The Influence of the Motivational Climate on Rehabilitation Behaviors and Patient Satisfaction.

CONTEXT: Athletic trainers influence the motivational climate in rehabilitation, but little is known about the role of the motivational climate on patient outcomes. The purpose of this study was to investigate the influence of the motivational climate in rehabilitation on athletes' behaviors in rehabilitation (eg, effort and energy) and overall satisfaction with rehabilitation. DESIGN: Cross-sectional, descriptive research. METHODS: A total of 78 male and female, NCAA Division II injured athletes receiving rehabilitation services, and 7 certified athletic trainers, and 8 athletic training students providing rehabilitation health care participated. All injured athletes completed an adapted version of the Perceived Motivational Climate in Sport Questionnaire 2 to measure perceptions of the motivational climate in rehabilitation, along with the Overall Satisfaction with Rehabilitation Scale. Athletic trainers and athletic training students completed a training behaviors assessment to rate the athletes' energy, effort, and persistence in rehabilitation. RESULTS: Injured athletes' perceptions of the motivational climate predicted rehabilitation behaviors and patient satisfaction. Higher perceptions of having an important role in rehabilitation predicted higher rehabilitation behaviors (F3,74 = 4.45, P < .01), while higher perceptions of unequal recognition during rehabilitation predicted lower desirable behaviors (F3,74 = 4.90, P < .01). Higher perceptions of a mastery climate in rehabilitation predicted greater patient satisfaction (F3,74 = 7.41, P < .001) and lower perceptions of being punished for mistakes predicted greater satisfaction (F3,74 = 5.92, P < .001). CONCLUSIONS: Productive athlete behaviors during rehabilitation and greater patient satisfaction with rehabilitation can be expected when athletes perceive a mastery motivational climate during rehabilitation. Athletic trainers can facilitate creating a mastery motivational climate by focusing on individual improvement, putting forth high effort, and evaluating success based on personal improvement.

Applying the Sport Commitment Model to Sport Injury Rehabilitation.

CONTEXT: Sustaining effort and persistence throughout injury rehabilitation are common goals for sport health care professionals. Considerable research in the sport domain has explored the issue of commitment to sport, as well as what predicts or influences an athlete's continued desire and resolve to continue participation. Scanlan and colleagues developed the sport commitment model (SCM) that places enjoyment as central construct influencing athletes' commitment. According to the model, perceptions of enjoyment, personal investments, involvement opportunities, attractive alternatives, social constraints, and social support should predict an athlete's level of sport commitment. One could argue the same may be true for commitment to sport injury rehabilitation. By applying the SCM to sport injury rehabilitation, practitioners may be able to enhance an athlete's commitment to their rehabilitation, prolong adherence, and increase other positive outcomes, such as increased enjoyment, motivation, and successful return to competition. OBJECTIVE: The purpose of this pilot study was to explore the applicability of the SCM to the injury rehabilitation setting. DESIGN: Correlational design was used. SETTING: Division I, intercollegiate athletic training room. PARTICIPANTS: 51 injured intercollegiate male and female athletes, 5 certified athletic trainers, and 8 senior, athletic training students. INTERVENTION: At the approximate midpoint of each athlete's injury rehabilitation, participants completed SCM measures. Certified athletic trainers and senior athletic training students independently assessed each injured athlete on effort, energy, and intensity during rehabilitation sessions. MAIN OUTCOME MEASURES: Rehabilitation commitment, enjoyment, investments, attractive alternatives, social constraints, perceived costs, and rehabilitation behaviors. RESULTS: Higher perceptions of investments predicted rehabilitation commitment. However, none of the SCM determinants predicted athletic trainer-rated rehabilitation behaviors. CONCLUSIONS: Future research should continue to explore commitment constructs in relation to rehabilitation motivation.

The Motivational Climate and Intrinsic Motivation in the Rehabilitation Setting.

CONTEXT: The motivational climate created by the athletic trainer in rehabilitation may be critical in influencing athletes' intrinsic motivation and other psychosocial outcomes in the rehabilitation and the recovery processes. OBJECTIVE: To examine intercollege athletes' perceptions of the motivational climate in the rehabilitation setting. Specifically, examining if perceptions of the motivational climate can predict athletes' levels of intrinsic motivation with rehabilitation as well as the relationship between perceptions of the motivational climate and athlete demographics (gender, starter status, athletic trainer gender, etc). DESIGN: Cross-sectional, descriptive research. SETTING: College sport team and athletic training center. PARTICIPANTS: National Collegiate Athletic Association Division II intercollege athletes from one institution (n = 187; 125 males and 62 females). MAIN OUTCOME MEASURES: Paper-based survey measuring mastery and performance perceptions of the motivational climate in rehabilitation, athletes' goal orientation in sport, and athletes' levels of motivation in rehabilitation. RESULTS: Perceptions of a performance climate were positively related to intrinsic motivation effort-improvement (effect size = 25.34%). Perceptions of a mastery climate were positively related to interest-enjoyment and perceived competence and negatively related to tension-pressure (effect size = 39.03%). In general, female athletes, as well as athletes with a female athletic trainer, had significantly higher perceptions of mastery motivational climate effort-improvement than male athletes and athletes with male athletic trainers. While male athletes and athletes with male athletic trainers had higher perceptions of intrateam member rivalry in rehabilitation. CONCLUSIONS: The athlete's gender and goal orientation, as well as the gender of the athletic trainer creating the motivational climate, can influence whether the environment is perceived as more mastery or performance. The recovering athletes' perceptions of the climate in rehabilitation can, in turn, affect their intrinsic motivation toward the therapeutic interventions.

Clinical Diagnostic Tests Versus MRI Diagnosis of ACL Tears.

Clinical Scenario: The anterior cruciate ligament (ACL) injury is a common knee injury within varying athletic levels. Clinical diagnostic tests and magnetic resonance imaging (MRI) are two methods of evaluating ACL injuries. Clinical Question: Are clinical diagnostic tests as accurate as MRI when diagnosing ACL tears? Summary of Key Findings: Three cross-sectional design studies were included. One study found that clinical diagnostic tests were superior to MRI when diagnosing an ACL tear. Another study found that clinical diagnostic tests were equal to MRI when measuring sensitivity, but scored higher in specificity, positive predictive value, negative predictive value, and diagnostic accuracy. The last study found that clinical diagnostic tests scored higher than MRI on specificity and positive predictive value, were equal when measuring accuracy, and scored lower when measuring sensitivity and negative predictive value. Clinical Bottom Line: The evidence supports the use of clinical diagnostic tests when diagnosing an ACL tear. Strength of Recommendation: Level 2-3.

Clinical Assessment Versus MRI Diagnosis of Meniscus Tears.

CLINICAL SCENARIO: Common injuries in high-level and recreational athletes, nonathletes, and the elderly are medial and lateral meniscus tears. Diagnosis of meniscus tears is done with clinical exam, magnetic resonance imaging (MRI), and arthroscopy. The gold standard is arthroscopy, but accuracy of a clinical exam versus MRI diagnosis of meniscus tears is in question. A clinician's ability to detect a meniscus tear is beneficial to the patient from a timing standpoint. The process of obtaining an MRI and results could be lengthy, but if the meniscus tear is accurately diagnosed clinically, the patient could be suspended from athletics or specific job duties to prevent further injury. In addition, rehabilitation could be initiated immediately, resulting in better outcomes for the patient. The ability to diagnose a meniscus tear clinically could initiate the rehabilitation process much sooner than waiting for MRI testing and results. Beginning the rehabilitation phase earlier may lead to faster postoperative rehabilitation and better patient outcomes. Clinical detection of a meniscus tear will facilitate possible suspension, early treatment, and rehabilitation recommendations, but the MRI will provide more specific information about the injury, including type and location of tear. Thus, surgical decisions such as operative versus nonoperative or meniscectomy versus repair would be based on MRI results. Focused Clinical Question: Is a clinical exam as accurate as an MRI scan for diagnosing meniscus tears?

Commitment to strength and conditioning: a sport commitment model perspective.

The purpose of this study was to empirically apply the sport commitment constructs within the realm of strength and conditioning. Based on prior research in the sport domain, it was predicted that higher enjoyment, investments, benefits, and social support and lower perceived costs and attractive alternatives would predict higher commitment to strength and conditioning. With a sample of 191 intercollegiate male and female athletes, a pilot study was conducted to examine the predictors of commitment to strength and conditioning. Multiple regression analysis revealed that the strongest predictors of strength and conditioning commitment were perceived investments, benefits, enjoyment, costs, and attractive alternatives. Interestingly, differences emerged between men and women regarding the most salient predictors of commitment to strength and conditioning. Gender differences also emerged with male athletes reporting higher perceptions of enjoyment, benefits, and perceived obligation to their best friend to continue strength and conditioning. These findings are important both theoretically and practically. The Sport Commitment Model may provide an avenue to gain a further insight into strength and conditioning motivation, and providing practical strategies for increasing athletes' commitment: increasing enjoyment and perceived benefits, and decreasing perceived downsides and attractive alternatives.

Sport commitment among competitive female athletes: test of an expanded model.

In the present study, we examined an expanded model of sport commitment by adding two determinants (perceived costs and perceived competence) and behavioural commitment as a consequence of psychological commitment, as well as identifying psychological commitment as a mediator of relationships between determinants and behavioural commitment. Competitive female gymnasts (N = 304, age 8-18 years) completed relevant measures while coaches rated each gymnast's training behaviours as an indicator of behavioural commitment. Path analysis revealed that the best fitting model was one in which original determinants (enjoyment, involvement opportunities, investments, attractive alternatives) and an added determinant (perceived costs) predicted psychological commitment, in addition to investments and perceived costs directly predicting behavioural commitment. These results provide further, but partial, support for the sport commitment model and also suggest that additional determinants and behavioural consequences be considered in future research.

Sport commitment among competitive female gymnasts: a developmental perspective.

The purpose of this study was to examine age and competitive level differences in the relationship between determinants and level of sport commitment. Gymnasts (N = 304) comprised three age groups (8-11, 11-14.5, and 14.5-18 years) and two competitive levels (Levels 5-6 and 8-10). Multiple regression analyses revealed: (a) perceived costs and social constraints from parents and best friends were the strongest predictors of commitment for the youngest gymnasts, (b) perceived costs, personal investments, and parent social constraints predicted commitment for 11-14.5-year-old gymnasts, and (c) perceived competence and costs predicted commitment for the oldest gymnasts. Competitive level differences also emerged; for Level 5-6 gymnasts, personal investments, perceived costs, coach social support, and social constraints by coach, best friend, and teammates were predictors of commitment. Personal investments and teammate social constraints were significant predictors for Level 8-10 gymnasts. Developmental factors and additional determinants are important to consider in further studies of the sport commitment model.