Psychosocial interventions help facilitate recovery following musculoskeletal sports injuries: a systematic review.

Context: Recent research demonstrates a connection between psychological factors and return to play following a musculoskeletal sports injury. Although it has been shown that psychological factors can influence when and if an athlete returns to play, it is unclear if the implementation of psychosocial interventions during the recovery process can address these factors and potentially increase the likelihood of return to play after physical recovery from injury. Objective: To examine the efficacy of interventions designed to address psychosocial factors that influence return to play after sports injuries. Methods: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Pubmed, Embase, and Google Scholar databases were searched from the earliest entry through May 2018. Search terms included 'psychology,' 'sports injury,' 'anterior cruciate ligament injury,' 'anterior cruciate ligament reconstruction,' 'intervention,' 'return to play,' and 'return to sport.' Studies were included and reviewed if they reported on the efficacy of a psychosocial intervention program in injured athletes. Results: Initial searches of Pubmed, Embase, and Google Scholar databases identified 560 articles, 329 articles, and 34,400 hits, respectively. After inclusion and exclusion criteria were applied, eight articles remained that met inclusion criteria. Interventions of relaxation/guided imagery, positive self-talk, goal setting, counseling, emotional/written disclosure, and modeling videos were found to be effective interventions for promoting recovery after a musculoskeletal sports injury. These interventions facilitated positive mood changes, pain management, exercise compliance, and rehabilitation adherence. No study examined the effect of psychosocial interventions on return to play. Conclusion: This systematic review demonstrates that psychosocial interventions can facilitate post-injury recovery in athletes by promoting a positive emotional state and rehabilitation adherence. Further research is necessary to determine the most effective psychosocial interventions for specific psychological factors, the ideal duration of interventions, the best method of implementation following a sports injury, and the impact of these interventions on return to play.

Reducing Fear of Reinjury and Pain Perception in Athletes With First-Time Anterior Cruciate Ligament Reconstructions by Implementing Imagery Training.

Clinical Scenario: The anterior cruciate ligament is one of the major stabilizing ligaments of the knee joint by preventing anterior translation of the femur in the closed kinetic chain. A ruptured anterior cruciate ligament may require reconstructive surgery for patients who wish to return to physical activity. For the most part, surgeries are successful at repairing the ruptured ligament and restoring ligamentous function; the percentage of athletes that return to a competitive level of physical activity is only 44%, and 24% of patients report a main factor of preventing their return is fear of reinjury and pain. Most physiotherapy and rehabilitation research has focused on the physical treatment and is limited on the psychological aspects of recovery. Imagery has been suggested to be effective at reducing anxiety, tension, and pain, while promoting and encouraging healing after an injury. Imagery is defined as a process of performing a skill in one's mind using the senses (touch, feel, smell, vision, etc) without any overt actions. Clinical Question: In athletes who are first-time anterior cruciate ligament reconstruction patients, does imagery training in combination with standard physical therapy reduce the fear of reinjury and pain perception? Summary of Key Findings: Previous research has primarily looked at the physical treatment aspect, and few studies have focused on the psychological factors affecting recovery. Researchers concluded that fear of reinjury was the unique predictor of return to sport even in a sample of participants that reported very little or almost no pain at all. Imagery as a therapy is an effective intervention in reducing fear of reinjury and confidence building. Furthermore, mental imagery is suggested to assist with a reduction in anxiety, pain, and tension, while promoting healing. Clinical Bottom Line: Based on the strength of recommendation taxonomy, there is a combination of level A and B evidence proposing that imagery, in combination with traditional physical therapy, can be effective at reducing psychological distress such as fear of reinjury and pain perception in first-time anterior cruciate ligament reconstruction patients.

Do psychosocial interventions improve rehabilitation outcomes after anterior cruciate ligament reconstruction? A systematic review.

OBJECTIVE: To examine the role of psychosocial interventions in improving patient-reported clinical outcomes, including return to sport/activity, and intermediary psychosocial factors after anterior cruciate ligament reconstruction. METHODS: MEDLINE/PubMed, CINAHL, PsycINFO, and Web of Science were searched from each database's inception to March 2017 for published studies in patients after anterior cruciate ligament reconstruction. Studies were included if they reported on the effects of a postoperative psychosocial intervention on a patient-reported clinical measure of disability, function, pain, quality of life, return to sport/activity, or intermediary psychosocial factor. Data were extracted using a standardized form and summary effects from each article were compiled. The methodological quality of randomized trials was assessed using the Physiotherapy Evidence Database Scale and scores greater than 5/10 were considered high quality. RESULTS: A total of 893 articles were identified from the literature search. Of these, four randomized trials ( N = 210) met inclusion criteria. The four articles examined guided imagery and relaxation, coping modeling, and visual imagery as postoperative psychosocial interventions. Methodological quality scores of the studies ranged from 5 to 9. There were inconsistent findings for the additive benefit of psychosocial interventions for improving postoperative function, pain, or self-efficacy and limited evidence for improving postoperative quality of life, anxiety, or fear of reinjury. No study examined the effects of psychosocial interventions on return to sport/activity. CONCLUSION: Overall, there is limited evidence on the efficacy of postoperative psychosocial interventions for improving functional recovery after anterior cruciate ligament reconstruction.