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Natalie L. Myers and Gilson J. Capilouto

Adherence is a documented problem in collegiate athletics. The patient–clinician relationship is an important component of how one will receive the idea of rehabilitation and adhere to the prescribed treatment protocol. Attachment theory states that an emotional bond between two individuals usually flourishes when one individual looks for support and assurance during a time of need. Attachment theory was initially proposed to describe the parent–child relationship and has implications into adulthood. If clinicians understand and recognize the different attachment styles a given patient might portray, then the relationship between the two may flourish, and consequently lead to greater adherence. Therefore, the purpose of this paper is to propose a model for improving treatment adherence by adjusting the patient–clinician relationship based on a patient’s attachment style.

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Megan D. Granquist, Diane L. Gill and Renee N. Appaneal

Context:

Rehabilitation adherence is accepted as a critical component for attaining optimal outcomes. Poor adherence is recognized as a problem in the athletic training setting. Measurement has been inconsistent, and no measure has been developed for athletic training settings.

Objective:

To identify indicators of sportinjury rehabilitation adherence relevant to athletic training and develop a Rehabilitation Adherence Measure for Athletic Training (RAdMAT) based on these indicators.

Design:

Mixed methods, 3 steps.

Setting:

College athletic training facility.

Participants:

Practicing certified athletic trainers (ATCs; n = 7) generated items, experts (n = 12) reviewed them, and practicing ATCs (n = 164) completed the RAdMAT for their most, average, and least adherent athlete.

Main Outcome Measure:

RAdMAT.

Results:

The RAdMAT is 16 items with 3 subscales. Subscales and total have good internal consistency and clearly discriminate among adherence levels.

Conclusions:

The RAdMAT is based on scholarly literature and clinical practice, making it particularly appropriate for use in athletic training clinical practice or for research purposes.

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Ailsa Niven

Context:

Athlete’s adherence behavior can influence the outcome of a rehabilitation program.

Objective:

To draw on sport physiotherapists’ expert knowledge to increase understanding of adherence issues in practice and identify factors that influence adherence and strategies that can be used to enhance adherence.

Design:

An interview design with inductive content analysis.

Participants:

Nine (6 women and 3 men) experienced sports physiotherapists.

Results:

Under-adherence and over-adherence were issues in practice for some practitioners, and adherence was viewed as important for successful recovery from injury. Three higher order themes emerged relating to the influence of athlete characteristics, situational characteristics, and characteristics of the injury and rehabilitation on both facilitating and preventing rehabilitation adherence. Strategies to improve adherence in practice emerged from the data and broadly addressed the key determinants of adherence.

Conclusion:

Adherence to rehabilitation is influenced by a number of factors and strategies to enhance adherence are identified.

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Megan D. Granquist, Leslie Podlog, Joanna R. Engel and Aubrey Newland

Context:

Adherence to sport-injury rehabilitation protocols may be pivotal in ensuring successful rehabilitation and return-to-play outcomes.

Objectives:

To investigate athletic trainers' perspectives related to the degree to which rehabilitation adherence is an issue in collegiate athletic training settings, gain insight from certified athletic trainers regarding the factors contributing to rehabilitation nonadherence (underadherence and overadherence), and ascertain views on the most effective means for promoting adherence.

Design:

Crosssectional, mixed methods.

Setting:

Collegiate athletic training in the United States.

Participants:

Certified athletic trainers (n = 479; 234 male, 245 female).

Main Outcome Measures:

Online survey consisting of 3 questions regarding rehabilitation adherence, each followed by an open-ended comments section. Descriptive statistics were calculated for quantitative items; hierarchical content analyses were conducted for qualitative items.

Results:

Most (98.3%) participants reported poor rehabilitation adherence to be a problem (1.7% = no problem, 29.2% = minor problem, 49.7% = problem, 19.4% = major problem), while most (98.96%) participants reported that they had athletes who exhibited poor rehabilitation adherence (1% = never, 71.4% = occasionally, 22.5% = often, 5% = always). In addition, the majority (97.91%) of participants reported that overadherence (eg, doing too much, failing to comply with activity restrictions, etc) was at least an occasional occurrence (2.1% = never, 69.3% = occasionally, 26.3% = often, 1.9% = always). Hierarchical content analyses regarding the constructs of poor adherence and overadherence revealed 4 major themes: the motivation to adhere, the development of good athletic trainer–athlete rapport and effective communication, athletic trainers' perception of the coaches' role in fostering adherence, and the influence of injury- or individual- (eg, injury severity, sport type, gender) specific characteristics on rehabilitation adherence.

Conclusions:

These results suggest that participants believe that underadherence (and to a lesser extent overadherence) is a frequent occurrence in collegiate athletic training settings. Strategies for enhancing rehabilitation adherence rates and preventing overadherence may therefore be important for optimizing rehabilitation outcomes.

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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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Monna Arvinen-Barrow, Nathan Maresh and Jennifer Earl-Boehm

-reported treatment compliance between the experimental groups were found. 35 Although the study did use a randomized trial design, it did not include measures of patient outcome (pain or function) or use reliable and valid measures of rehabilitation adherence or perceived readiness to return to sport. Furthermore

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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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A. Craig Fisher and Laurie A. Bitting

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Jennifer J. Jeansonne, Jennifer Hoenig and Dan Hollander

Edited by Adam Naylor

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Britton W. Brewer, Joanne M. Daly, Judy L. Van Raalte, Albert J. Petitpas and Joseph H. Sklar