Psychological readiness to return to sport following injury: a state-of-the-art review

Podlog, Leslie; Wadey, Ross; Caron, Jeffrey G.; Fraser, John J.; Ivarsson, Andréas; Heil, John; Podlog, Stefanie; Casucci, Tallie

doi:10.1080/1750984x.2022.2081929

Cited by 16 publications

(41 citation statements)

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“…Specifically, intrinsic factors such as knowledge, beliefs, and attitudes of injury and care and extrinsic factors such as social support are salient mediators to restoring HRQoL and return to sport, especially after ankle sprain. 1,10 As such, there is a need to increase the emphasis on the use of patient-reported outcomes (PROs) in order to capture the changes in HRQoL following treatment. 11 A recent CAI treatment paradigm proposed that lower HRQoL could be addressed by improving physical deficits using common interventions, 12 which is partially supported by a meta-analysis 4 examining the effect of CAI interventions on HRQoL.…”

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confidence: 99%

Participant-Level Analysis of the Effects of Interventions on Patient-Reported Outcomes in Patients With Chronic Ankle Instability

Powden

Koldenhoven

Simon

et al. 2023

Journal of Sport Rehabilitation

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Context: Intervention studies for chronic ankle instability (CAI) often focus on improving physical impairments of the ankle complex. However, using an impairments-focused approach may miss psychological factors that may mediate function and recovery. Patient-reported outcome (PRO) measures can be used to assess several dimensions of the health-related quality of life (HRQoL) and deliver enhanced patient-centered care. Therefore, the purpose of this investigation was to evaluate group-level improvements in HRQoL and treatment response rates following various interventions in patients with CAI. Design: Cross-sectional. Methods: Data from 7 previous studies were pooled by the chronic ankle instability outcomes network for participant-level analysis, resulting in 136 patients with CAI. Several interventions were assessed including balance training, gait biofeedback, joint mobilizations, stretching, and strengthening, with treatment volume ranging from 1 to 4 weeks. Outcome measures were PROs that assessed ankle-specific function (Foot and Ankle Ability Measure), injury-related fear (Tampa Scale of Kinesiophobia and Fear Avoidance Belief Questionnaire), and global well-being (Disablement in the Physically Active); the PROs assessed varied between studies. Preintervention to postintervention changes were evaluated using separate Wilcoxon signed-rank tests and effect sizes, and a responder analysis was conducted for each PRO. Results: Significant, moderate to large improvements were observed in PROs that assessed ankle-specific function, injury-related fear, and global well-being following intervention (P < .001). Responder rates ranged from 39.0% to 53.3%, 12.8% to 51.4%, and 37.8% for ankle specific function, injury-related fear, and global well-being, respectively. Conclusions: Various interventions can lead to positive improvements in HRQoL in patients with CAI. Treatment response rates at improving HRQoL are similar to response rates at improving impairments such as balance, further reinforcing the need for individualized treatment approaches when treating a patient with CAI.

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Participant-Level Analysis of the Effects of Interventions on Patient-Reported Outcomes in Patients With Chronic Ankle Instability

Powden

Koldenhoven

Simon

et al. 2023

Journal of Sport Rehabilitation

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“…A recent state-of-the-art review from Podlog et al (2022) revealed that there remains a lack of conceptual clarity around the nature of psychological readiness to RTS following musculoskeletal injury. Researchers have used different measures to quantify psychological readiness (see Table 1 in Podlog et al, 2022), which feature both unidimensional (e.g., confidence) and multidimensional (e.g., confidence and fear of reinjury) conceptualizations of psychological readiness. To streamline research efforts, Podlog et al (2022) offered a nomothetic definition of psychological readiness, such that it refers to " … an individual's state of mental preparedness to resume sportspecific activities and is likely comprised of three dimensions, including cognitive appraisals, affective, and behavioral components" (p. 10).…”

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confidence: 99%

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confidence: 99%

“…Researchers have used different measures to quantify psychological readiness (see Table 1 in Podlog et al, 2022), which feature both unidimensional (e.g., confidence) and multidimensional (e.g., confidence and fear of reinjury) conceptualizations of psychological readiness. To streamline research efforts, Podlog et al (2022) offered a nomothetic definition of psychological readiness, such that it refers to “… an individual’s state of mental preparedness to resume sport-specific activities and is likely comprised of three dimensions, including cognitive appraisals, affective, and behavioral components” (p. 10). Although producing a definition is an important development for the field, much remains unclear, including the extent to which the proposed definition is relevant for SRC.…”

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Exploring student-athletes’ perceptions of their psychological readiness to return to sport following a concussion.

Lassman¹,

Rathwell²,

Black³

et al. 2022

Sport, Exercise, and Performance Psychology

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Athletes returning to sport following a concussion are deemed "ready" once they progress through the return to sport (RTS) steps. However, this process largely overlooks psychological factors involved in returning to sport. We used a constructivist philosophical position to understand 12 (n = 6 females, n = 6 males) formerly concussed Canadian university student-athletes' perceptions of factors involved in feeling psychologically ready to RTS. Each student-athlete participated in two videoconference interviews (Interview 1: M = 103 min; Interview 2: M = 88 min). We identified six themes from the life-story interviews: confidence, fear, identity, pressure, support, and case-bycase. Subsequently, we used creative nonfiction analysis to write two composite stories depicting the athletes' experiences returning to sport following a concussion. Pierre-Olivier's story portrays a second-year university men's ice hockey player who experienced a successful RTS following a concussion. His story focuses on his feelings of psychological readiness leading up to his first game following medical clearance. Andrea's story portrays a women's rugby captain who experienced an unsuccessful RTS following a concussion. Her story depicts a conversation with her doctor regarding medical clearance as well as interactions with a former teammate seeking advice about her own concussion. This study provides insights about the psychological factors experienced by athletes who are attempting to RTS following concussion. Our results highlight a need to better understand and more comprehensively assess the psychological aspects involved in returning to sport following a concussion.

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“…Podlog et al's (2015) model further describes these dimensions to include rehabilitation progress, fear of re-injury, awareness and understanding of injury, and motivation to progress. Psychological readiness can also be viewed from a positive, adaptive forward state of thinking (for example, developing confidence) or from an absence of negative thinking (for example, fear of re-injury) (Podlog et al, 2022). Further research is needed to determine the what level of psychological readiness is needed for medical clearance for RTP (Caron et al, 2018).…”

Section: Psychological Readiness To Return To Playmentioning

confidence: 99%

Ready to Play: A Biopsychosocial Approach to Return-to-Sport in Adults with Prolonged Concussion Symptoms

Wong¹

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Introduction: Sport-related concussions are recognized in all types of sports in athletes of all ages. While concussion presentation involves transient symptoms, some may have prolonged symptoms that linger past the typical 2-week recovery time for adults. These prolonged symptoms can affect physical, emotional, cognitive, and sleep domains.Research Significance: This thesis examined adult athletes who experience prolonged symptoms of sport-related concussion to further our understanding of the type of symptoms that are common in an understudied population. Many of the psychological and sociological deficits are not evaluated in preparation for return to sport, but the aim of the thesis is to show their need to be included. Links between psychosocial and physical impairments can drive decisions regarding return to sport. Methods:Based on the biopsychosocial model, 3 cross-sectional studies assessed which symptom domains were clinically relevant, associated with disability, and related to each other. The studies included several clinical outcome measures delivered in online format such as the concussion symptoms, fear avoidance, sleep changes, cogniphobia, pain catastrophizing, and disability post-concussion. The last study included a small sample of participants doing a qualitative interview to confirm objective findings. They were asked to reflect on mental health, sociological impacts, and physical symptoms. Results:The concussion groups showed clinically relevant levels of concussion symptoms, mental health distress, and fear avoidance behaviour. The athletes also presented with significant changes in their abilities of daily activities. Episodic memory was also found to be a deficit for this study. Athlete interviews had statements about fear, loss of self, acceptance, and emotional regulation. Limitations included changing to online formats due to Covid-19, small sample sizes, and utilization of new outcome measures. Future work would expand on the emotional and sociological findings and address cognitive tasks for adults with prolonged symptoms. Evaluation in conjunction with physical activity or training helps an athlete return to sport.Conclusions: Adult athletes with prolonged symptoms of sport-related concussion live with many physical, emotional, and sociological impairments. It is a population that needs further research to focus on their impact and future intervention plans.

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Psychological readiness to return to sport following injury: a state-of-the-art review

Cited by 16 publications

References 58 publications

Participant-Level Analysis of the Effects of Interventions on Patient-Reported Outcomes in Patients With Chronic Ankle Instability

Participant-Level Analysis of the Effects of Interventions on Patient-Reported Outcomes in Patients With Chronic Ankle Instability

Exploring student-athletes’ perceptions of their psychological readiness to return to sport following a concussion.

Ready to Play: A Biopsychosocial Approach to Return-to-Sport in Adults with Prolonged Concussion Symptoms

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