Severity of Overuse Injury Impacts Self-Efficacy and Quality of Life in Runners: A 2-Year Prospective Cohort Study

in Journal of Sport Rehabilitation
Restricted access

Purchase article

USD  $24.95

Student 1 year online subscription

USD  $76.00

1 year online subscription

USD  $101.00

Student 2 year online subscription

USD  $144.00

2 year online subscription

USD  $192.00

Context: While 55 million Americans incorporate running into their exercise routines, up to 65% of runners sustain an overuse injury annually. It has been consistently shown that regular physical activity positively impacts quality of life (QOL), an essential public health indicator; however, the impact of running-related injuries on QOL is unknown. This study seeks to determine whether overuse injury severity impacts QOL in recreational runners, and if self-efficacy mediates this relationship. Design: Community-based prospective cohort study of 300 runners who had been running injury free for at least 5 miles/wk in the past 6 months. Methods: Self-efficacy for running and QOL measures (Short Form-12 Physical Component and Mental Component, Satisfaction with Life, Positive Affect and Negative Affect) were assessed at baseline, time of injury, and follow-up visits. Over 2 years of observation, overuse injuries were diagnosed by an orthopedic surgeon and injured runners were referred to a physical therapist. Results: Injury severity was significantly (P < .01) related with 2 indices of QOL, such that the effect of injury severity was −2.28 units on the Short Form-12 physical component and −0.73 units on positive affect. Self-efficacy accounted for 19% and 48% of the indirect effects on Short Form-12 physical component and positive affect, respectively. Conclusions: Since self-efficacy is a modifiable factor related to decreased QOL, these findings have important clinical implications for rehabilitation interventions.

Mihalko, Cox, Love, and Messier are with the Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA. Ip and Saldana are with the Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA. Martin is with the Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA. DeVita is with the Department of Kinesiology, East Carolina University, Greenville, NC, USA. Cannon is with Wayne Cannon Physical Therapy and Associates, Winston-Salem, NC, USA. Fellin and Seay are with the Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, MA, USA.

Mihalko (mihalksl@wfu.edu) is corresponding author.
  • 1.

    Statista. Number of participants in running/jogging and trail running in the U.S. from 2006 to 2017 (in millions). Statista—The Statistics Portal. 2018. https://www.statista.com/statistics/190303/running-participants-in-the-us-since-2006/. Accessed October 23, 2018.

    • Search Google Scholar
    • Export Citation
  • 2.

    Fries JF, Singh G, Morfeld D, Hubert HB, Lane NE, Brown BW. Running and the development of disability with age. Ann Intern Med. 1994;121(7):502509. PubMed ID: 8067647 doi:

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

    Szabo A, Ábrahám J. The psychological benefits of recreational running: a field study. Psychol Health Med. 2013;18(3):251261. PubMed ID: 22780910 doi:

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

    Morris M, Salmon P. Qualitative and quantitative effects of running on mood. J Sports Med Phys Fitness. 1994;34(3):284291. PubMed ID: 7830393

  • 5.

    Hespanhol Junior LC, van Mechelen W, Postuma E, Verhagen E. Health and economic burden of running-related injuries in runners training for an event: a prospective cohort study. Scand J Med Sci Sports. 2016;26(9):10911099. PubMed ID: 26282068 doi:

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

    Clarsen B, Myklebust G, Bahr R. Development and validation of a new method for the registration of overuse injuries in sports injury epidemiology: the Oslo Sports Trauma Research Centre (OSTRC) Overuse Injury Questionnaire. Br J Sports Med. 2013;47(8):495502. PubMed ID: 23038786 doi:

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

    Kluitenberg B, van Middelkoop M, Diercks R, van der Worp H. What are the differences in injury proportions between different populations of runners? A systematic review and meta-analysis. Sports Med. 2015;45(8):11431161. PubMed ID: 25851584 doi:

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

    Brewer BW. Self-identity and specific vulnerability to depressed mood. J Pers. 1993;61(3):343364. PubMed ID: 8246106 doi:

  • 9.

    Moreira NB, Vagetti GC, de Oliveira V, de Campos W. Association between injury and quality of life in athletes: a systematic review, 1980-2013. Apunt Med l’Esport. 2014;49(184):123138. doi:

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

    Pavot W, Diener E. Review of the satisfaction with life scale. Psychol Assess. 1993;5(2):164172. doi:

  • 11.

    Rejeski WJ, Mihalko SL. Physical activity and quality of life in older adults. J Gerontol A Biol Sci Med Sci. 2001;56(suppl 2):2335. doi:

  • 12.

    Houston MN, Hoch MC, Hoch JM. Health-related quality of life in athletes: a systematic review with meta-analysis. J Athl Train. 2016;51(6):442453. PubMed ID: 27258942 doi:

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

    Houston MN, Hoch JM, Van Lunen BL, Hoch MC. The impact of injury on health-related quality of life in college athletes. J Sport Rehabil. 2017;26(5):365375. PubMed ID: 27632873 doi:

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

    Marshall AN, Snyder Valier AR, Yanda A, Lam KC. The impact of a previous ankle injury on current health-related quality of life in college athletes. J Sport Rehabil. 2019;26(5):18. doi:

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

    Forsdyke D, Smith A, Jones M, Gledhill A. Psychosocial factors associated with outcomes of sports injury rehabilitation in competitive athletes: a mixed studies systematic review. Br J Sports Med. 2016;50(9):537544. PubMed ID: 26887414 doi:

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

    Vela LI, Denegar C. Transient disablement in the physically active with musculoskeletal injuries, part I: a descriptive model. J Athl Train. 2010;45(6):615629. PubMed ID: 21062186 doi:

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

    Bandura A. Self-Efficacy: The Exercise of Control. New York, NY: W.H. Freeman; 1997.

  • 18.

    McAuley E, Konopack JF, Morris KS, et al. . Physical activity and functional limitations in older women: influence of self-efficacy. Journals Gerontol Ser B Psychological Sci Soc Sci. 2006;61(5):P270P277. doi:

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

    Amireault S, Godin G, Vézina-Im L-A. Determinants of physical activity maintenance: a systematic review and meta-analyses. Health Psychol Rev. 2013;7(1):5591. doi:

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

    Rejeski WJ, King AC, Katula JA, et al. . Physical activity in prefrail older adults: confidence and satisfaction related to physical function. J Gerontol B Psychol Sci Soc Sci. 2008;63(1):P19P26. PubMed ID: 18332190 doi:

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

    Thomeé P, Währborg P, Börjesson M, Thomeé R, Eriksson BI, Karlsson J. Self-efficacy of knee function as a pre-operative predictor of outcome 1 year after anterior cruciate ligament reconstruction. Knee SurgSports Traumatol Arthrosc. 2008;16(2):118127. doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Taylor AH, May S. Threat and coping appraisal as determinants of compliance with sports injury rehabilitation: an application of protection motivation theory. J Sports Sci. 1996;14(6):471482. PubMed ID: 8981286 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Ericsson YB, Ringsberg K, Dahlberg LE. Self-efficacy, physical activity and health-related quality of life in middle-aged meniscectomy patients and controls. Scand J Med Sci Sport. 2011;21(6):e150e158. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    Messier SP, Martin DF, Mihalko SL, et al. . A 2-year prospective cohort study of overuse running injuries: the runners and injury longitudinal study (TRAILS). Am J Sports Med. 2018;46(9):22112221. PubMed ID: 29791183 doi:

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

    Roos KG, Marshall SW, Kerr ZY, et al. . Epidemiology of overuse injuries in collegiate and high school athletics in the United States. Am J Sports Med. 2015;43(7):17901797. PubMed ID: 25930673 doi:

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

    Marti B, Vander JP, Minder CE, Abelin T. On the epidemiology of running injuries. Am J Sports Med. 1988;16(3):285294. PubMed ID: 3381988 doi:

  • 27.

    McAuley E, Mihalko SL. Measuring exercise-related self-efficacy. In: Duda JL, ed. Advances in Motivation in Sport & Exercise. Morgantown, WV: Fitness Information Technology; 1998:371390.

    • Search Google Scholar
    • Export Citation
  • 28.

    Ware J, Kosinski M, Keller SD. A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220233. PubMed ID: 8628042 doi:

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

    Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol. 1988;54(6):10631070. PubMed ID: 3397865 doi:

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

    MacKinnon DP. Introduction to Statistical Mediation Analysis. New York, NY: Taylor & Francis Group/Lawrence Erlbaum Associates; 2008.

  • 31.

    Crawford JR, Henry JD. The positive and negative affect schedule (PANAS): construct validity, measurement properties and normative data in a large non-clinical sample. Br J Clin Psychol. 2004;43(3):245265. doi:

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

    Hanmer J, Kaplan RM. Update to the report of nationally representative values for the noninstitutionalized us adult population for five health-related quality-of-life scores. Value Heal. 2016;19(8):10591062. doi:

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

    Samsa G, Edelman D, Rothman ML, Williams GR, Lipscomb J, Matchar D. Determining clinically important differences in health status measures: a general approach with illustration to the Health Utilities Index Mark II. Pharmacoeconomics. 1999;15(2):141155. PubMed ID: 10351188 doi:

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

    Clark LA, Watson D, Leeka J. Diurnal variation in the positive affects. Motiv Emot. 1989;13(3):205234. doi:

  • 35.

    Liao Y, Shonkoff ET, Dunton GF. The acute relationships between affect, physical feeling states, and physical activity in daily life: a review of current evidence. Front Psychol. 2015;6:17. doi:

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

    Farivar SS, Liu H, Hays RD. Half standard deviation estimate of the minimally important difference in HRQOL scores? Expert Rev Pharmacoeconomics Outcomes Res. 2004;4(5):515523. doi:

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

    Lyubomksky S, Sheldon KM, Schkade D. Pursuing happiness: the architecture of sustainable change. Rev Gen Psychol. 2005;9(2):111131. doi:

  • 38.

    Bandura A. A social cognitive perspective on positive psychology. Rev Psicol Soc. 2011;26(1):720. doi:

  • 39.

    McAuley E, Konopack JF, Motl RW, Morris KS, Doerksen SE, Rosengren KR. Physical activity and quality of life in older adults: influence of health status and self-efficacy. Ann Behav Med. 2006;31(1):99103. PubMed ID: 16472044 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Howard JS, Sciascia A, Hoch JM. Using patient evidence to guide clinical care: consulting the other expert in the room. Int J Athl Ther Train. 2018;23(2):5356. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 41.

    Brinkman C, Baez SE, Genoese F, Hoch JM. Use of goal setting to enhance self-efficacy after sports-related injury: a critically appraised topic. J Sport Rehabil. 2020;29(4):498502. PubMed ID: 31586432 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42.

    Brewer BW. Psychology of sport injury rehabilitation. In: Tenenbaum G, Eklund RC, eds. Handbook of Sport Psychology. Hoboken, NJ: John Wiley & Sons, Inc.; 2012:404424.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 43.

    Hollander K, Baumann A, Zech A, Verhagen E. Prospective monitoring of health problems among recreational runners preparing for a half marathon. BMJ Open Sport Exerc Med. 2018;4(1):e000308. PubMed ID: 29387447 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    Buist I, Bredeweg SW, Bessem B, van Mechelen W, Lemmink KAPM, Diercks RL. Incidence and risk factors of running-related injuries during preparation for a 4-mile recreational running event. Br J Sports Med. 2010;44(8):598604. PubMed ID: 18487252 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 269 269 41
Full Text Views 9 9 0
PDF Downloads 6 6 0