Abstract:
Two interrelated studies were performed to examine the role of psychological factors in
the prediction and prevention of sport-related injury. As far as injury prediction is concerned,
Study 1 tested the Williams and Andersen (1998) revised stress-injury model. It was
hypothesised through the model that athletes with a history of stressors, a shortage of coping
resources, and personality dispositions that augment the stress response, would be the most
vulnerable to injury. Four-hundred and seventy-rugby players from 37-teams participated in
the study and completed measures corresponding to variables in the Williams and Andersen
stress-injury model at the beginning of the playing season. The number of injuries sustained
and the amount of time loss due to injury were recorded throughout the season. Data were
analysed using product moment correlations between life-stress and injury for groups of
participants who fell in the upper and lower third of the moderator variables (i.e., coping
resources—type of coping and social support, history of stressor—previous injury, and
personality—competitive anxiety) distributions. As expected, a mild positive relationship
was found between life-stress and injury time loss (r = .09, p < .05) and number of injuries
sustained (r = .11, p < .05). Results also showed that previous injury, the type of coping,
social support, and competitive anxiety interacted in a conjunctive fashion to produce a
maximum moderator effect (explaining up to 29% of the injury variance).
A second study (Study 2) was performed to determine whether a stress management
intervention programme could effectively reduce injury among athletes identified from Study
1 to be most vulnerable to injury. A second purpose was to examine what might explain a
positive result by exploring psychological (i.e., coping and anxiety) and stress response (i.e.,
reaction time and perceptual sensitivity) variables.
Fifty-one rugby players from Study 1 who were found to be most vulnerable to injury
(i.e., a rugby player with many recent life-stresses, high competition anxiety, inappropriate
coping skills, and a history of previous injury) were recruited and randomly assigned to either
an intervention (stress management programme) or a control condition. Participants
completed psychological inventories at the beginning (Time 1) and end (Time 2) of the 2002
rugby season. Prospective and objective injury data were obtained for both number of
injuries and time loss. In addition, a purpose built apparatus was used to assess stress
response variables at the beginning (Time 1) and end (Time 2) of the 2002 rugby season.
Prior to the start of the 2002 rugby season participants in the intervention group started
a 6-session stress management programme that lasted 4-consecutive weeks. Emphasis was
placed on how athletes could modify their reaction to stress. Participants were contacted
monthly to reinforce the intervention, discuss implementation of the skills, and any relevant
issues.
ANCOVA results showed a significant condition (control versus intervention) effect for
total time missed, but not for number of injuries sustained. Participants in the stress
management intervention reported missing less time due to injury at the end of the 2002
season compared to their non-intervention counterparts. Furthermore, the intervention group
appeared to only marginally increase the amount of time missed in 2002 compared to 2001,
whereas the control group missed significantly more time due to injury.
ANCOVA results provided some insight into the potential reasons for injury reduction.
For the psychological variables, a significant condition effect was found for total coping
resources. The intervention group showed an increase in the amount of coping resources at
Time 2 compared to Time 1, and showed greater coping resources than did the control group
at Time 2. The intervention group also showed a decrease in worry at Time 2 compared to
Time 1 and less worry than the control group at Time 2. The condition effect for
concentration disruption (CD) approached statistical significance, with the intervention group
showing less CD at Time 2 compared to the control group at Time 2. For the stress response
variables no significant condition effects were found for reaction times or perceptual
sensitivity (d’).
Overall, results support the recommendation that a stress management programme is
effective in preventing further time loss due to injury for athletes with an “at-risk” injury
profile. This result in part, is due to these athletes increasing their coping skills, and
decreasing their worry and concentration disruption cognitions.
In an extension of the prediction and prevention studies, a third study was conducted to
examine the effectiveness of a psychological intervention (modelling) in affecting
rehabilitation outcomes. Specifically the purpose of Study 3 was to investigate whether a
coping modelling intervention could decrease pre-operative anxiety and perceptions of
expected pain, as well as increasing rehabilitation self-efficacy and motivation associated
with surgical reconstruction of the anterior cruciate ligament (ACLR). A second purpose was
to determine whether the modelling intervention would be associated with improved
functional outcomes in the early post-operative period (6-weeks) following ACLR.
Sixty-four patients undergoing arthroscopic ACLR were randomised to receive a
coping modelling intervention or to act as a control. Participants completed psychological
inventories at different time periods during a 6-week period. In addition, the following
functional outcomes were assessed, days walking with crutches, range of motion (ROM), and
International Knee Documentation Committee assessment (IKDC). ANCOVA results
revealed a significant condition effect for perceptions of expected pain, but not for state
anxiety. Significant group differences were found for crutch self-efficacy, with the
intervention group reporting greater self-efficacy than the control group. Repeated measure
ANOVA results revealed significant time x condition effects for walking self-efficacy and
exercise self-efficacy. No condition effect was found for jogging self-efficacy, nor were
there any condition effects found for the motivation variables. ANCOVA results showed a
significant condition effect (modelling) for functional outcome improvements (IKDC scores
and crutch use) with the intervention group reporting superior IKDC scores and fewer days
walking with crutches. No effects were found for ROM.
Collective findings from the three studies highlight the importance of psychological
factors in the prediction, prevention, and rehabilitation of athletic-related injury. Moreover,
studies 2 & 3 support the use of psychological based interventions for reducing injury and
augmenting traditional rehabilitation outcomes. Opportunities for future research are
discussed.