The structural validity of the IKDC and its relationship with quality of life following ACL reconstruction.

OBJECTIVE: The purpose of this study was to (a) examine the structural validity of the International Knee Documentation Committee Subjective Knee Form in light of previously reported dimensionality issues, and (b) examine the relationships between the IKDC and patients' knee-related quality of life 2-9 years after anterior cruciate ligament (ACL) reconstruction. METHODS: A prospective research design was employed, wherein 319 patients (mean age = 29.07, SD = 9.03) completed the IKDC before surgery, 191 patients (mean age = 29.71, SD = 9.36) completed the IKDC at 6 months post-surgery, and 132 patients (mean age = 34.34, SD = 7.89) completed the IKDC and the Anterior Cruciate Ligament Quality of Life Survey (ACL-QOL) at 2-9 years post-surgery. RESULTS: Bayesian structural equation modeling analysis confirmed the two-factor structure (symptom & knee articulation and activity level) represented the most accurate conceptualization of perceived knee function across the three time-points. Moreover, findings revealed that of the two IKDC subscales pre-operatively, activity level was most strongly associated with long-term quality of life at 2-9 years following surgery, whereas 2-9 years post-operatively, symptoms and knee articulation was most strongly associated with long-term quality of life. CONCLUSIONS: The IKDC provides clinicians with a convenient total score to assess patients' perceived knee function, but its unidimensional factor structure is a poor representation of its items and fails to detect discrepancies in patients' post-operative quality of life, such as the relative importance of perceived knee activity level before reconstructive surgery.

An in-depth appraisal of career termination experiences in professional cricket.

This qualitative study explored the career termination experiences of 9 male, retired professional cricketers between the ages of 28 and 40 (mean value 34, s = 4.65 m). The participants took part in retrospective, semi-structured interviews. Data from the interviews were inductively content analysed within three transition phases of the retirement process: reasons for retirement, factors affecting adaptation and reactions to retirement. The reasons for retirement were multicausal with the majority of the participants highlighting contractual pressures and a lack of communication as important precursors to retirement. Three main themes accounted for the factors affecting adaptation: a limited pursuit of other interests, developmental experiences and coping strategies. In terms of reactions to retirement, all of the participants reflected negatively on the termination of their career, with a sense of loss and resentment characterising the post-retirement period. The findings illustrated the sport-specific nature of career termination in professional cricket and added further support to the emerging consensus that the distinction between voluntary and involuntary retirement is, at best, unclear.

Participatory research, people with intellectual disabilities and ethical approval: making reasonable adjustments to enable participation.

AIMS AND OBJECTIVES: The aim of this paper is to explore how making reasonable adjustments to the process of securing ethical approval for research can facilitate the meaningful involvement of people with intellectual disabilities as members of a research team. This is achieved through critical reflection upon the approach taken within one participatory research study whose objective was to explore how people with intellectual disabilities understand abuse. BACKGROUND: Internationally participatory research studies (in which active involvement of community members in all stages of the research process is sought) are becoming increasingly common in the context of health care and, more specifically, within research involving people with intellectual disabilities. However, whilst it is acknowledged that participatory research gives rise to specific ethical challenges, how (or if) involvement in securing ethical approval is facilitated, is not discussed in most research reports. The significance of this paper is that it seeks to address this gap by exploring how meaningful participation can be promoted by making reasonable adjustments. METHODS: Within the study, the research team worked in collaboration with the ethics committee to identify potential barriers that could prevent the participation of members of the research team who had intellectual disabilities. Reasonable adjustments (such as redesigning forms) were made to the processes involved in securing ethical approval. CONCLUSIONS: This study demonstrated that it is possible to ensure that ethical standards are upheld and the requirements of ethics committees met whilst also facilitating the meaningful involvement of people with intellectual disabilities. RELEVANCE TO CLINICAL PRACTICE: The reasonable adjustments approach explored within this paper can be translated into the context of clinical practice: making changes to the way that services are delivered can promote greater involvement of people with intellectual disabilities in their own health care.

Stressors experienced by injured athletes.

The purpose of this study was twofold: (a) to examine the stressors experienced by injured athletes during three phases of their recovery from sport injury, and (b) to explore the differences in the stressors experienced by team as compared to individual-sport athletes. Participants comprised previously injured high-level rugby union players (n = 5) and golfers (n = 5). Semi-structured interviews were used to explore the stressors participants experienced during three phases of injury (onset, rehabilitation and return to competitive sport). Within- and cross-case analyses showed that athletes experienced sport, medical/physical, social and financial stressors. There were a number of differences in the stressors experienced across the three phases and between team and individual-sport athletes. Findings have important implications for the design and implementation of interventions aimed at managing the potentially stressful sport injury experience and facilitating injured athletes' return to competitive sport.

The Role of Optimism and Psychosocial Factors in Athletes Recovery From ACL Injury: A Longitudinal Study.

Despite a growing interest into the role of psychosocial factors during the recovery period following sports injuries, there remains a paucity of longitudinal studies examining the indirect relationships between psychosocial factors, psychological responses, and recovery outcomes. The purpose of this study was to construct and test a conceptual model which examined the indirect relationships between optimism, psychosocial factors, rehabilitation adherence, and perceived knee function up to 12 months post anterior cruciate ligament (ACL) surgery. A prospective, longitudinal, and repeated measures design was employed, wherein 81 injured athletes (M age 26.89, SD = 7.52) completed measures of optimism, psychosocial factors, rehabilitation adherence, and perceived knee function on seven occasions (pre-surgery to 1 year post-surgery). Bayesian structural equation modeling evaluated the hypothesized indirect relationships proposed within the conceptual model. The main findings from this study was empirical support for a time-ordered, conceptual model which demonstrated that pre-surgery optimism had a significant overall indirect effect on perceived knee function at 12 months post-surgery (sum of indirect; αß = 0.08, post. SD = 0.05, CI [0.01, 0.04]), as well as a specific indirect effect through secondary appraisal at 1 month post-surgery, efficacy at 2 months post-surgery, and rehabilitation adherence at 6 months post-surgery (αß = 0.03, post. SD = 0.03, CI [0.00, 0.10]). Collectively, this study provides support for a number of previously hypothesized, but not empirically examined, indirect relationships between optimism, psychosocial factors and recovery outcomes. In doing so, we provide a conceptual model which has the potential to help guide individualized treatment recommendations, as well as identify individuals at risk of compromised recovery outcomes following ACL surgery.

An Interdisciplinary Examination of Stress and Injury Occurrence in Athletes.

This paper adopts a novel, interdisciplinary approach to explore the relationship between stress-related psychosocial factors, physiological markers and occurrence of injury in athletes using a repeated measures prospective design. At four data collection time-points, across 1-year of a total 2-year data collection period, athletes completed measures of major life events, the reinforcement sensitivity theory personality questionnaire, muscle stiffness, heart rate variability and postural stability, and reported any injuries they had sustained since the last data collection. Two Bayesian networks were used to examine the relationships between variables and model the changes between data collection points in the study. Findings revealed muscle stiffness to have the strongest relationship with injury occurrence, with high levels of stiffness increasing the probability of sustaining an injury. Negative life events did not increase the probability of injury occurrence at any single time-point; however, when examining changes between time points, increases in negative life events did increase the probability of injury. In addition, the combination of increases in negative life events and muscle stiffness resulted in the greatest probability of sustaining an injury. Findings demonstrated the importance of both an interdisciplinary approach and a repeated measures design to furthering our understanding of the relationship between stress-related markers and injury occurrence.

Can Preinjury Adversity Affect Postinjury Responses? A 5-Year Prospective, Multi-Study Analysis.

Informed by and drawing on both the integrated model of response to sport injury (Wiese-Bjornstal et al., 1998) and the biopsychosocial model of challenge and threat states (Blascovich, 2008), this multi-study paper examined whether preinjury adversity affected postinjury responses over a 5-year time period. Study 1 employed a prospective, repeated measures methodological design. Non-injured participants (N = 846) from multiple sites and sports completed a measure of adversity (Petrie, 1992); 143 subsequently became injured and completed a measure of coping (Carver et al., 1989) and psychological responses (Evans et al., 2008) at injury onset, rehabilitation, and return to sport. MANOVAs identified significant differences between groups categorized as low, moderate, and high preinjury adversity at each time phase. Specifically, in contrast to low or high preinjury adversity groups, injured athletes with moderate preinjury adversity experienced less negative psychological responses and used more problem- and emotion-focused coping strategies. Study 2 aimed to provide an in-depth understanding of why groups differed in their responses over time, and how preinjury adversity affected these responses. A purposeful sample of injured athletes from each of the three groups were identified and interviewed (N = 18). Using thematic analysis, nine themes were identified that illustrated that injured athletes with moderate preinjury adversity responded more positively to injury over time in comparison to other groups. Those with high preinjury adversities were excessively overwhelmed to the point that they were unable to cope with injury, while those with low preinjury adversities had not developed the coping abilities and resources needed to cope postinjury. Practical implications and future research directions are discussed.

Great British medalists: Psychosocial biographies of Super-Elite and Elite athletes from Olympic sports.

Participants were 32 former GB athletes from Olympic sports, 16 Super-Elite athletes who had won multiple medals at major championships, and 16 matched Elite athletes who had not. In-depth interviews with the athletes, their coaches, and one of their parents explored all psychosocial aspects of their development and careers. Content analyses revealed that there were no differences between Super-Elite and Elite athletes with regard to family values, conscientiousness, or commitment to training. However, the two groups were found to be different with regard to: (1) the experience of a foundational negative life event coupled with a foundational positive sport-related event; (2) the experience of a career turning point that enhanced motivation and focus for their sport; (3) need for success; (4) obsessiveness and/or perfectionism with regard to training and performance; (5) ruthlessness and/or selfishness in the pursuit of their sporting goals; (6) dual focus on both mastery and outcome; (7) the use of counterphobic attitudes and/or total preparation to maintain higher levels of performance under pressure; and (8) the relative importance of sport over other aspects of life. The results are discussed within the context of psychodynamic theory, and recommendations are made for both applied implications and future research.

Great British medalists: Response to the commentaries.

Hardy et al. (2017) reported the findings of a large-scale, multisource, qualitative study that examined the commonalities of, and discriminators between, a group of super-elite (SE) and a group of elite (E) athletes who were matched on gender, sport, discipline, and era. Fifteen research teams who are actively engaged in research in the domain then provided critical commentaries on the target paper. In our response to these commentaries, we briefly remind the reader of the primary findings of the original paper and then deal with the commentaries under the subheadings: Necessary and Sufficient Conditions for Elite Performance; Mediating and Moderating Variables; Methodological Issues; Omissions; and Alternative Approaches. Finally, we discuss the very small number of disagreements that we have with any of the commentaries.

A pharmacokinetic/pharmacodynamic model for a platelet activating factor antagonist based on data arising from Phase I studies.

A nonlinear mixed-effects modelling approach was used to analyse pharmacokinetic and pharmacodynamic data from two Phase I studies of a platelet activating factor (PAF) antagonist under development for the treatment of seasonal allergic rhinitis. Data for single-dose (8 subjects) and multiple-dose (9 subjects) administration were available for analysis with a program based on an EM algorithm. Pharmacokinetic analyses of plasma drug concentrations were performed using a biexponential model with first-order absorption. PAF response data were modelled with a hyperbolic Emax model. The drug showed nonlinear pharmacokinetics, with the clearance decreasing from 46.0 to 27.1 L h(-1) over a dose range of 160-480 mg. There was an apparent dose dependency within the C50 (concentration producing 50% of the maximum effect) but at higher doses most of the data was above the estimated C50 and when the data was analysed simultaneously a value of 17.57 ng mL(-1) was obtained for C50, with considerable intersubject variability (103%). Consistent results were obtained from the two studies and the population and individual pharmacodynamic parameter estimates from the analyses provided predicted responses that were in good agreement with the observed data. The results were used to simulate a 320-mg twice-daily dosing regimen.

Stressors, social support, and tests of the buffering hypothesis: effects on psychological responses of injured athletes.

OBJECTIVE: The purpose of this article was to examine the main and stress-buffering effect relationships between social support and psychological responses to injury. DESIGN: The article presents two studies, both of which matched social support types with injury stressors. Study 1 used measures of stressors, perception of social support availability, and psychological responses of injured athletes. Study 2 utilized measures of stressors, received social support, and psychological responses of injured athletes. METHODS: During physiotherapy clinic visits, injured athletes (Study 1, N = 319; Study 2, N = 302) completed measures of stressors, social support, and psychological responses to injury. Confirmatory factor analysis (CFA) and moderated hierarchical regression were used to analyse the data. RESULTS: In both studies, CFA suggested adequate model fit for measures of social support and psychological responses to injury. Moderated hierarchical regression analyses in Study 1 revealed significant (p < .05) stress-buffering effects for the perception of available esteem support in relation to restlessness, isolation, and feeling cheated, and the perception of emotional support in relation to isolation. In both studies, moderated hierarchical regression analyses revealed significant (p < .05) main effects for esteem, emotional, and tangible support in relation to restlessness, isolation, and feeling cheated. CONCLUSION: The findings of the current studies enhance our understanding of the stress-buffering effects of social support in relation to injury stressors and psychological responses; that is, the relationships between social support, stressors, and psychological responses to sport injury may differ with regard to received or perceived available support. The findings have important implications for the design of social support interventions with injured athletes aimed at alleviating the detrimental effects of injury stressors. STATEMENT OF CONTRIBUTION: What is already known on this subject? The health, social, and sport-injury related research suggests that social support has the potential to moderate (i.e., buffer) those psychological responses to stress that are detrimental to health and well-being. Despite what is a growing body of empirical research that has explored the role of social support in a sport injury context, there has been a paucity of research that has examined how social support functions in relation to injury-related stressors and psychological responses, particularly with regard to the effect of perceived and received support. In addition, there has been limited regard for current conceptualizations of social support as well as injured athletes, psychological responses in the measurement strategies adopted and measures employed. What does this study add? Enhances our understanding of the stress-buffering effects of perceived and received social support in sport. Provides support for the functional aspects of perceived support when dealing with injury-related stressors. Has important implications for the design of social support interventions that aim to expedite injured athletes successful return to sport.

Effect of dispositional optimism before and after injury.

PURPOSE: This study examined the direct, moderating, and indirect effects of dispositional optimism on the prediction of, and athletes' responses to, injury. METHODS: A 2-yr longitudinal design was conducted with a baseline sample of 694 asymptomatic participants (389 men, 305 women; mean ± SD age = 19.17 ± 1.69 yr), 104 of which subsequently became injured. Logistic regression, Pearson product-moment correlations, and a bootstrapping procedure were used to analyze the data. RESULTS: Findings revealed a significant direct effect (i.e., as optimism increased, the likelihood of injury occurrence decreased) and a nonsignificant moderating effect for optimism before injury. Significant direct and indirect effects for optimism after injury were found. CONCLUSIONS: These findings have important implications for practitioners who have a vested interest in reducing the likelihood of injury and expediting the rate and quality of recovery from injury. Future avenues of research that include the need to embrace more objective indicators of recovery from injury are discussed.

An examination of hardiness throughout the sport injury process.

OBJECTIVES: This primary objective of the study was to examine the direct and moderating effects of hardiness on the prediction of sport injury, and the direct and indirect effects of hardiness on athletes' responses to injury. DESIGN: This study employed a longitudinal methodological design. Specifically, the injury status of 694 asymptomatic participants was monitored for 2 years. From the original sample, 104 athletes subsequently became injured and then completed a number of questionnaires throughout their recovery. METHODS: Logistic regression, Pearson product-moment correlation and Preacher and Hayes's (2008) bootstrapping procedure were used to analyse the data. RESULTS: Findings revealed a direct and moderating effect of hardiness on the prediction of injury. Hardiness was also found to positively correlate with desirable, and negatively correlate with undesirable post-injury psychological responses and coping strategies throughout recovery. Finally, problem-focused coping was found to mediate certain effects of hardiness on injured athletes' psychological responses. CONCLUSIONS: These findings have important implications for practitioners who have a vested interest in the health and well-being of those who participate in sport and exercise in terms of minimizing rates of injury occurrence and/or facilitating recovery from injury.

An examination of hardiness throughout the sport-injury process: a qualitative follow-up study.

OBJECTIVES: This qualitative follow-up study aimed to enhance the interpretability and meaningfulness of the findings that emerged from a quantitative study that explored the effect of hardiness on the prediction of, and response to, sport injury (i.e., Wadey, Evans, Hanton, & Neil, 2012). DESIGN: Using theory-based and maximum-variation sampling to contextualize and provide an in-depth understanding of the previous findings, the participants comprised a purposeful sample of 10 athletes from the quantitative study (M age = 21.7; SD= 1.06). METHODS: Data were derived through semi-structured interviews, and analysed and displayed using composite sequence analysis (Miles & Huberman, 1994). RESULTS: The findings extended Wadey et al.'s (2012) study by identifying the perceived mechanisms by which athletes high and low in hardiness exacerbated or attenuated the impact of pre-injury negative major life events (i.e., a significant predictor of sport injury) and post-injury responses. Specifically, the findings demonstrate that athletes high in hardiness possessed a refined repertoire of problem- and emotion-focused coping strategies that they used pre- and post-injury. Those athletes low in hardiness used avoidance coping strategies that had long-term negative implications. CONCLUSIONS: These findings have important implications for the structure, timing, and content of hardiness interventions that aim to reduce rates of injury occurrence and expedite injured athletes' return to competitive sport.

The development of a measure of psychological responses to injury.

OBJECTIVE: The current paper reports the initial development of a theoretically derived measure to assess the psychological responses of injured athletes. DESIGN: 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. SETTING: Sport injury clinics. PARTICIPANTS: Study 1 comprised repeated observations (n=486) on 56 injured athletes. Study 2 comprised single observations on 418 injured athletes. MEASURE: Psychological Responses to Sport Injury Inventory (PRSII). RESULTS: 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. CONCLUSIONS: The study provides some support for the PRSII as a measure of athletes' psychological responses to injury.

Injury rehabilitation: a goal-setting intervention study.

The study examined the effects of a 5-week goal-setting intervention on athletes' rehabilitation adherence, self-efficacy, treatment efficacy, and the psychological response variables: dispirited and reorganization. Participants were matched across six variables and randomly assigned to one of three groups: goal-setting intervention, social support control, and control. The results confirmed some of the hypothesized effects of the goal-setting intervention: (a) athlete self-report of adherence showed the goal-setting group adhered significantly more to the rehabilitation program than the other two groups; (b) the goal-setting intervention resulted in significant group differences for self-efficacy (the goal-setting group having the highest level of self-efficacy); and (c) there was a significant increase across time for reorganization and decrease across time for dispirited (between specific time phases).

Injury rehabilitation: a qualitative follow-up study.

The current qualitative follow-up study was conducted to enhance the interpretability and meaningfulness of the findings emerging from a 5-week goal-setting intervention study with injured athletes. Semistructured interviews were conducted with a sample of 9 injured athletes, 3 from each of the three intervention study groups (goal-setting, social support control, and control), and cross-case summaries were inductively derived. The study highlighted the importance of individual difference variables, and the interaction of person and situational variables, including support from coaches and club, inability to train, weight gain, slowness of progress, physiotherapist support, and the importance of long-term outcome goals. Possible mechanisms for the observed effects of the goal-setting intervention included the effects of goal-setting on self-efficacy, attributions, perceptions of control, and attention.