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.

The effectiveness of hydrotherapy on return to play in sports following hip arthroscopic surgery: a comparative study.

BACKGROUND: The postoperative management of femoroacetabular impingement (FAI) is variable with favourable surgical outcomes. Yet there is no evidence on the efficacy of hydrotherapy in athletes undergoing hip arthroscopy for FAI. The purpose of this study was to evaluate the role and the impact of hydrotherapy on return to sports following hip arthroscopy for symptomatic FAI. METHODS: 2 cohorts of mixed level of athletes from various sports: a hydrotherapy group that followed land-based exercises in combination with hydrotherapy exercises and a control group that followed solely the same land-based exercises. Pre- and postoperative pain and hip-specific outcome scores were completed, and patient satisfaction was rated. RESULTS: A total of 88 hip arthroscopies were included with a minimum of 2 years follow-up; the hydrotherapy group comprised of 36 hips and the control group, 52 hips. There was a significant improvement in time to return to previous performance (HR 1.91, 95% CI, 1.21-3.01; p = 0.005) in the hydrotherapy group compared with the control. The hip-specific scores and patient satisfaction were considerably improved in the hydrotherapy group. CONCLUSIONS: The analysis of our data indicates that the incorporation of hydrotherapy into postoperative rehabilitation for hip arthroscopy for FAI accelerates the return of athletes to their pre-injury performance, since recovery time decreased significantly.

Understanding the Relationship between Sport Courage and Female Soccer Performance Variables.

The purpose of this study was to examine the relationships between female soccer players' courage and key performance variables (level of participation, injury past, being selected or non-selected by a national team, being starter or substitute). Methods: The Sport Courage Scale-31, by Konter and Ng (2012) and key performance variables were collected from 210 female soccer players aged 12 to 27 (M = 17.97 ± 3.34 years old). Spearman correlations and Mann−Whitney U tests were used to analyse the collected data. Results: The correlations between mastery (r = 0.196), determination (p = 0.239), assertiveness (r = 0.325), sacrifice behaviour (r = 0.182), total sport courage (r = 0.265) and age of female soccer players were found to be significant (p < 0.05). Female soccer players who have sustained an injury in the past scored significantly higher on the venturesome scale (p = 0.006) than those who have not sustained an injury in the past. In comparison, female soccer players who have not sustained an injury in the past or who have not been substituted had significantly more mastery than female soccer players who have sustained an injury in the past or who have been substituted (p = 0.017, p = 0.002, respectively). Conclusions: This study indicates that sport courage is related to key performance variables among female soccer players. Mastery and age seem to be related to courageous behaviour, whereas increasing venturesomeness might cause injuries in female soccer. Some relevant implications for practitioners can be drawn from the present findings.

Perceived Social Support, Reinjury Anxiety, and Psychological Readiness to Return to Sport in Soccer Players.

The burden of sports injury in soccer is high, and return to sport outcomes following injury are often poor. This is compounded by a current lack of understanding surrounding the factors that may optimize psychological readiness to return to sport. Consequently, in the present study, we aim to further our understanding of these issues by examining the role of perceived social support in predicting psychological readiness to return to sport. In doing so, we extend previous research by examining whether reinjury anxiety is a mediating factor in this relationship. A sample of 150 previously injured soccer players (mean age = 25.32 y) completed measures of perceived social support, reinjury anxiety during rehabilitation, and psychological readiness to return to sport. Mediation analyses showed that reinjury anxiety partly accounted for the positive relationship between perceived social support and psychological readiness to return to sport. These findings suggest that injured soccer players with higher perceptions of social support will experience less reinjury anxiety during rehabilitation and, as a consequence, will be more psychologically ready upon return to sport.

Examining European Talent Development Environments: Athlete, Parent and Coach Perceptions.

Talent Development Environments (TDEs) aim to provide the appropriate conditions for youth athletes to realise their full sporting potential. How TDEs are designed and operated is therefore of great importance for the development of elite athletes. Stakeholders are vital in this process, yet their perspectives are poorly understood. This study assessed the quality of TDEs across 5 European countries, comparing athlete, parent and coach perceptions. A total of 571 athletes (Mean age = 15.2 ± 1.5 years), 759 parents and 134 coaches were recruited from TDEs across 27 sports. Participants completed the Talent Development Environment Questionnaire-5 or adapted versions. Overall, perceptions of European TDEs were positive. Coaches reported higher perceptions of TDE quality compared to athletes and parents, athletes reported marginally higher perceptions compared to parents. Across stakeholders, Long-Term Development was highest rated, followed by Communication. Support Network was lowest rated. Stakeholder perceptions varied most for the Holistic Quality Preparation subscale, highlighting perceived differences in TDE support for rounded athlete development. From an organisational perspective, identified strengths and weaknesses provide direction to coach and parent education. Practically, TDE leaders should consider how they can refine stakeholder coordination through integrating stakeholder perceptions as valuable feedback into their environment, especially for intangible factors.

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

OBJECTIVE: To systematically review studies examining the role of psychological interventions in injury prevention. The primary research question was: What is the real-world effectiveness of psychological intervention in preventing sports injuries? DESIGN: Mixed methods systematic review with best evidence synthesis. DATA SOURCES: CINAHL, MEDLINE, PsycARTICLES, PsycINFO, SPORTDiscus, Science Direct and PubMed. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials (RCT), non-RCTs that included a comparison group, before and after study designs and qualitative methods. Studies were required to outline specific unimodal or multimodal psychological interventions used in relation to injury prevention in the real-world setting. OUTCOME MEASURE: Studies were independently appraised with the Mixed Methods Appraisal Tool. RESULTS: Thirteen papers (incorporating 14 studies) met the eligibility criteria, of which 93% (13/14) reported a decrease in injury rates (effect size range=0.2-1.21). There was an overall moderate risk of bias in reporting (52%). There is a dominance of stress management-based interventions in literature due to the prominence of the model of stress and athletic injury within the area. SUMMARY/CONCLUSIONS: Psychological interventions demonstrate small (0.2) to large (1.21) effects on sports injury rates. The research area demonstrates a cumulative moderate risk in reporting bias (52%). PROSPERO REGISTRATION NUMBER: CRD42016035879.

Psychosocial factors associated with outcomes of sports injury rehabilitation in competitive athletes: a mixed studies systematic review.

BACKGROUND: The prime focus of research on sports injury has been on physical factors. This is despite our understanding that when an athlete sustains an injury it has psychosocial as well as physical impacts. Psychosocial factors have been suggested as prognostic influences on the outcomes of rehabilitation. The aim of this work was to address the question: are psychosocial factors associated with sports injury rehabilitation outcomes in competitive athletes? STUDY DESIGN: Mixed studies systematic review (PROSPERO reg.CRD42014008667). METHOD: Electronic database and bibliographic searching was undertaken from the earliest entry until 1 June 2015. Studies that included injured competitive athletes, psychosocial factors and a sports injury rehabilitation outcome were reviewed by the authors. A quality appraisal of the studies was undertaken to establish the risk of reporting bias. RESULTS: 25 studies were evaluated that included 942 injured competitive athletes were appraised and synthesised. Twenty studies had not been included in previous reviews. The mean methodological quality of the studies was 59% (moderate risk of reporting bias). Convergent thematic analysis uncovered three core themes across the studies: (1) emotion associated with rehabilitation outcomes; (2) cognitions associated with rehabilitation outcomes; and (3) behaviours associated with rehabilitation outcomes. Injury and performance-related fears, anxiety and confidence were associated with rehabilitation outcomes. There is gender-related, age-related and injury-related bias in the reviewed literature. CONCLUSIONS: Psychosocial factors were associated with a range of sports injury rehabilitation outcomes. Practitioners need to recognise that an injured athlete's thoughts, feelings and actions may influence the outcome of rehabilitation.