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Jessica J. DeGaetano, Andrew T. Wolanin, Donald R. Marks and Shiloh M. Eastin

The purpose of this study was to explore the influence of psychosocial factors and psychological flexibility on rehabilitation protocol adherence in a sample of injured collegiate athletes. Self-report measures were given to injured athletes before the start of a physical rehabilitation protocol. Upon completion of rehabilitation, each athlete was assessed by the chief athletic trainer using a measure of rehabilitation adherence. Correlational analyses and bootstrapped logistic regression analyses were conducted to determine whether broad psychosocial factors and level of psychological flexibility predicted engagement and adherence to a rehabilitation protocol. Psychological flexibility, as measured on the Acceptance and Action Questionnaire (2nd ed.; Bond et al., 2011), contributed significantly to the overall logistic regression model. Study findings suggested that assessment of psychological flexibility could give medical providers a way to evaluate both quickly and quantitatively potentially problematic behavioral responding among injured athletes, allowing for more effective adherence monitoring.

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Yannis Theodorakis, Anastasia Beneca, Parascevi Malliou and Marios Goudas

The aim of this study was to examine the effectiveness of goal setting on performance and on a number of psychological variables such as self-efficacy, pretesting anxiety, and self-satisfaction during an injury rehabilitation program. An experimental group (n = 20) and a control group (n = 17) of injured physical education students were studied. Both groups underwent a 4-week quadriceps strengthening program on an isokinetic dynamometer, with the experimental group setting specific personal goals in each training session. The experimental group improved in performance significantly more than the control group. Although both groups exhibited an increase in self-efficacy and a decrease in pretesting anxiety, only the experimental group had an increase in self-satisfaction with performance. Results confirm that incorporating goal setting in the rehabilitation process enhances rehabilitation results.

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Kendahl M. Shortway, Andrew Wolanin, Jennifer Block-Lerner and Donald Marks

, Magnusson, & Olsson, 2005 ; Vowles & McCracken, 2008 ). ACT and Sport Injury Rehabilitation Despite support for the effectiveness of mindfulness- and acceptance-based approaches for performance enhancement and psychological well-being in the sport context as well as ACT for chronic pain, there is a

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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.

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Carla Sordoni, Craig Hall and Lorie Forwell

Objectives:

To determine whether athletes use motivational and cognitive imagery during injury rehabilitation and to develop an instrument for measuring imagery use.

Design:

A survey concerning imagery use during rehabilitation was administered to injured athletes.

Setting:

The Fowler Kennedy Sport Medicine Clinic in London, Ontario, Canada.

Participants:

Injured athletes (N = 71) receiving physiotherapy.

Main Outcome Measure:

The Athletic Injury Imagery Questionnaire (AIIQ).

Results:

As hypothesized, 2 distinct factors emerged from the items on the AIIQ: motivational and cognitive imagery. Motivational imagery was used more often than cognitive imagery in this context, yet less frequently than in other sport situations (eg, training and competition).

Conclusions:

The study indicates that the AIIQ is a potentially useful tool through which physiotherapists and sport psychologists can examine athletes' use of imagery in injury rehabilitation.

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Joe Hart, Damien Clement, Jordan Hamson-Utley, Monna Arvinen-Barrow, Cindra Kamphoff, Rebecca A. Zakrajsek and Scott B. Martin

Context:

Injured athletes begin the rehabilitation process with expectations about the nature of the working relationship with an athletic trainer. These expectations can infuence the effectiveness of the assistance provided.

Objective:

To determine whether male and female athletes differed in terms of expectations about injury rehabilitation services with an athletic trainer.

Design:

A questionnaire was administered to student athletes that assessed expectations about injury rehabilitation. Setting: Five colleges and universities.

Patients or Other Participants:

Questionnaire responses were provided by 679 student athletes (443 males and 236 females).

Main Outcome Measure:

Responses to the Expectations about Athletic Training questionnaire were used to assess factors identifed as Personal Commitment, Facilitative Conditions, Athletic Trainer Expertise, and Realism.

Results:

A statistically signifcant interaction between gender and prior experience was identifed. Male athletes with no prior experience had lower expectations for a facilitative environment. Female athletes with prior experience were less likely to have realistic expectations.

Conclusions:

Gender and prior experience infuence athletes’ expectations of injury rehabilitation with an athletic trainer.

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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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Britton W. Brewer, Joshua B. Avondoglio, Allen E. Cornelius, Judy L. Van Raalte, John C. Brickner, Albert J. Petitpas, Gregory S. Kolt, Tania Pizzari, Adrian M.M. Schoo, Kelley Emery and Stephen J. Hatten

Context:

Adherence to clinic-based rehabilitation might influence outcomes.

Objective:

To examine the construct validity and interrater agreement of a measure of adherence to clinic-based rehabilitation.

Design:

Repeated-measures in both study 1 and study 2.

Participants:

43 student rehabilitation practitioners in study 1 and 12 patients undergoing rehabilitation after anterior cruciate ligament reconstruction in study 2.

Interventions:

Participants in study 1 rated the adherence of a simulated videotaped patient exhibiting high, moderate, and low adherence. Two certified athletic trainers rated the adherence of patients at 4 consecutive appointments in study 2.

Main Outcome Measure:

The Sport Injury Rehabilitation Adherence Scale.

Results:

In study 1, adherence ratings increased in a linear fashion across the 3 levels of adherence, and r WG(J) and rater-agreement-index values ranging from .84 to .95 were obtained. In study 2, the rater-agreement index was .94.

Conclusions:

Strong support was found for the construct validity and interrater agreement of the Sport Injury Rehabilitation Adherence Scale.

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Andrew R. Levy, Remco C.J. Polman, Peter J. Clough, David C. Marchant and Keith Earle

Objective:

To investigate the relationship between mental toughness, sport injury beliefs, pain, and adherence toward a sport injury rehabilitation program.

Design:

A prospective design was employed that evaluated adherence over the entire rehabilitation period.

Participants:

70 patients undertaking a sport injury rehabilitation program for a tendonitis related injury.

Main Outcome Measures:

Adherence was measured using self report measures of clinic and home based rehabilitation alongside attendance.

Results:

No association was found between mental toughness and coping appraisals, although high mentally tough individuals displayed more positive threat appraisals and were better able to cope with pain than their less mentally tough counterparts. Greater attendance at rehabilitation sessions was displayed by more mentally tough individuals; however, more positive behavior during clinic rehabilitation was characterized by low mental toughness.

Conclusions:

Despite the 0benefits of being mentally tough, sports medicine providers need to be aware that a high degree of mental toughness may have negative consequences upon rehabilitation behavior and subsequently recovery outcomes.

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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.