Distinguishing Characteristics Between High and Low Adherence Patients Following Anterior Cruciate Ligament Reconstruction: A Qualitative Examination

in The Sport Psychologist
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  • 1 Faculty of Sport, Allied Health & Performance Science, St Mary’s University, Twickenham, United Kingdom
  • | 2 School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
  • | 3 Cardiff Sports Orthopaedics LLP, Spire Cardiff Hospital, Cardiff, United Kingdom
  • | 4 School of Sport, Health & Exercise Sciences, Bangor University, Bangor, Gwynedd, United Kingdom
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The purpose of this study was to identify factors that distinguished between injured athletes who displayed high compared with low levels of rehabilitation adherence following anterior cruciate ligament reconstructive surgery. In order to gain an in-depth understanding of these factors, semistructured qualitative interviews were conducted with six high adherers, six matched low adherers and for each injured athlete, a significant other. Thematic analysis was used to identify the themes that distinguished between high and low adherers. Three themes were generated based on the findings: (a) preparation for postoperative rehabilitation, (b) an active versus passive approach to rehabilitation, and (c) the threat of a poor outcome. Each theme comprised a number of subthemes that further elucidated the participants’ rehabilitation experiences and adherence behaviors. The findings have important implications for medical professionals, sport psychology consultants, coaches, and athletes with a vested interest in expediting recovery following anterior cruciate ligament reconstructive surgery.

  • Ardern, C.L., Taylor, N.F., Feller, J.A., & Webster, K.E. (2014). Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: An updated systematic review and meta-analyses including aspects of physical functioning and contextual factors. British Journal of Sports Medicine, 48, 15431552. https://doi.org/10.1136/bjsports-2013-093398

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bhaskar, R. (1975). A realist theory of science. Routledge.

  • Bianco, T., & Eklund, R.C. (2001). Conceptual considerations for social support research in sport and exercise settings: The case of sport injury. Journal of Sport and Exercise Psychology, 23, 85107. https://doi.org/10.1123/jsep.23.2.85

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bolger, N., & Amarel, D. (2007). Effects of social support visibility on adjustment to stress: Experimental evidence. Journal of Personality and Social Psychology, 92, 458475. https://doi.org/10.1037/0022-3514.92.3.458

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77101.

  • Brewer, B.W., Cornelius, A.E., Van Raalte, J.L., Petitpas, A.J., Sklar, J.H., Pohlman, M.H., Krushell, R.J., & Ditmar, T.D. (2003). Protection motivation theory and adherence to sport injury rehabilitation revisited. The Sport Psychologist, 17, 95103. https://doi.org/10.1123/tsp.17.1.95

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Brewer, B.W., Cornelius, A.E., Van Raalte, J.L., Tennen, H., & Armeli, S. (2013). Predictors of adherence to home rehabilitation exercises following anterior cruciate ligament reconstruction. Rehabilitation Psychology, 58, 6472. https://doi.org/10.1037/a0031297

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Brewer, B.W., Van Raalte, J.L., Cornelius, A.E., Petitpas, A.J., Sklar, J.H., Pohlman, M.H., Krushell, R.J., & Ditmar, T.D. (2000). Psychological factors, rehabilitation adherence, and rehabilitation outcome following anterior cruciate ligament reconstruction. Rehabilitation Psychology, 45, 2037. https://doi.org/10.1037/0090-5550.45.1.20

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Cavallerio, F., Wadey, R., & Wagstaff, C.R.D. (2016). Understanding overuse injuries in rhythmic gymnastics: A 12-month ethnography. Psychology of Sport and Exercise, 25, 100109. https://doi.org/10.1016/j.psychsport.2016.05.002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Chan, D.K., Lonsdale, C., Ho, P.Y., Yung, P.S., & Chan, K.M. (2009). Patient motivation and adherence to postsurgery rehabilitation exercise recommendations: The influence of physiotherapists’ autonomy-supportive behaviors. Archives of Physical Medicine and Rehabilitation, 90, 19771982. https://doi.org/10.1016/j.apmr.2009.05.024

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Chang, E.C. (1998). Dispositional optimism and primary and secondary appraisal of a stressor: Controlling for confounding influences and relations to coping and psychological and physical adjustment. Journal of Personality and Social Psychology, 74, 11091120. https://doi.org/10.1037/0022-3514.74.4.1109

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Clement, D., Arvinen-Barrow, M.M., & Fetty, T. (2015). Psychosocial responses during different phases of sport-injury rehabilitation: A qualitative study. Journal of Athletic Training, 50, 95104. https://doi.org/10.4085/1062-6050-49.3.52

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Coulter, T., Mallett, C., & Singer, J. (2016). A subculture of mental toughness in an Australian Football League club. Psychology of Sport and Exercise, 22, 98113. https://doi.org/10.1016/j.psychsport.2015.06.007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Culvenor, A.G., & Barton, C.J. (2018). ACL injuries: The secret probably lies in optimising rehabilitation. British Journal of Sports Medicine, 52, 14161418. https://doi.org/10.1136/bjsports-2017098872

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Deabate, L., Previtali, D., Grassi, A., Filardo, G., Candrian, C., & Delcogliano, M. (2020). Anterior cruciate ligament reconstruction within 3 weeks does not increase stiffness and complications compared with delayed reconstruction: A meta-analysis of randomized controlled trials. The American Journal of Sports Medicine, 48, 12631272. https://doi.org/10.1177/0363546519862294

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Durand, H., Casey, M., Glynn, L.G., Hayes, P., Murphy, A.W., & Molloy, G.J. (2019). A qualitative comparison of high and low adherers with apparent treatment-resistant hypertension. Psychology, Health and Medicine, 21, 114. https://doi.org/10.1080/13548506.2019.1619788

    • Search Google Scholar
    • Export Citation
  • Ebert, J.R., Edwards, P., Yi, L., Joss, B., Ackland, T., Carey-Smith, R, Buelow, J.-U., & Hewitt, B. (2018). Strength and functional symmetry is associated with post-operative rehabilitation in patients following anterior cruciate ligament reconstruction. Knee Surgery Sports Traumatology Arthroscopy, 26, 23532361. https://doi.org/10.1007/s00167-017-4712-6

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Endler, N.S., Parker, J.D., & Summerfeldt, L.J. (1998). Coping with health problems: Developing a reliable and valid multidimensional measure. Psychological Assessment, 10, 195205. https://doi.org/10.1037/1040-3590.10.3.195

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Evans, L., Wadey, R., Hanton, S., & Mitchell, I. (2012). Stressors experienced by injured athletes. Journal of Sports Sciences, 30, 917927. https://doi.org/10.1080/02640414.2012.682078

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Fields, J., Murphey, M., Horodyski, M., & Stopka, C. (1995). Factors associated with adherence to sports injury rehabilitation in college-age recreational athletes. Journal of Sport Rehabilitation, 4, 172180. https://doi.org/10.1123/jsr.4.3.172

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Filbay, S., Ackerman, I., Russell, T., & Crossley, K. (2017). Return to sport matters—Longer-term quality of life after ACL reconstruction in people with knee difficulties. Scandinavian Journal of Medicine & Science in Sports, 27, 514524. https://doi.org/10.1111/sms.12698

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Goddard, K., Roberts, C.-M., Byron-Daniel, J., & Woodford, L. (2020). Psychological factors involved in adherence to sport injury rehabilitation: A systematic review. International Review of Sport and Exercise Psychology, 13, 123. https://doi.org/10.1080/1750984X.2020.1744179

    • Search Google Scholar
    • Export Citation
  • Grindem, H., Arundale, A.J., & Ardern, C.L. (2018). Alarming underutilisation of rehabilitation in athletes with anterior cruciate ligament reconstruction: Four ways to change the game. British Journal of Sports Medicine, 52, 11621163. https://doi.org/10.1136/bjsports-2017-098746

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Grindem, H., Granan, L.P., Risberg, M.A., Engebretsen, L., Snyder-Mackler, L., & Eitzen, I. (2015). How does a combined preoperative and postoperative rehabilitation programme influence the outcome of ACL reconstruction 2 years after surgery? A comparison between patients in the Delaware-Oslo ACL Cohort and the Norwegian National Knee Ligament Registry. British Journal of Sports Medicine, 49, 385389. https://doi.org/10.1136/bjsports-2014-093891

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hilliard, R.C., Brewer, B.C., Cornelius, A.E., & Van Raalte, J.L. (2013). Big five personality characteristics and adherence to clinic-based rehabilitation activities after ACL surgery: A prospective analysis. Open Rehabilitation Journal, 7, 15. https://doi.org/10.2174/1874943701407010001

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Johnston, L.H., & Carroll, D. (1998). The context of emotional responses to athletic injury: A qualitative analysis. Journal of Sport Rehabilitation, 7, 206220. https://doi.org/10.1123/jsr.7.3.206

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Johnston, L.H., & Carroll, D. (2000). The psychological impact of injury: Effects of prior sport and exercise involvement. British Journal of Sports Medicine, 34, 436439. http://dx.doi.org/10.1136/bjsm.34.6.436

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kyritsis, P., Bahr, R., Landreau, P., Miladi, R., & Witvrouw, E. (2016). Likelihood of ACL graft rupture: Not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. British Journal of Sports Medicine, 50, 946951. https://doi.org/10.1136/bjsports-2015-095908

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lai, C.C.H., Ardern, C.L., Feller, J.A., & Webster, K.E. (2017). Eighty-three per cent of elite athletes return to preinjury sport after anterior cruciate ligament reconstruction: A systematic review with meta-analysis of return to sport rates, graft rupture rates and performance outcomes. British Journal of Sports Medicine, 52, 128138. https://doi.org/10.1136/bjsports-2016-096836

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lee, A.S.Y., Yung, P.S.-H., Mok, K.-M., Hagger, M.S., Chan, D.K. (2020). Psychological processes of ACL-patients’ post-surgery rehabilitations: A prospective test of an integrated theoretical model. Social Science & Medicine, 244, Article 112646. https://doi.org/10.1016/j.socscimed.2019.112646

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Levy, A.R., Polman, R.C.J., & Clough, P.J. (2008). Adherence to sport injury rehabilitation programs: An integrated psycho-social approach. Scandinavian Journal of Medicine & Science in Sports, 18, 798809. https://doi.org/10.1111/j.1600-0838.2007.00704.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Levy, A.R., Polman, R.C.J., Nicholls, A.R., & Marchant, D.C. (2009). Sport injury rehabilitation adherence: Perspectives of recreational athletes. International Journal of Sport and Exercise Psychology, 7, 212229. https://doi.org/10.1080/1612197X.2009.9671901

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Maddux, J.E., & Rogers, R.W. (1983). Protection motivation and self-efficacy: A revised theory of fear appeals and attitude change. Journal of Experimental Social Psychology, 19, 469479. https://doi.org/10.1016/0022-1031(83)90023-9

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mannion, A.F., Impellizzeri, F.M., Naal, F.D., & Leunig, M. (2013). Fulfilment of patient-rated expectations predicts the outcome of surgery for femoroacetabular impingement. Osteoarthritis and Cartilage, 21, 4450. https://doi.org/10.1016/j.joca.2012.09.013

    • Crossref
    • Search Google Scholar
    • Export Citation
  • McKay, C.D., & Verhagen, E. (2015). ‘Compliance’ versus ‘adherence’ in sport injury prevention: Why definition matters. British Journal of Sports Medicine, 50(7), 382383. https://doi.org/10.1136/bjsports-2015-095192

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Meichenbaum, D., & Turk, D.C. (1987). Facilitating treatment adherence. Plenum.

  • Minichiello, V., Aroni, R., Timewell, E., & Alexander, L. (1990). In-depth interviewing: Researching people. Longman Cheshire.

  • Nagelli, C.V., & Hewett, T.E. (2017). Should return to sport be delayed until 2 years after anterior cruciate ligament reconstruction? Biological and functional considerations. Sports Medicine, 47, 221232. https://doi.org/10.1007/s40279-016-0584-z

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Niven, A., Nevill, A., Sayers, F., & Cullen, M. (2012). Predictors of rehabilitation intention and behavior following anterior cruciate ligament surgery: An application of the theory of planned behavior. Scandinavian Journal of Medicine & Science in Sports, 22, 316322. https://doi.org/10.1111/j.1600-0838.2010.01236.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Niven, A.G. (2007). Rehabilitation adherence in sport injury: Sport physiotherapists’ perceptions. Journal of Sport Rehabilitation, 16, 93110. https://doi.org/10.1123/jsr.16.2.93

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Patton, M.Q. (2002). Qualitative research and evaluation methods. Sage.

  • Pizzari, T., McBurney, H., Taylor, N.F., & Feller, J.A. (2002). Adherence to anterior cruciate ligament rehabilitation: A qualitative analysis. Journal of Sport Rehabilitation, 11, 90102. https://doi.org/10.1123/jsr.11.2.90

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Plotnikoff, R.C., Rhodes, R.E., & Trinh, L. (2009). Protection motivation theory and physical activity: A longitudinal test among a representative population sample of Canadian adults. Journal of Health Psychology, 14, 11191134. https://doi.org/10.1177/1359105309342301

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ronkainen, N.J., & Wiltshire, G. (2021). Rethinking validity in qualitative sport and exercise psychology research: A realist perspective. International Journal of Sport and Exercise Psychology, 19, 1328. https://doi.org/10.1080/1612197X.2019.1637363

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Scheier, M.F., Carver, C.S., & Bridges, M.W. (1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A re-evaluation of the Life Orientation Test. Journal of Personality and Social Psychology, 67, 10631078. https://doi.org/10.1037//0022-3514.67.6.1063

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Smith, B., & McGannon, K.R. (2018). Developing rigor in qualitative research: Problems and opportunities within sport and exercise psychology. International Review of Sport and Exercise Psychology, 11, 101121. https://doi.org/10.1080/1750984X.2017.1317357

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Stake, R.E. (1995). The art of case study research. Sage.

  • Taylor, A.H., & May, S. (1996). Threat and coping appraisal as determinants of compliance with sports injury rehabilitation: An application of protection motivation theory. Journal of Sport Sciences, 14, 471481. https://doi.org/10.1080/02640419608727734

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Tomberg, T., Toomela, A., Ennok, M., & Tikk, A. (2007). Changes in coping strategies, social support, optimism and health-related quality of life following traumatic brain injury: A longitudinal study. Brain Injury, 21, 479488.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Uchino, B.N. (2009). Understanding the links between social support and physical health: A life span perspective with emphasis on the separability of perceived and received support. Perspectives on Psychological Science, 4, 236255. https://doi.org/10.1111/j.1745-6924.2009.01122.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Udry, E. (1997). Coping and social support among injured athletes following surgery. Journal of Sport and Exercise Psychology, 19, 7190. https://doi.org/10.1123/jsep.19.1.71

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Udry, E., Shelbourne, D.K., & Gray, T. (2003). Psychological readiness for anterior cruciate ligament surgery: Describing and comparing the adolescent and adult experiences. Journal of Athletic Training, 38, 167171.

    • Search Google Scholar
    • Export Citation
  • van Melick, N., van Cingel, R.E., Brooijmans, F., Neeter, C., van Tienen, T., Hullegie, W., & Nijhuis-van der Sanden, M.W. (2016). Evidence-based clinical practice update: Practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. British Journal of Sports Medicine, 50, 15061515. https://doi.org/10.1136/bjsports-2015-095898

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Wadey, R., Day, M., Cavallerio, F., & Martinelli, L. (2018). The multilevel model of sport injury: Can coaches impact and be impacted by injury? In R. Thelwell & M. Dicks (Eds.), Professional advances in sports coaching: Research and practice. Routledge.

    • Search Google Scholar
    • Export Citation
  • Walker, A., Hing, W., & Lorimer, A. (2020). The influence, barriers to and facilitators of anterior cruciate ligament rehabilitation adherence and participation: A scoping review. Sports Medicine, 6, 32. https://doi.org/10.1186/s40798-020-00258-7

    • Search Google Scholar
    • Export Citation
  • Waters, A.G. (2005). The role of confidence in rehabilitation and the recovery of motor performance [Unpublished Doctoral dissertation, University of Wales].

    • Search Google Scholar
    • Export Citation
  • Wiese-Bjornstal, D.M., Smith, A.M., Shaffer, S.M., & Morrey, M.A. (1998). An integrated model of response to sport injury: Psychological and sociological dynamics. Journal of Applied Sport Psychology, 10, 4669. https://doi.org/10.1080/10413209808406377

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Williams, T., Evans, L., Robertson, A., Hardy, L., Roy, S., Lewis, D., & Glendinning, F. (2020). The role of optimism and psychosocial factors in athletes’ recovery from ACL injury: A longitudinal study. Frontiers in Sports and Active Living, 2, 116. https://doi.org/10.3389/fspor.2020.00116

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Wiltshire, G. (2018). A case for critical realism in the pursuit of interdisciplinary and impact. Qualitative Research in Sport, Exercise and Health, 10, 525542. https://doi.org/10.1080/2159676X.2018.1467482

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Zhang, C.-Q., Zhang, R., Schwarzer, R., & Hagger, M.S. (2019). A meta-analysis of the health action process approach. Health Psychology, 38, 623637. https://doi.org/10.1037/hea0000728

    • Crossref
    • Search Google Scholar
    • Export Citation
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