with, building effective working relationships with treatment providers can help promote and increase SPCs involvement in providing holistic, interprofessional care to athletes with injuries. To ensure athletes' successful biopsychosocial return to sport, different individuals and professionals should work together for the benefit of the athlete by adopting holistic care during sports injury rehabilitation.

Athletes' Expectations About Sport-Injury Rehabilitation: A Cross-Cultural Study.

CONTEXT: Athletes enter injury rehabilitation with certain expectations about the recovery process, outcomes, and the professional providing treatment. Their expectations influence the effectiveness of the assistance received and affect the overall rehabilitation process. Expectations may vary depending on numerous factors such as sport experience, gender, sport type, and cultural background. Unfortunately, limited information is available on athletes' expectations about sport-injury rehabilitation. OBJECTIVE: To examine possible differences in athletes' expectations about sport-injury rehabilitation based on their country of residence and type of sport (contact vs noncontact). DESIGN: Cross-sectional. SETTING: Recreational, college, and professional athletes from the US, UK, and Finland were surveyed. PARTICIPANTS: Of the 1209 athletes ranging from 12 to 80 y of age (mean 23.46 ± 7.91), 529 US [80%], 253 UK [86%], and 199 Finnish [82%] athletes provided details of their geographical location and were included in the final analyses. MAIN OUTCOME MEASURES: The Expectations About Athletic Training (EAAT) questionnaire was used to determine athletes' expectations about personal commitment, facilitative conditions, and the expertise of the sports-medicine professional (SMP). RESULTS: A 3 × 2 MANCOVA revealed significant main effects for country (P = .0001, ηp2 = .055) and sport type (P = .0001, ηp2 = .023). Specifically, US athletes were found to have higher expectations of personal commitment and facilitative conditions than their UK and Finnish counterparts. Athletes participating in contact sports had higher expectations of facilitative conditions and the expertise of the SMP than did athletes participating in noncontact sports. CONCLUSIONS: SMPs, especially those in the US, should consider the sport and environment when providing services. In addition, SMPs need to highlight and demonstrate their expertise during the rehabilitation process, especially for those who compete in contact sports.

Athletes' use of mental skills during sport injury rehabilitation.

CONTEXT: Existing theoretical frameworks and empirical research support the applicability and usefulness of integrating mental skills throughout sport injury rehabilitation. OBJECTIVE: To determine what, if any, mental skills athletes use during injury rehabilitation, and by who these skills were taught. Cross-cultural differences were also examined. DESIGN: Cross-sectional design. SETTING: College athletes from 5 universities in the United States and a mixture of collegiate, professional, and recreational club athletes from the United Kingdom and Finland were recruited for this study. PARTICIPANTS: A total of 1283 athletes from the United States, United Kingdom, and Finland, who participated in diverse sports at varying competitive levels took part in this study. MAIN OUTCOME MEASURES: As part of a larger study on athletes' expectations of injury rehabilitation, participants were asked a series of open-ended and closed-ended questions concerning their use of mental skills during injury rehabilitation. RESULTS: Over half (64.0%) of the sample reported previous experience with athletic training, while 27.0% indicated that they used mental skills during injury rehabilitation. The top 3 mental skills reported were goal setting, positive self-talk/positive thoughts, and imagery. Of those athletes that used mental skills, 71.6% indicated that they felt mental skills helped them to rehabilitate faster. A greater proportion of athletes from the United States (33.4%) reported that they used mental skills during rehabilitation compared with athletes from the United Kingdom (23.4%) and Finland (20.3%). A small portion (27.6%) of the participants indicated that their sports medicine professional had taught them how to use mental skills; only 3% were taught mental skills by a sport psychologist. CONCLUSIONS: The low number of athletes who reported using mental skills during rehabilitation is discouraging, but not surprising given research findings that mental skills are underutilized by injured athletes in the 3 countries examined. More effort should be focused on educating and training athletes, coaches, and sports medicine professionals on the effectiveness of mental training in the injury rehabilitation context.

Psychosocial responses during different phases of sport-injury rehabilitation: a qualitative study.

CONTEXT: Athletic trainers have traditionally conceptualized rehabilitation programs in terms of 3 distinct physiologic phases; however, these phases appear to neglect athletes' psychosocial responses to their injuries. OBJECTIVE: To document injured athletes' psychosocial responses during the different phases of injury rehabilitation. DESIGN: Qualitative study. SETTING: National Collegiate Athletic Association Division II university in the mid-Atlantic region of the United States. PATIENTS OR OTHER PARTICIPANTS: A total of 8 previously injured athletes (4 men and 4 women) participated in the study. DATA COLLECTION AND ANALYSIS: We collected participant data by using semistructured interviews, transcribed verbatim and analyzed by directed content analysis. Established themes were triangulated to determine trustworthiness. RESULTS: Initially, athletes' cognitive appraisals were predominantly negative in nature, leading to negative emotions. These appraisals changed after diagnosis and when moving to the reaction-to-rehabilitation phase and the reaction-to-sport phase. During the reaction-to-rehabilitation phase, athletes reported mixed cognitive appraisals and identified frustration as the main emotional response. When returning to sport, athletes reflected on the lessons learned, yet they expressed some doubts related to their ability to return to play. These cognitive appraisals served as a precursor to the resulting emotional responses of nervousness and reinjury anxiety, as well as excitement. Throughout the various phases of rehabilitation, athletes reported seeking out social support: initially from significant others and then from their athletic trainers during the reaction-to-rehabilitation phase. CONCLUSIONS: The results appear to support the use of the integrated model of psychological response to sport injury and the rehabilitation process and the 3 phases of rehabilitation as a framework for understanding how physical and psychosocial factors may interact during sport-injury rehabilitation. Understanding this interaction may help athletic trainers provide better care to their injured athletes.

Psychosocial aspects of athletic injuries as perceived by athletic trainers.

CONTEXT: Despite the Psychosocial Strategies and Referral content area, athletic trainers (ATs) generally lack confidence in their ability to use this information. OBJECTIVE: The current study's primary purpose was to determine (a) perceived psychological responses and coping behaviors athletes may present to ATs, (b) psychosocial strategies ATs currently use with their athletes, (c) psychosocial strategies ATs deem important to learn more about, and (d) ATs' current practices in referring athletes to counseling or sport psychology services. DESIGN: Mixed-methods study. SETTING: Online survey containing both quantitative and qualitative items. PATIENTS OR OTHER PARTICIPANTS: A total of 215 ATs (86 male, 129 female), representing a response rate of 22.50%. MAIN OUTCOME MEASURE(S): The Athletic Training and Sport Psychology Questionnaire. RESULTS: Stress/anxiety (4.24 ± 0.82), anger (3.70 ± 0.96), and treatment adherence problems (3.62 ± 0.94) were rated as the primary psychological responses athletes may present upon injury. Adherence and having a positive attitude were identified as key determinants in defining athletes' successful coping with their injuries. The top 3 selected psychosocial strategies were keeping the athlete involved with the team (4.57 ± 0.73), using short-term goals (4.45 ± 0.67), and creating variety in rehabilitation exercises (4.32 ± 0.75). The top 3 rated psychosocial strategies ATs deem important to learn more about were understanding motivation (4.29 ± 0.89), using effective communication (4.24 ± 0.91), and setting realistic goals (4.22 ± 0.97). Of the sample, only 59 (27.44%) ATs reported referring an athlete for counseling services, and 37 (84.09%) of those who had access to a sport psychologist (n = 44) reported referring for sport psychology services. CONCLUSIONS: These results not only highlight ATs' current use of psychosocial strategies but also their desires to increase their current knowledge and understanding of these strategies while caring for injured athletes.

Injured athletes' perceptions about social support.

CONTEXT: According to the buffering hypothesis, social support moderates the harmful effects of stress and, in turn, indirectly affects injured athletes' health and well-being. Previous research suggests that perceptions of social support influence athletes' psychological reactions, as well as their rehabilitation adherence, but additional research in this area is warranted. OBJECTIVE: To examine injured athletes' perceptions regarding satisfaction, availability, and contribution for each of the 8 types of social support. DESIGN: Descriptive. SETTING: Mid-Atlantic Division II and III institutions. PARTICIPANTS: 49 injured athletes. MAIN OUTCOME MEASURES: Social support was assessed using a modified version of the Social Support Survey. RESULTS: Injured athletes were significantly more satisfied with social support provided by athletic trainers (ATCs) than that provided by coaches and teammates. In addition, injured athletes reported that social support provided by ATCs contributed significantly more to their overall well-being. Athletes reported several significant differences regarding satisfaction and contribution to well-being among the 8 different types of social support. CONCLUSIONS: Injury, an unavoidable part of sport, is often accompanied by negative psychological reactions. This reaction may have a negative influence on an athlete's experience of injury and rehabilitation. Findings suggest that perceptions of social support provided by ATCs have the greatest influence on injured athletes' rehabilitation and well-being.

The transtheoretical model: an exploratory look at its applicability to injury rehabilitation.

CONTEXT: The transtheoretical model has been widely used in the investigation of how people adapt to new behaviors; however, the literature appears to be lacking documentation of any assessment/s administered to injured athletes to determine their readiness for rehabilitation, which depending on the severity of the injury, could possibly represent a behavior change for that individual. OBJECTIVE: To validate the application of the transtheoretical model to injury rehabilitation and assess the impact of stages of change on athletes' adherence and compliance rates. DESIGN: Descriptive correlational. SETTING: Large Mid Atlantic Division I institution. PARTICIPANTS: Seventy injured athletes. MAIN OUTCOME MEASURES: Readiness was assessed using the Transtheoretical Model. Adherence was assessed using the percentage of rehabilitation attendance and compliance was assessed using the Sport Injury Rehabilitation Scale. RESULTS: Participants who were advanced in their stages of change generally reported an increase in self efficacy, utilization of pros versus cons, and the use of behavioral processes instead of experiential processes of change. No significant relationships were found between stages of change and athletes' adherence and compliance. CONCLUSION: Although no statistical significance was found between stages of change and adherence and compliance the results did validate the application of the transtheoretical model to injury rehabilitation.