Fear of injury in gymnastics: Self-efficacy and psychological strategies to keep on tumbling

Factors and expectations influencing concussion disclosure within NCAA Division I athletes: A mixed methodological approach

BACKGROUND

Participation in sports is associated with many benefits to all aspects of health; however, it also comes with the risk of injury, particularly concussions. Self-disclosure and care seeking following a concussion are especially important because of the lack of outwardly visible signs and/or symptoms. Although recent research has explored factors affecting concussion disclosure, use of isolated methodologies limits the ability to contextualize how disclosure or nondisclosure occurs. Therefore, the purpose of this study was to describe the factors and expectations of National Collegiate Athletic Association (NCAA) athletes that may influence concussion disclosure.

METHODS

This mixed-methods convergent parallel research study included 25 NCAA Division I athletes representing 13 sports, all of whom completed a concussion-education session with pre-/post-test surveys and a semistructured interview. Eligible athletes were at least 18 years old and on an NCAA roster. The surveys focused on previous concussion-related disclosure behaviors, knowledge, attitudes, beliefs, norms, and intentions about disclosing concussion. Interviews focused on the athletes' experiences related to concussion disclosure. Survey data were analyzed using descriptive statistics and Mann-Whitney U tests. Interviews were analyzed using a Consensual Qualitative Research tradition.

RESULTS

Participants had good concussion knowledge (median = 46.0), positive attitudes (median = 38.0), strong beliefs (median = 13.0), and strong intentions to disclose concussion symptoms (median = 7.0). None of the constructs differed by participants' gender. Although quantitative findings were mostly positive, interview data highlighted factors that may explain why some participants are successful in disclosing concussions and why others may find disclosure difficult. Educational efforts, sport culture, and medical professional presence were the primary facilitators discussed by participants. Stigma, pressure, and a lack of team support were perceived as disclosure barriers.

CONCLUSION

The context in which concussion disclosure occurs or does not occur is vital to the success of educational interventions. Interventions must prioritize stakeholder- and team-based perspectives on concussion to establish a network supportive to disclosure.

The psychological responses of British amateur point-to-point jockeys to personal injury

Previous research has reported significant psychological consequences of injury on rehabilitation success, performance, and wellbeing in athletes, although little is known within horse-based sports. There is a high prevalence of injury reported in point-to-point (P2P) jockeys, but despite this, comparatively little research exists examining the psychological implications resulting from physical trauma within horseracing. The aim of this study was to investigate the psychological responses to personal injury in British amateur P2P jockeys. Five amateur P2P jockeys (two male, three female, x- age 25 years old) were interviewed about their experiences post an injury sustained during racing in the preceding 12 months. Interview questions explored their pre-injury career, the rehabilitation phase, pre-return to racing phase issues and coping strategies used by jockeys. Thematic analysis revealed three higher order themes: emotional responses, coping strategies, and factors affecting recovery. Subjects universally cited negative emotional responses following injury, including grief, a sense of loss, and frustration, and all experienced denial at the onset of injury. Typical coping strategies included strong support networks of family, friends and racing staff, and goal setting. Fear of reinjury was identified by all athletes, particularly on return to the saddle, and the attitudes towards injury management, such as denial, seen in this study may provide opportunities to develop targeted education campaigns for P2P jockeys on injury services. Targeted marketing for P2P jockeys on available injury support is recommended, such as seen for professional jockeys, as well as the creation of career development resources to offer alternative routes for P2P jockeys following injury.

An extended challenge-based framework for practice design in sports coaching

The challenge-point framework as a model for thinking about motor learning was first proposed in 2004. Although it has been well-cited, surprisingly this framework has not made its way into much of the applied sport science literature. One of the reasons for this omission is that the original framework had not been encapsulated into a paper accessible for sports practitioners. The framework had mostly a theoretical focus, providing a mechanistic summary of motor learning research. Our aims in this paper were to explain and elaborate on the challenge point framework to present an applied framework guiding practice design. We connect the framework to other theories that involve predictive coding, where information is attended when it disconfirms current predictions, providing a strong signal for learning. We also consider how two new dimensions (learners' motivation and practice specificity) need to be considered when designing practice settings. By moving around the different dimensions of functional difficulty, motivation, and specificity, coaches can optimize practice to achieve different learning goals. Specifically, we present three general "types" of practice: practice to learn, to transfer to competition, and to maintain current skills. Practical examples are given to illustrate how this framework can inform coach practice.

Finnish adolescents' self-efficacy in peer interactions: a critical incident study

Peers play a significant role in influencing adolescent self-efficacy. Self-efficacy, in turn, has been considered to influence health behavior. The purpose of this qualitative descriptive study was to describe adolescents' perceptions about their self-efficacy in peer interactions to strengthen the theoretical understanding about the sources of self-efficacy during adolescence. The sample comprised of 155 adolescents (13 - 17 years) in three upper comprehensive schools within two Finnish cities. The data were collected using the critical incident technique with an open-ended questionnaire. Adolescents were asked to describe two situations: one in which they had, and another in which they had not been able to act according to their own choice in peer interactions. Adolescents' written descriptions were analyzed using inductive thematic analysis. The data suggests that adolescents' perceptions about their self-efficacy in peer interactions manifests itself as a dynamic process characterized by debating with oneself and reflecting on information relevant for judging personal abilities. Debating with oneself consisted of five themes which influenced the adolescents' self-efficacy in peer interactions: adolescents' self-identity, social atmosphere, adolescents' cognitive and emotional aspects as well as evaluating the consequences of the intended action. Adolescents' self-identity, which included self-confidence and morals, appeared to be the most solid theme, whereas social atmosphere varied according to the situation. Social atmosphere often diminished the adolescents' self-efficacy in peer interactions. Although the findings are partly consistent with previous literature, they also put more emphasis on adolescents' own active role in the formation of self-efficacy in the context of peer interactions.

Well-Come Back! Professional Basketball Players Perceptions of Psychosocial and Behavioral Factors Influencing a Return to Pre-injury Levels

The psychological factors influencing a return to sport has gained increased research attention. In the current investigation, we explored professional basketball players’ perceptions of the psychosocial and behavioral factors facilitating a return to performance equal to or exceeding previous performance standards. We also sought to describe athletes’ experiences – both positive and negative – of returning to sport following injury recovery. Ten Italian professional male basketball players (age range 22–36 years), were retrospectively interviewed in relation to three time-periods: (1) from the commencement of rehabilitation to their first official competition, (2) the first official competition, and (3) the 6-months following the initial competition. Qualitative content analysis of the data revealed numerous themes across the three time periods. In regards to Period 1, participants indicated that social support, investment in rehabilitation and training programs, coping skills and motivation were fundamental in reaching pre-injury performance levels. During their first official game (i.e., Period 2), athletes reported that realistic performance expectations, focusing on the performance, positive emotions, motivation, arousal and social support facilitated their return to sport. Athletes, however, also described a predominance of factors that hindered their return to pre- injury levels (i.e., low confidence in personal abilities, decrements in skill execution and dysfunctional physical sensations). Moreover, participants typically described a substandard level of performance during their first competition back following injury. In recounting experiences during the 6 months following their first official game, basketballers reported improvements in skill execution and highlighted the importance of coping skills, motivation and social support. The process of restoring self-confidence in one’s ability to successfully perform was perceived as crucial in enabling participants to move beyond a mere return to sport to a return to high performance – that is, to reach a level of proficiency equal to or exceeding previous performance standards. Findings support the relevance of cognitive, emotional and behavioral responses highlighted in the Integrated Model and suggest the importance of addressing psychological factors throughout the return-to-sport process. Finally, results from the present study hold a number of practical implications for athletes’ aiming to achieve a return to pre-injury levels.

The emotional coaching model: quantitative and qualitative research into relationships, communication and decisions in physical and sports rehabilitation

The emotional coaching model uses quantitative and qualitative elements to demonstrate some assumptions relevant to new methods of treatment in physical rehabilitation, considering emotional, cognitive and behavioral aspects in patients, whether or not they are sportsmen. Through quantitative tools (Tampa Kinesiophobia Scale, Emotional Interview Test, Previous Re-Injury Test, and reports on test scores) and qualitative tools (training contracts and relationships of emotional alliance or "contagion"), we investigate initial assumptions regarding: the presence of a cognitive and emotional mental state of impasse in patients at the beginning of the rehabilitation pathway; the curative value of the emotional alliance or "emotional contagion" relationship between healthcare provider and patient; the link between the patient's pathology and type of contact with his own body and emotions; analysis of the psychosocial variables for the prediction of possible cases of re-injury for patients who have undergone or are afraid to undergo reconstruction of the anterior cruciate ligament (ACL). Although this approach is still in the experimental stage, the scores of the administered tests show the possibility of integrating quantitative and qualitative tools to investigate and develop a patient's physical, mental and emotional resources during the course of his rehabilitation. Furthermore, it seems possible to identify many elements characterizing patients likely to undergo episodes of re-injury or to withdraw totally from sporting activity. In particular, such patients are competitive athletes, who fear or have previously undergone ACL reconstruction. The theories referred to (the transactional analysis theory, self-determination theory) and the tools used demonstrate the usefulness of continuing this research in order to build a shared coaching model treatment aimed at all patients, sportspeople or otherwise, which is not only physical but also emotional, cognitive and behavioral.

A qualitative investigation of the decision to return to sport after anterior cruciate ligament reconstruction: to play or not to play

BACKGROUND

Primary anterior cruciate ligament (ACL) reconstruction is known to have excellent outcomes, but many patients do not return to their preinjury level of sport participation. Previous studies have used subjective outcome scores to evaluate this discrepancy, but none to date has used qualitative, in-depth patient interviews.

PURPOSE

To understand the factors influencing a patient's decision to return to his or her preinjury level of sport after ACL reconstruction.

HYPOTHESIS

Extrinsic and intrinsic factors may affect one's decision to return to sport after primary ACL reconstruction despite good functional knee scores.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

An experienced interviewer conducted qualitative, semistructured interviews of 31 patients, aged 18 to 40 years, who had undergone primary ACL reconstruction surgery. All participated in sport before injury and had a minimum 2-year follow-up with no further surgeries or knee injuries. Qualitative analysis was then performed to derive codes, categories, and themes. An assessment of preinjury and current sport participation by type, level of competition, and Marx activity score, along with patient-reported knee function, was also conducted.

RESULTS

Patient interviews revealed 3 overarching themes: fear, lifestyle changes, and innate personality traits. Elements of these factors were shown to largely influence the decision to return to the preinjury sport both in those patients who had returned and those who had not returned to sport. Less common factors included the surgeon's advice not to return, depressed mood, and persistent knee pain.

CONCLUSION

Patients who did not return to their preinjury level of sport after primary ACL reconstruction despite having good knee function were largely influenced by fear, shifts in priority, and individual personalities. This study highlights the importance for treating physicians to recognize and address psychological factors and lifestyle changes that largely contribute to a patient's postoperative decision to return to sport. Results from this study will allow surgeons and health care professionals to educate patients contemplating surgery and to better understand the recovery process not only from sport-related surgeries but other surgical interventions with the goal of returning to activity.

A meta-study of qualitative research examining stressor appraisals and coping among adolescents in sport

The main aim of this study was to create an integrated theoretical perspective of the qualitative adolescent sport stressor appraisal and coping literature. A secondary aim was to critique theoretical and methodological issues in the extant literature. Following database searches, 20 studies were retained for analysis. Meta-data, meta-theory, and meta-method analyses were conducted followed by a final meta-synthesis of findings. Analyses produced four themes: contextual and dynamic stressor appraisals, contextual and dynamic coping, coping resources and processes of acquisition, and social networks as assets and liabilities. Findings highlight the need for precise use of theory in the study of coping. Finally, while several data collection methods have been used, there is scope for greater methodological diversity to advance our understanding of coping among adolescent athletes.

Development and validation of the Causes of Re-Injury Worry Questionnaire

Re-injury worry is an important construct in competitive sport that may influence performance and increase the risk of re-injury. However, there are currently no available instruments to measure the causes of re-injury worry. The purpose of this study was to develop the Causes of Re-Injury Worry Questionnaire (CR-IWQ). The study was conducted in three independent research phases to investigate the following: (a) the content relevance, (b) the factor structure and the factorial validity, (c) the concurrent validity, (d) the discriminant validity, and (e) the test-retest reliability (intraclass correlation coefficients; ICC), and the internal consistency of the instrument. Exploratory factor analysis (EFA) was chosen to examine the factor structure of the CR-IWQ. Confirmatory factor analysis (CFA) was used to examine further the factorial validity of the instrument. A number of valid constructs were used to assess the concurrent and discriminant validity of the CR-IWQ. The reliability of the new instrument was examined using Pearson r (ICC) and Cronbach α. Three hundred and seventy athletes with an acute musculoskeletal sport injury in the last year participated in the study. EFA revealed a 12-item model, representing two factors ("Re-injury worry due to rehabilitation" and "Re-injury worry due to opponent's ability"). CFA supported the two-factor model of the CR-IWQ. The concurrent and discriminant validity of the CR-IWQ was confirmed by examining correlations between the CR-IWQ with other constructs. The ICCs and the Cronbach α indices of the CR-IWQ were acceptable. We have demonstrated that the CR-IWQ is a good psychometric instrument that can be used for clinical and research purposes.

Specification of Variables Predictive of Victories in the Sport of Boxing: II. Further Characterization of Previous Success

Previous success, i.e., performance in the preceding bout and total number of wins and losses, was predictive of victory. Clarification of this effect was sought in examining whether the prior performance against a particular opponent or in a common location would be predictive of a victory in a bout against that opponent or in that locale. The career records of 739 male professional boxers who participated in contests held in the USA in November 2007 were collected from the BoxRec online database. Chi-squared tests and logistic regression analyses indicated that performance in the preceding bout, prior performance against the same opponent, and prior performance in a particular location were predictive of the outcome in a current bout.

Worries and Fears Associated With Competitive Gymnastics

The purpose of this investigation was to explore the frequency and intensity of worries and fears associated with competitive gymnastics. These issues were initially examined in a sample of 7 female college gymnasts using a semistructured guided interview. From the themes that emerged and relevant literature, a survey including parallel intensity and frequency of worry questions was administered to 120 female gymnasts competing in USA Gymnastics sanctioned events. Results indicated that even though gymnasts worry about attempting and performing skills on the balance beam and uneven bars, more of them experienced a greater number of injuries on the floor exercise. Analysis of covariance for intensity and frequency using age as the covariate revealed that advanced gymnasts had more intense worries about body changes and performing skills and more frequent worries about body changes than less skilled gymnasts (p < .05). Advanced gymnasts also reported using more strategies to modify their worries than did less skilled gymnasts.

Specification of variables predictive of victories in the sport of boxing

Compared to other sports, very little research has been conducted on which variables can predict victory in the sport of boxing. This investigation examined whether boxers' age, weight change from their preceding contest, country of origin, total number of wins, total number of losses, performance in their preceding contest, or the possession of a championship title was predictive of a winning performance in a given bout. A 1-mo. sample of male professional boxing records for all contests held in the USA (N = 400) were collected from the BoxRec online database. Logistic regression analysis indicated that only boxers' age, total number of wins and losses, and the performance in the preceding contest predicted significant variance in outcome.

Experiences of Australian professional female tennis players returning to competition from injury

BACKGROUND

This study examined the experiences of professional female tennis players returning to competition from injury.

METHODS

In a study commissioned by Tennis Australia, 55 Australian professional female tennis players responded anonymously to a questionnaire developed for the purposes of this study. The questionnaire consisted of open and closed questions that assessed a player's attribution style, the occurrence and effect of minor and major injuries, frequency and type of treatment sought, attitudinal chances following injury and preventative injury factors.

RESULTS

The quantitative and qualitative analyses of participants' responses revealed players generally displayed an internal attribution style with the majority of minor injuries involving lower limb injuries (attributed to playing on hard surfaces). Players reported these injuries were addressed in a variety of ways including self-treatment. The majority of severe injuries were upper limb/shoulder and these were generally treated at tournament sites with some requiring surgery.

CONCLUSIONS

Players adopted a range of measures to assist recovery from severe injury including the services of health professionals. In further findings, a player's attribution style was not a predictive variable, except in terms of the number of tournaments missed for minor injuries. Implications of the study's results and future research directions for cross-cultural studies are highlighted.