There is an increasing awareness within the sport-related literature of the importance of psychological factors in the rehabilitation of injured athletes. This awareness and subsequent investigations have led to the proposed application of grief response models to injury. However, to date limited attention has been paid to the clinical psychology literature on grief. The purpose of this paper is to redress this oversight by providing a review of the most relevant literature on the psychological responses of injured athletes in light of the philosophical and empirical research into loss and grief in the clinical literature. As a result of this review, a number of issues are raised for future research into grief models of injury.
Sport Injury and Grief Responses: A Review
Lynne Evans and Lew Hardy
Intervention Strategies with Injured Athletes: An Action Research Study
Lynne Evans, Lew Hardy, and Scott Fleming
This action research study employed a multi-modal intervention with three athletes rehabilitating from injury. The efficacy of a number of intervention strategies emerged, including social support, goal setting, imagery, simulation training, and verbal persuasion. Emotional support was perceived by athletes as important when rehabilitation progress was slow, setbacks were experienced, or other life demands placed additional pressures on participants. Task support mainly took the form of goal setting. There was support for the use of long-term and short-term goals, and both process and performance goals. The effect of outcome expectancy, rehabilitation setbacks, financial concerns, isolation, social comparison, and the need for goal flexibility emerged as salient to athletes’ responses to, and rehabilitation from, injury. In the reentry phase of rehabilitation, confidence in the injured body part, and the ability to meet game demands was perceived by participants as important to successful return to competition.
Situating Action Research: A Response to Gilboure
Lynne Evans, Scott Fleming, and Lew Hardy
This brief paper is intended to develop the epistemological and methodological discussion stimulated in the last edition of this journal. In the journal, our paper, “Intervention Strategies with Injured Athletes: An Action Research Study,” was published in the Professional Practice section alongside a response from David Gilbourne, “Searching for the Nature of Action Research: A Response to Evans, Hardy and Fleming” (unless otherwise indicated, citations of Gilbourne’s work in the present paper are from this source). In his critique of our paper, Gilboume addressed a set of themes and issues relating to the fundamental under-pinning principles of action research.
An Imagery Intervention during the Competitive Season with an Elite Rugby Union Player
Lynne Evans, Leigh Jones, and Richard Mullen
The purpose of the present study was to explore the use of imagery by an elite rugby union football player and to examine the effects of an imagery intervention in a practical performance environment. The study took place over a 14-week period of the competitive season. Data collection comprised semi-structured interviews, diaries, and the Sport Imagery Questionnaire. The findings suggested that the participant primarily used cognitive specific and cognitive general imagery. Post-intervention, the participant reported greater clarity; detail; control over his anxiety, activation, and motivation levels; an improvement in his ability to generate confidence in his playing ability prior to games; and more structure to his imagery use. The study highlighted the importance of individualizing imagery interventions to meet the specific needs of different athletes.
Multiple Roles in an Applied Setting: Trainee Sport Psychologist, Coach, and Researcher
Leigh Jones, Lynne Evans, and Richard Mullen
This is a follow-up article to an action research study that explored the effects of an imagery intervention on an elite rugby union player conducted over a 14-week period during the competitive season (Evans, Jones, & Mullen, 2004). A key feature of the study was that the same individual fulfilled multiple roles, specifically those of trainee sport psychologist, coach, and researcher. The aim of this article is to explore, from a trainee sport psychologist’s perspective, some of the issues that resulted from fulfilling multiple roles, both in the context of the study and in professional practice generally. The issues that emerged were consistent with the dual-role literature and involved role conflict surrounding areas of responsibility, scientific evidence versus social validity, confidentiality versus public statement, and the interpersonal welfare of both athlete and coach-sport psychologist (Ellickson & Brown, 1990). The findings highlighted (a) the importance of establishing ground rules (and planning), (b) the intensified emotional demands placed on the multirole practitioner, (c) the importance of involving a critical friend or outside agent, and (d) the potential for role conflict and the threat to objectivity.
Imagery Use during Rehabilitation from Injury: A Case Study of an Elite Athlete
Rebecca Hare, Lynne Evans, and Nichola Callow
The present study explored the perceived affect of personal and situational variables, perception of pain, and imagery ability on the function and outcome of an Olympic athlete’s use of imagery. To gain an in-depth understanding of these factors, semistructured interviews were conducted across three phases of injury rehabilitation, and return to competition. The athlete also completed the Athletic Injury Imagery Questionnaire-2 (Sordoni, Hall, & Forwell, 2002), the Vividness of Movement Imagery Questionnaire-2 (Roberts, Callow, Markland, Hardy, & Bringer, 2008), and the Visual Analogue Scale for pain (Huskisson, 1974). Findings highlight the perceived affects of personal and situational variables and imagery ability on the athlete’s responses to injury and function of imagery use. Further, this usage was perceived by the athlete to affect outcome depending on the phase of rehabilitation. Interestingly, perception of pain was not considered by the athlete to influence imagery use, this might have been due to the low pain rating reported.
The Effects of Perfectionism in Elite Sport: Experiences of Unhealthy Perfectionists
Paul A. Sellars, Lynne Evans, and Owen Thomas
This study examined the perfectionism experiences of 10 elite perfectionist athletes (5 male and 5 female). Following completion of the Sport Multidimensional Perfectionism Scale-2 (Gotwals & Dunn, 2009), a purposeful sample of unhealthy perfectionists were interviewed in relation to the study aims. Several themes emerged from the data that related to: effects of perfectionism and its antecedents on sporting experiences, specificity and level of perfectionism, and the coping skills and techniques used to counter the potentially detrimental effects of perfectionism. The findings highlighted the multidimensional nature of perfectionism and the need for future research to further explore the efficacy of techniques athletes use to promote healthy and reduce unhealthy facets of perfectionism.
The Development of a Measure of Psychological Responses to Injury
Lynne Evans, Lew Hardy, Ian Mitchell, and Tim Rees
The current paper reports the initial development of a theoretically derived measure to assess the psychological responses of injured athletes.
The paper comprises two studies. The first examines the factorial validity of the Psychological Responses to Sport Injury Inventory (PRSII) originally reported by Evans, Hardy, and Mullen.1 The second reexamines the factorial validity of the PRSII following scale refinement. Confirmatory factor analysis was employed in both studies.
Sport injury clinics.
Study 1 comprised repeated observations (n = 486) on 56 injured athletes. Study 2 comprised single observations on 418 injured athletes.
Psychological Responses to Sport Injury Inventory (PRSII).
The five factor model from the first study demonstrated variable model fit. The six factor model that emerged from the second study showed improved model fit.
The study provides some support for the PRSII as a measure of athletes’ psychological responses to injury.
Distinguishing Characteristics Between High and Low Adherence Patients Following Anterior Cruciate Ligament Reconstruction: A Qualitative Examination
Tom Williams, Lynne Evans, Angus Robertson, Lew Hardy, Stuart Roy, and Daniel Lewis
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.
Sport Psychology Consultants’ Perspectives on Facilitating Sport-Injury-Related Growth
Ross Wadey, Kylie Roy-Davis, Lynne Evans, Karen Howells, Jade Salim, and Ceri Diss
Despite recent conceptual, methodological, and theoretical advancements in sport-injury-related growth (SIRG), there is no research on sport psychology consultants’ (SPCs) experiential knowledge of working with injured athletes to facilitate SIRG. Toward this end, this study examined SPCs’ perspectives on facilitating SIRG to provide an evidence base for professional practice. Participants (4 female, 6 male; mean 19 years’ applied experience) were purposefully sampled and interviewed. Transcripts were thematically analyzed. Methodological rigor and generalizability were maximized through self-reflexivity and eliciting external reflections. Five themes were identified: Hear the Story, Contextualize the Story, Reconstruct the Story, Live the Story, and Share the Story. Findings offer practitioners a novel approach to working with injured athletes. Rather than focusing on returning to preinjury level of functioning, the findings illustrate how SPCs can work with injured athletes to help transform injury into an opportunity to bring about positive change.