The Relationship Between Injury-Related Fear and Visuomotor Reaction Time in Individuals With a History of Anterior Cruciate Ligament Reconstruction

in Journal of Sport Rehabilitation
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Context: Deficits in reaction time, decreased self-reported knee function, and elevated levels of injury-related fear have been observed in individuals who sustain anterior cruciate ligament injury. Understanding the relationship between these variables may provide the impetus to further investigate effective intervention strategies to address these deficits in individuals after anterior cruciate ligament reconstruction (ACLR). Objective: To examine the relationship between injury-related fear and lower-extremity visuomotor reaction time (VMRT) in individuals with a history of ACLR. A secondary purpose was to determine the relationship between self-reported knee function and lower-extremity VMRT in individuals with a history of ACLR. Design: Cross-sectional study. Setting: Laboratory. Participants: Twenty participants between the ages of 18–35 years, with history of unilateral ACLR within the last 10 years, who injured their knee playing or training for organized or recreational sports. Main Outcome Measures: Scores on the athlete fear avoidance questionnaire, the fear-avoidance beliefs questionnaire (FABQ), the knee injury and osteoarthritis outcome score, and reaction time (in seconds) on the lower-extremity VMRT task using the FitLight Trainer, bilaterally. Spearman Rho correlations examined the relationship between the dependent variables. Results: There was a moderate positive correlation between VMRT and FABQ-total (r = .62, P < .01), FABQ-sport (r = .56, P = .01), and FABQ-physical activity (r = .64, P < .01) for the injured limb. Correlations between FABQ scores and VMRT for the uninjured limb were weak positive correlations (r = .36–.41, P > .05). Weak correlations between the osteoarthritis outcome score subscales, athlete fear avoidance questionnaire, and VMRT were observed for the injured limb (P > .05). Conclusions: Individuals with a history of ACLR who exhibited elevated levels of injury-related fear demonstrated slower VMRT. There were no relationships between self-reported knee function and VMRT. Future research should explore interventions to address injury-related fear and VMRT in individuals after ACLR.

Genoese is with Regis Jesuit High School, Aurora, CO, USA. Baez is with the Department of Kinesiology, Michigan State University, East Lansing, MI, USA. Heebner and M.C. Hoch are with the Sports Medicine Research Institute; Heebner, M.C. Hoch, and J.M. Hoch are with the Department of Athletic Training and Clinical Nutrition, College of Health Sciences; University of Kentucky, Lexington, KY, USA.

J.M. Hoch (Johanna.hoch@uky.edu) is corresponding author.
  • 1.

    Ardern CL. Anterior cruciate ligament reconstruction—Not exactly a one-way ticket back to the preinjury level: a review of contextual factors affecting return to sport after surgery. Sports Health. 2015;7(3):224230. PubMed ID: 26131299 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE. Psychological responses matter in returning to preinjury level of sport after anterior cruciate ligament reconstruction surgery. Am J Sports Med. 2013;41(7):15491558. PubMed ID: 23733635 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Piva SR, Fitzgerald GK, Irrgang JJ, et al. Associates of physical function and pain in patients with patellofemoral pain syndrome. Ach Phys Med Rehabil. 2009;90(2):285295. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Ross MD. The relationship between functional levels and fear-avoidance beliefs following anterior cruciate ligament reconstruction. J Orthop Traumatol. 2010;11(4):237243. PubMed ID: 21116674 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Glaviano NR, Baellow A, Saliba S. Physical activity levels in individuals with and without patellofemoral pain. Phys Ther Sport. 2017;27:1216. PubMed ID: 28780340 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Kvist J, Ek A, Sporrstedt K, Good L. Fear of re-injury: a hindrance for returning to sports after anterior cruciate ligament reconstruction. Knee Surg Sport Traumatol. 2005;13(5):393397. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Hoch JM, Sinnott CW, Robinson KP, Perkins WO, Hartman JW. The examination of patient-reported outcomes and postural control measures in patients with and without a history of ACL reconstruction: a case control study. J Sport Rehabil. 2018;27:170176. PubMed ID: 28253055 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Swanik CB, Covassin T, Stearne DJ, Schatz P. The relationship between neurocognitive function and noncontact anterior cruciate ligament injuries. Am J Sports Med. 2007;35(6):943948. PubMed ID: 17369562 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Williams JM, Andersen MB. Psychosocial influences on central and peripheral vision and reaction time during demanding tasks. Ann Behav Med. 1997;22(4):160167. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Anderson MB, Williams JM. A model of stress and athletic injury: prediction and prevention. J Sport Exerc Psyhcol. 1988;10(3):294306. doi:

  • 11.

    Wilkerson GB, Simpson KA, Clark RA. Assessment and training of visuomotor reaction time for football injury prevention. J Sport Rehabil. 2017;26(1):2634. PubMed ID: 27632871 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Miller JO, Low K. Motor processes in simple, go/no-go, and choice reaction time tasks: a psychophysiological analysis. J Exp Psychol Hum Percept Perform. 2001;27(2):266289. PubMed ID: 11318047 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Wilkerson GB, Giles JL, Seibel DK. Prediction of core and lower extremity strains and sprains in collegiate football players: a preliminary study. J Athl Train. 2012;47(3):264272. PubMed ID: 22892407 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Wiggins AJ, Grandhi RK, Schneider DK, Stanfield D, Webster KE, Myer GD. Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Am J Sports Med. 2016;44(7):18611876. PubMed ID: 26772611 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Grooms D, Appelbaum G, Onate J. Neuroplasticity following anterior cruciate ligament injury: a framework for visual-motor training approaches in rehabilitation. J Orthop Sports Phys Ther. 2015;45(5):381393. PubMed ID: 25579692 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Andersen MB, Williams JM. Athletic injury, psychosocial factors and perceptual changes during stress. J Sports Sci. 1999;17(9):735741. PubMed ID: 10521004 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Dover G, Amar V. Development and validation of the athlete fear avoidance questionnaire. J Athl Train. 2015;50(6):634642. PubMed ID: 25793458 doi:

  • 18.

    Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A fear-avoidance beliefs questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993;52(2):157168. PubMed ID: 8455963 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee injury and osteoarthritis outcome score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998;28(2):8896. PubMed ID: 9699158 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    McPherson AL, Feller JA, Hewett TE, Webster KE. Psychological readiness to return to sport is associated with second anterior cruciate ligament injuries. Am J Sports Med. 2019;47(4):857862. PubMed ID: 30753794 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Zale EL, Ditre JW. Pain-related fear, disability, and the fear-avoidance model of chronic pain. Curr Opin Psychol. 2015;5:2430. PubMed ID: 25844393 doi:

  • 22.

    Klavora P, Gaskovski P, Forsyth R. Test-retest reliability of the Dynavision apparatus. Percept Mot Skills. 1994;79(1):448450. doi:

  • 23.

    Klavora P, Gaskovski P, Forsyth RD. Test-retest reliability of three Dynavision tasks. Percept Mot Skills. 1995;80(2):607610. PubMed ID: 7675601 doi:

  • 24.

    Klavora P, Gaskovski P, Martin K, et al. The effects of Dynavision rehabilitation on behind-the-wheel driving ability and selected psychomotor abilities of persons after stroke. Am J Occup Ther. 1995;49(6):534542. PubMed ID: 7645666 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Klavora P, Warren M. Rehabilitation of visuomotor skills in poststroke patients using the Dynavision apparatus. Percept Mot Skills. 1998;86(1):2330. PubMed ID: 9530706 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Zwierko T, Florkiewicz B, Fogtman S, Kszak-Krzyżanowska A. The ability to maintain attention during visuomotor task performance in handball players and non-athletes. Centr Eur J Sport Sci Med. 2014;3(7):99106.

    • Search Google Scholar
    • Export Citation
  • 27.

    Evans JD. Straightforward Statistics for the Behavioral Sciences. Pacific Grove, CA: Thomson Brooks/Cole Publishing Co; 1996.

  • 28.

    Paterno MV, Flynn K, Thomas S, Schmitt LC. Self-reported fear predicts functional performance and second ACL injury after ACL reconstruction and return to sport: a pilot study. Sports Health. 2018;10(3):228233. PubMed ID: 29272209 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Webster KE, Nagelli CV, Hewett TE, Feller JA. Factors associated with psychological readiness to return to sport after anterior cruciate ligament reconstruction surgery. Am J Sports Med. 2018;46(7):15451550. PubMed ID: 29718684 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Lentz TA, Zeppieri Jr G, George SZ, et al. Comparison of physical impairment, functional, and psychosocial measures based on fear of reinjury/lack of confidence and return-to-sport status after ACL reconstruction. Am J Sports Med. 2015;43(2):345353. PubMed ID: 25480833 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Paterno MV, Rauh MJ, Schmitt LC, Ford KR, Hewett TE. Incidence of second ACL injuries 2 years after primary ACL reconstruction and return to sport. Am J Sports Med. 2014;42(7):15671573. PubMed ID: 24753238 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Covassin T, Beidler E, Ostrowski J, Wallace J. Psychosocial aspects of rehabilitation in sports. Clin Sports Med. 2015;34(2):199212. PubMed ID: 25818709 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Main CJ, George SZ. Psychologically informed practice for management of low back pain: future directions in practice and research. Phys Ther. 2011;91(5):820824. PubMed ID: 21451091 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Miller RP, Kori SH, Todd DD. The tampa scale: a measure of kinisophobia. The Clin J Pain. 1991;7(1):51. doi:

  • 35.

    Webster KE, Feller JA, Lambros C. Development and preliminary validation of a scale to measure the psychological impact of returning to sport following anterior cruciate ligament reconstruction surgery. Phys Ther Sport. 2008;9(1):915. PubMed ID: 19083699 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Cormier ML, Zizzi SJ. Athletic trainers’ skills in identifying and managing athletes experiencing psychological distress. J Athl Train. 2015;50(12):12671276. PubMed ID: 26599960 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Vlaeyen JW, de Jong J, Geilen M, Heuts PH, van Breukelen G. The treatment of fear of movement/(re)injury in chronic low back pain: further evidence on the effectiveness of exposure in vivo. Clin J Pain. 2002;18:251261. PubMed ID: 12131067 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 38.

    Grooms DR, Page SJ, Nichols-Larsen DS, Chaudhari AM, White SE, Onate JA. Neuroplasticity associated with anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther. 2017;47(3):180189. PubMed ID: 27817301 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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