Purpose of Review Treatment for musculoskeletal sports injuries often neglects the psychological components of health and recovery. Pediatric patients require particular consideration of their psychosocial and cognitive development. This systematic review investigates the effects of musculoskeletal injury on mental health in pediatric athletes. Recent Findings Athlete identity may increase in adolescence and is associated with worse mental health post-injury. Psychological models suggest loss of identity, uncertainty, and fear mediate the association between injury and symptoms of anxiety, depression, post-traumatic stress disorder, and obsessive–compulsive disorder. Fear, identity, and uncertainty also influence return to sport. Summary In the reviewed literature, there were 19 psychological screening tools and 8 different physical health measures with various adaptations to athlete developmental level. In pediatric patients, no interventions were studied to reduce the psychosocial impacts of injury. Musculoskeletal injury is associated with worse mental health in pediatric athletes, and stronger athlete identity is a risk factor for the development of depressive symptoms. Psychological interventions that reduce uncertainty and address fear may help mitigate these risks. More research is needed on screening and interventions to improve mental health post-injury.
Purpose of Review The psychological aspects of musculoskeletal injury are often overlooked in the rehabilitation process. This review examines the effects of musculoskeletal injury on mental health in adult athletes and identifies themes to guide further research. Recent Findings Athletes are at risk for mental health struggles due to high athletic identity and identity foreclosure. Injured athletes have specifically been shown to have higher rates of anxiety and depression when compared to the general population. There is a lack of intervention-based research on the psychological well-being of athletes, and there are no systematic reviews synthesizing the impact of musculoskeletal injury on the mental health of adult athletes across a variety of sports. Summary Across professional, college-level, and amateur athletes, musculoskeletal injury is associated with worse mental health scores, including higher distress, higher anxiety and depression, lower social functioning, and lower health-related quality of life. For adults, involuntary retirement from sports due to musculoskeletal injury is a common theme associated with increased psychological distress, anxiety, and depression. In the reviewed literature, 22 unique mental health and 12 distinct physical health screening tools were used. Two articles studied interventions addressing mental health post-injury. Further research using an integrated physical and psychological approach to recovery is warranted and may improve mental and physical outcomes for injured athletes.
Purpose While posterior spinal instrumentation and fusion (PSIF) for severe adolescent idiopathic scoliosis (AIS) is the gold standard, anterior vertebral body tethering (AVBT) is becoming an alternative for select cases. Several studies have compared technical outcomes for these two procedures, but no studies have compared post-operative pain and recovery. Methods In this prospective cohort, we evaluated patients who underwent AVBT or PSIF for AIS for a period of 6 weeks after operation. Pre-operative curve data were obtained from the medical record. Post-operative pain and recovery were evaluated with pain scores, pain confidence scores, PROMIS scores for pain behavior, interference, and mobility, and functional milestones of opiate use, independence in activities of daily living (ADLs), and sleeping. Results The cohort included 9 patients who underwent AVBT and 22 who underwent PSIF, with a mean age of 13.7 years, 90% girls, and 77.4% white. The AVBT patients were younger (p = 0.03) and had fewer instrumented levels (p = 0.03). Results were significant for decreased pain scores at 2 and 6 weeks after operation (p = 0.004, and 0.030), decreased PROMIS pain behavior at all time points (p = 0.024, 0.049, and 0.001), decreased pain interference at 2 and 6 weeks post-operative (p = 0.012 and 0.009), increased PROMIS mobility scores at all time points (p = 0.036, 0.038, and 0.018), and faster time to functional milestones of weaning opiates, independence in ADLs, and sleep (p = 0.024, 0.049, and 0.001). Conclusion In this prospective cohort study, the early recovery period following AVBT for AIS is characterized by less pain, increased mobility, and faster recovery of functional milestones, compared with PSIF. Level of evidence IV.
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