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The Transtheoretical Model: An Exploratory Look at Its Applicability to Injury Rehabilitation

Damien Clement

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.

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Injured Athletes’ Perceptions About Social Support

Damien Clement and Vanessa R. Shannon

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.

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

Damien Clement and Monna Arvinen-Barrow

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.

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Helping Athletic Training Students Deal With Stress

Adam Naylor, Damien Clement, and Todd Gilson

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Rationale for Using a Pre-Assessment Tool Prior to Injury Rehabilitation

Damien Clement and Vanessa R. Shannon

Edited by Adam Naylor

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Performance Enhancement Groups for Injured Athletes

Damien Clement, Vanessa R. Shannon, and Ian J. Connole

Edited by Adam Naylor

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Performance Enhancement Groups for Injured Athletes, Part 2: Implementation and Facilitation

Damien Clement, Vanessa R. Shannon, and Ian J. Connole

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Performance Enhancement Groups for Injured Athletes, Part 1: Preparation and Development

Damien Clement, Vanessa R. Shannon, and Ian J. Connole

Edited by Jatin P. Ambegaonkar

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

Monna Arvinen-Barrow, Damien Clement, Jennifer Jordan Hamson-Utley, Cindra Kamphoff, Rebecca Zakrajsek, Sae-Mi Lee, Brian Hemmings, Taru Lintunen, and Scott B. Martin

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, ηp 2 = .055) and sport type (P = .0001, ηp 2 = .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.

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Athletes’ Use of Mental Skills During Sport Injury Rehabilitation

Monna Arvinen-Barrow, Damien Clement, Jennifer J. Hamson-Utley, Rebecca A. Zakrajsek, Sae-Mi Lee, Cindra Kamphoff, Taru Lintunen, Brian Hemmings, and Scott B. Martin

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.