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

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.

Functional Outcomes and Psychological Benefits of Active Video Games in the Rehabilitation of Lateral Ankle Sprains: A Case Report.

CONTEXT: The use of active video games (AVG) as a treatment modality in the rehabilitation context is increasing. However, little is known about the functional outcomes and psychological benefits of such rehabilitation in college athletes with lateral ankle sprains (LASs). OBJECTIVE: To examine functional outcomes and psychological benefits of AVG-aided rehabilitation program for LAS. DESIGN: A mixed-methods, single-subject case series design. SETTING: College athletic training clinic. PATIENTS: Two female college soccer players who sustained LAS (grades I and II) during sport participation. INTERVENTION: A 4-week balance training program. One patient completed balance exercises using AVG, whereas the other patient completed traditional balance exercises. MAIN OUTCOME MEASURES: Several validated instruments were used to evaluate different functional outcomes and psychological factors: balance (Balance Error Scoring System, Star Excursion Balance Test), rehabilitation adherence (Rehabilitation Adherence Measure for Athletic Training), foot and ankle function (Foot and Ankle Ability Measure), perceptions of pain (Visual Analog Scale for pain), perceived readiness to return to sport (Injury-Psychological Readiness to Return to Sport Scale), and mood (Brunel Mood Scale). RESULTS: It appears that the balance training protocols (AVG and traditional balance exercises) were equally effective in restoring patient's balance to functional levels. Despite very individualistic processes of rehabilitation, the participants' perceived pain, perceived readiness to return to sport, and mood states were closely linked with objective and subjective functional measures of progress. CONCLUSIONS: Based on the results, AVG has the potential to provide more versatility into the static and dynamic postural control exercises typically used following acute LAS. Moreover, the current results support the existing psychological and biopsychosocial theoretical conceptualizations of athletes' responses to injuries and rehabilitation process.

Exploring the Use of Psychological Skills Training Interventions in a Music Domain: A Systematic Review.

AIM: The aim of this paper was to systematically review existing empirical literature addressing the use of psychological skills training (PST) interventions commonly employed in sport applied to a music domain. Included PST studies must have an experimental or quasi-experimental design and no clinical or pharmacological interventions and/or assessments. METHODS: The databases MEDLINE (EBSCO), PsychInfo, Psych Articles, CINAHL Plus with full text, Google Scholar, SportDiscus, and Music Index were searched using a combination of the terms. music*, performance psychology, performance enhancement, music performance, intervention, psychological skills training, and music performance psychology. Due to the novelty of the existing literature, there were no limitation restrictions to publication year, the standard of musician (e.g., expert, novice, professional, amateur), participant age, or type of intervention setting. RESULTS: The initial search revealed 323 published articles. After applying the inclusion and exclusion criteria, 10 articles were deemed sufficient for review. Four additional articles were found via pen-and-paper method by evaluating the reference sections of the included articles. All reviewed studies demonstrated that aspects of PST interventions commonly employed in sport (except Alexander technique) are effective at subjectively enhancing performance in a music domain. The PST interventions varied vastly in duration, as well as the types of (and a theoretical and empirical rationale for) psychological skills employed. CONCLUSIONS: Music performers may benefit from PST interventions typically used in sport; however, unique considerations of the music performance environment must be addressed in the design of such PST interventions.

Sport-related anxiety: current insights.

To date, much research has been devoted to understanding how anxiety can affect sport performance, both in practice and in competitive settings. It is well known that sport has the potential for high levels of stress and anxiety, and that practicing and employing a range of psychological strategies can be beneficial in anxiety management. Equally, growing evidence also suggests that anxiety can play a role in sport injury prevention, occurrence, rehabilitation, and the return to sport process. The purpose of this paper is to provide current insights into sport-related anxiety. More specifically, it will provide the reader with definitions and theoretical conceptualizations of sport-related anxiety. This will be followed by making a case for considering the term "performance" to be broader than activities associated with sport-related performance in practice and competition, by including performance activities associated with sport injury prevention, rehabilitation, and the return to sport process. The paper will then highlight the importance of recognizing early signs and symptoms of anxiety, and the potential need for referral. Finally, the conclusions will emphasize the need for appropriate, client-specific, and practitioner competent care for athletes experiencing sport-related anxiety.

Preliminary investigation into sport and exercise psychology consultants' views and experiences of an interprofessional care team approach to sport injury rehabilitation.

Sport injury rehabilitation has moved from predominately physical treatment to a more holistic care. However, limited research has explored the views and experiences of those involved in such an approach. The purpose of this study was to preliminarily investigate sport psychology consultants' (SPCs') views and experiences of an interprofessional team approach to sport injury rehabilitation. A cross-sectional online survey previously used with athletic trainers was distributed via a US-based sport/exercise psychology list-serve (N = 1245). A total of 62 (27 men, 35 women, M age 38.2 years, age range: 22-73 years) participants with 10.6 (SD = 9.8) years of experience as an SPC were included in the final analyses. On average, SPCs felt that it was very important (M = 6.6; SD = 0.6) for athletes to have access to an interprofessional care team. Of the sample, 64.5% (n = 40) typically worked as part of an interprofessional care team 44.7% of the time. The SPCs (n = 28; 45.2%) also indicated that the primary treatment providers (e.g., athletic trainer, physical therapist) were typically serving as the primary point person for such teams. Since gaining entry to sport medicine can be an area SPCs struggle with, building effective working relationships with treatment providers can help promote and increase SPCs involvement in providing holistic, interprofessional care to athletes with injuries. To ensure athletes' successful biopsychosocial return to sport, different individuals and professionals should work together for the benefit of the athlete by adopting holistic care during sports injury rehabilitation.

"I think I became a swimmer rather than just someone with a disability swimming up and down:" paralympic athletes perceptions of self and identity development.

PURPOSE: The purpose of this study was to explore the role of swimming on Paralympic athletes' perceptions of self and identity development. METHOD: A hermeneutic phenomenological approach was taken. During semi-structured interviews, five Paralympic swimmers (aged 20-24 years) were asked questions about their swimming career, perceptions of self, integration, and impairment. Interviews were audio-recorded and transcribed verbatim. RESULTS: An Interpretative Phenomenological Analysis yielded three superordinate themes: (a) "One of the crowd"; none of the participants viewed themselves as disabled, nor as supercrips; these perceptions stemmed from family-, school-, and swimming-related experiences, (b) "Becoming me"; participation in swimming facilitated self- and social-acceptance, and identity development, and c) "A badge of honor"; swimming presented opportunity to present and reinforce a positive identity. CONCLUSIONS: Swimming experiences enabled the participants to enhance personal and social identities, integrate through pro-social mechanisms, and to develop a career path following retirement from competition. Implications for rehabilitation Offering equal sporting opportunities for people with/without physical disability can help facilitate social integration and act as a buffer against stigmatization. Our research suggests that participation in sport had afforded the participants a heightened sense of self-concept, independence, ability and corresponding pride. When working with individuals with physical disabilities, rehabilitation professionals could utilize sport as a means of increasing an individual's feelings of independence, confidence and normalization. As such, part of rehabilitation should be to ensure opportunities for sport participation for people with physical disability are available for people of all ages.

Functional Movement Screen Factorial Validity and Measurement Invariance Across Sex Among Collegiate Student-Athletes.

Gnacinski, SL, Cornell, DJ, Meyer, BB, Arvinen-Barrow, M, and Earl-Boehm, JE. Functional Movement Screen factorial validity and measurement invariance across sex among collegiate student-athletes. J Strength Cond Res 30(12): 3388-3395, 2016-The Functional Movement Screen (FMS) is a screening tool used to evaluate functional movement quality and subsequent musculoskeletal injury risk. Despite recent research on the factorial validity of the FMS, no confirmatory factor analysis (CFA) has been conducted to examine measurement invariance across sex among student-athletes. The primary purpose of the current study was to confirm the factor structure of the FMS measurement model in a collegiate student-athlete population. It was hypothesized that the 1-factor model would demonstrate better model fit than the recently proposed 2-factor model. The secondary purpose of the study was to examine FMS measurement invariance across sex using the previously identified measurement model. It was hypothesized that FMS measurement invariance would hold across sex. Male (n = 88) and female (n = 88) collegiate student-athletes completed FMS screening during the off-season. Factorial validity was examined using CFA procedures, and model parameters were estimated using maximum likelihood estimation. Measurement invariance was examined by comparison of fit indices between hierarchically constrained models. Results revealed support for both the 1- and the 2-factor models; however, the 2-factor model failed to fit the data significantly better than the 1-factor model. Results also indicated that measurement invariance did not hold across sex, indicating that the FMS sum score construct is not measured equivalently in male and female populations. Collectively, results provide evidence for the use of the unidimensional FMS sum score among collegiate student-athletes, yet prompt caution because it relates to the evaluation of sex differences in sum or movement pattern scores.

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

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, ηp2 = .055) and sport type (P = .0001, ηp2 = .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.

Athletes' use of mental skills during sport injury rehabilitation.

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.

Psychosocial responses during different phases of sport-injury rehabilitation: a qualitative study.

CONTEXT: Athletic trainers have traditionally conceptualized rehabilitation programs in terms of 3 distinct physiologic phases; however, these phases appear to neglect athletes' psychosocial responses to their injuries. OBJECTIVE: To document injured athletes' psychosocial responses during the different phases of injury rehabilitation. DESIGN: Qualitative study. SETTING: National Collegiate Athletic Association Division II university in the mid-Atlantic region of the United States. PATIENTS OR OTHER PARTICIPANTS: A total of 8 previously injured athletes (4 men and 4 women) participated in the study. DATA COLLECTION AND ANALYSIS: We collected participant data by using semistructured interviews, transcribed verbatim and analyzed by directed content analysis. Established themes were triangulated to determine trustworthiness. RESULTS: Initially, athletes' cognitive appraisals were predominantly negative in nature, leading to negative emotions. These appraisals changed after diagnosis and when moving to the reaction-to-rehabilitation phase and the reaction-to-sport phase. During the reaction-to-rehabilitation phase, athletes reported mixed cognitive appraisals and identified frustration as the main emotional response. When returning to sport, athletes reflected on the lessons learned, yet they expressed some doubts related to their ability to return to play. These cognitive appraisals served as a precursor to the resulting emotional responses of nervousness and reinjury anxiety, as well as excitement. Throughout the various phases of rehabilitation, athletes reported seeking out social support: initially from significant others and then from their athletic trainers during the reaction-to-rehabilitation phase. CONCLUSIONS: The results appear to support the use of the integrated model of psychological response to sport injury and the rehabilitation process and the 3 phases of rehabilitation as a framework for understanding how physical and psychosocial factors may interact during sport-injury rehabilitation. Understanding this interaction may help athletic trainers provide better care to their injured athletes.

Role of sport medicine professionals in addressing psychosocial aspects of sport-injury rehabilitation: professional athletes' views.

CONTEXT: Research from the sport medicine professional's (SMP's) perspective indicates that SMPs are often required to address psychosocial aspects of injuries during treatment. However, only a few authors have investigated injured athletes' experiences with these concerns. OBJECTIVE: To explore injured professional athletes' views on the role of SMPs in the psychosocial aspects of sport-injury rehabilitation. Design : Qualitative study. SETTING: Professional association football and rugby union clubs. PATIENTS OR OTHER PARTICIPANTS: Ten professional, male football (n = 4; 40%) and rugby union (n = 6; 60%) players (age = 22.4 ± 3.4 years). Data Collection and Analysis : We collected data using a semistructured interview guide, and the data were then transcribed and analyzed following the interpretative phenomenological analysis guidelines. We peer reviewed and triangulated the established emergent themes to establish trustworthiness. RESULTS: Athletes in our study viewed injuries as "part and parcel" of their sports. Despite normalizing sport injuries, athletes reported frequent feelings of frustration and self-doubt throughout the rehabilitation process. However, athletes' perceived the role of SMPs in injury rehabilitation as addressing physical concerns; any intervention aimed at psychosocial outcomes (eg, motivation, confidence) needed to be subtle and indirect. CONCLUSIONS: The SMPs working with injured athletes need to understand the psychosocial principles that underpin athletes' sport-injury processes and the effect psychosocial reactions can have on athletes. Moreover, SMPs must understand the self-regulatory processes that may take place throughout injury rehabilitation and be able to apply psychological principles in natural and subtle ways to aid athletes' self-regulatory abilities.

Identifying barriers to remaining physically active after rehabilitation: differences in perception between physical therapists and older adult patients.

STUDY DESIGN: Cross-sectional study. OBJECTIVE: To describe readiness for change and barriers to physical activity in older adults and to contrast perceptions of physical therapists and patients using the Barriers to Being Active Quiz. BACKGROUND: Regular physical activity is vital to recovery after discharge from physical therapy. Physical therapists are positioned to support change in physical activity habits for those transitioning to home care. Understanding of readiness for change and barriers to physical activity could optimize recovery. METHODS: Thirteen physical therapists enrolled in the study and invited patients who met the inclusion criteria to enroll (79 patients enrolled). The physical therapists provided the ICD-9 code, the physical therapist diagnosis, and completed the Barriers to Being Active Quiz as they perceived their patients would. The enrolled patients provided demographics and filled out the Satisfaction With Life Scale, the stages-of-change scale for physical activity, and the Barriers to Being Active Quiz. RESULTS: Patients were predominantly in the early stages of readiness for change. Both patients and physical therapists identified lack of willpower as the primary barrier to physical activity. Patients identified lack of willpower and social influence as critical barriers more often than physical therapists, whereas physical therapists identified fear of injury and lack of time more often than their patients did. Differences between physical therapists and their patients were noted for fear of injury (z = 2.66, P = .008) and lack of time (z = 3.46, P = .001). The stage of change for physical activity impacted perception of social influence (χ2 = 9.64, P<.05), lack of willpower (χ2 = 21.91, P<.01), and lack of skill (χ2 = 12.46, P<.05). Women ranked fear of injury higher than men did (χ2 = 6.76, P<.01). CONCLUSION: Understanding readiness for change in and barriers to physical activity may allow physical therapists to better tailor intervention strategies to impact physical activity behavior change.

Psychosocial aspects of athletic injuries as perceived by athletic trainers.

CONTEXT: Despite the Psychosocial Strategies and Referral content area, athletic trainers (ATs) generally lack confidence in their ability to use this information. OBJECTIVE: The current study's primary purpose was to determine (a) perceived psychological responses and coping behaviors athletes may present to ATs, (b) psychosocial strategies ATs currently use with their athletes, (c) psychosocial strategies ATs deem important to learn more about, and (d) ATs' current practices in referring athletes to counseling or sport psychology services. DESIGN: Mixed-methods study. SETTING: Online survey containing both quantitative and qualitative items. PATIENTS OR OTHER PARTICIPANTS: A total of 215 ATs (86 male, 129 female), representing a response rate of 22.50%. MAIN OUTCOME MEASURE(S): The Athletic Training and Sport Psychology Questionnaire. RESULTS: Stress/anxiety (4.24 ± 0.82), anger (3.70 ± 0.96), and treatment adherence problems (3.62 ± 0.94) were rated as the primary psychological responses athletes may present upon injury. Adherence and having a positive attitude were identified as key determinants in defining athletes' successful coping with their injuries. The top 3 selected psychosocial strategies were keeping the athlete involved with the team (4.57 ± 0.73), using short-term goals (4.45 ± 0.67), and creating variety in rehabilitation exercises (4.32 ± 0.75). The top 3 rated psychosocial strategies ATs deem important to learn more about were understanding motivation (4.29 ± 0.89), using effective communication (4.24 ± 0.91), and setting realistic goals (4.22 ± 0.97). Of the sample, only 59 (27.44%) ATs reported referring an athlete for counseling services, and 37 (84.09%) of those who had access to a sport psychologist (n = 44) reported referring for sport psychology services. CONCLUSIONS: These results not only highlight ATs' current use of psychosocial strategies but also their desires to increase their current knowledge and understanding of these strategies while caring for injured athletes.

Sport psychology education: a preliminary survey on chartered physiotherapists' preferred methods of training delivery.

OBJECTIVE: To gain an insight to the existing suggestions and recommendations on chartered physiotherapists' preferred methods of delivery for further training in sport psychology. PARTICIPANTS: 22 delegates (14 women, 8 men) from the 2006 Association of Chartered Physiotherapists in Sports Medicine/International Federation of Sports Physiotherapy annual conference (response rate 53.7%). MEASUREMENTS: A questionnaire survey for best method of sport psychology delivery was developed. RESULTS: The most suitable methods for sport-psychology-training delivery were workshops, seminars, mentoring, and coaching. Intense training days and weekends were considered most appropriate. The vast majority were willing to travel over 50 miles to receive training, and they indicated that the most suitable organizations to arrange training would be professional bodies and associations. CONCLUSIONS: The findings provide suggestions into how further training in sport psychology for chartered physiotherapists could be delivered. To gain more detailed information on these issues, however, further research with a larger sample size is recommended.

Views of chartered physiotherapists on the psychological content of their practice: a follow-up survey in the UK.

OBJECTIVE: To assess, on a national level, the views of chartered physiotherapists with regard to the psychological content of physiotherapy practice. DESIGN: A postal survey to a national list of sport injury and physiotherapy clinics was employed. PARTICIPANTS: A total of 361 responses were included in the descriptive statistical and qualitative analyses. MEASUREMENTS: The Physiotherapist and Sport Psychology Questionnaire (PSPQ). RESULTS: On average, physiotherapists felt that athletes were psychologically affected 83% of the time when injured. Key psychological characteristics were also identified in athletes who cope/do not cope successfully with their injuries. Physiotherapists reported using psychological techniques in their work and expressed the need for further training in the field. Only 24.1% of the physiotherapists stated having accesses to accredited sport psychologists. CONCLUSIONS: Results suggest that UK physiotherapists possess practical experiences and good awareness for psychological aspects of injuries and acknowledge the importance of treating a range of psychological conditions.