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Factorial validity and measurement invariance of the Perceived Susceptibility to Sport Injury scale
Abstract
The Perceived Susceptibility to Sport Injury (PSSI) scale is a measure that has recently surfaced in the sport injury literature. The factor structure of the PSSI scale has not been subjected to a rigorous factor analysis; thus, the factorial validity of the measure in athlete populations is unknown. To establish the validity of the PSSI scale in sports medicine research, the purpose of this study was to examine the factor structure and measurement invariance across gender of the PSSI scale. Male and female intercollegiate athletes (N = 217) completed the PSSI scale during the off-season. The factor structure was analyzed using confirmatory factor analysis (CFA) procedures and maximum likelihood estimation. The measurement invariance analysis was conducted via comparisons of fit indices within a series of hierarchically constrained models. Results of the CFA yielded a very good fit of the measurement model: χ(2) (2) = 4.535, P = 0.104; RMSEA = 0.076; SRMR = 0.018; CFI = 0.995; NNFI = 0.985. Results of the measurement invariance analysis demonstrated strict invariance across gender, and no significant latent mean differences emerged between men and women. Study results support the factorial validity of the PSSI scale for use in future sports medicine research.
... To assess athlete perceived susceptibility to sport injury, the Perceived Susceptibility to Sport Injury (Deroche et al., 2007) was administered. The Perceived Susceptibility to Sport Injury is a four-item measure, with all items scored on a 5-point Likert scale (for scoring procedure, see Gnacinski, Arvinen-Barrow, Brewer, & Meyer, 2017). An example of an item on this measure includes "What do you believe is the chance that you will get an injury during your sport season?". ...
... An example of an item on this measure includes "What do you believe is the chance that you will get an injury during your sport season?". The reliability and validity of the measure for use in adult athlete populations have been established in previous research (Gnacinski et al., 2017). ...
The purpose of the current study was to identify psychological predictors (i.e., exercise intensity tolerance, pain catastrophizing, perceived susceptibility to sport injury, and chronic psychological stress) of perceived acute stress and recovery responses. Athletes (N = 493, Mage = 20.04 years, SD = 2.15 years) completed a battery of online psychological questionnaires. Structural equation modeling results indicated that exercise intensity tolerance, pain catastrophizing, perceived susceptibility to sport injury, and chronic psychological stress had a direct positive effect on perceived stress. In addition, exercise intensity tolerance had a direct positive effect on perceived recovery, whereas pain catastrophizing, perceived susceptibility to sport injury, and chronic psychological stress had a direct negative effect on perceived recovery. Age, gender, and sport type were the only demographic variables considered for indirect effects on perceived stress and recovery. Gender was the only significant variable. The current data provide evidence for practitioners’ consideration of monitoring individual-specific psychological predictors of perceived stress and recovery.
... The unpredictability of highly variable natural turfgrass fields influence athletes' perceptions between field types and within individual fields (Mears, Osei-Owusu, Harland, Owen, & Roberts, 2018;Straw et al., 2019). As a result, perceived risk of injury and behavioral factors, such as aggressiveness or tentativeness, may be affected, which likely contributes negatively to overall athlete performance and injury occurrence (Gnacinski, Arvinen-Barrow, Brewer, & Meyer, 2017;Mears et al., 2018;Straw et al., 2019;Wiese-Bjornstal, Smith, Shaffer, & Morrey, 1998). Including field conditions into psychological assessments of individual athletes, such as Wiese-Bjornstal's (2010) biopsychosocial sport injury risk profile, could be useful for creating practical intervention strategies to improve athletes' perceptions and confidence with certain turfgrass sports field conditions. ...
Natural turfgrass sports fields can be highly variable depending on construction, usage, and management. Research involving athlete–surface interactions often fails to thoroughly account for variability by grouping these fields into the single category of “natural turfgrass.” This can obscure results and make it difficult to identify specific field characteristics that most strongly influence athletes, making it almost impossible to implement strategies for improvement. The purpose of this literature review was to highlight the between‐ and within‐field variations of turfgrass sports fields and their influence on athlete–surface interactions. The components of turfgrass sports fields and common methods used to objectively quantify surface characteristics in situ are discussed. Then, current literature is reviewed that involves several athlete–surface interactions under a variety of turfgrass sports field scenarios. It was found that turfgrass surface characteristics generally influence athlete biomechanics, performance and physiology, perceptions, and injury occurrence. To better interpret and compare findings, it is recommended that future studies fully describe field characteristics and management practices. Consistency with field and athlete data collection methods, analysis, and reporting are also important. Athlete–surface interaction research incorporating new technologies; addressing athlete performance, physiology, and psychological aspects; and investigating athletes other than professionals is also needed. These recommendations are more likely to happen with increased collaboration between turfgrass scientists, sports turf managers, sports scientists, and sports medicine clinicians. Ultimately, the goal would be to develop evidence‐based guidelines for turfgrass sports field management that improve the overall athlete experience under an assortment of turfgrass sports field scenarios.
... For example, it is possible that the competitive trait anxiety-sport injury relationship is influenced by an athlete's perception of situational injury risk 36 and/or his/her perceived susceptibility to sport injury (PSSI). 37 Some limited evidence in support of the aforementioned exists. Prospective research on 434 adult hockey, soccer, and football players found a positive relationship between athletes' perceptions of injury risk (i.e., fear of being injured) and probability of injury occurrence. ...
To date, much research has been devoted to understanding how anxiety can affect sport performance, both in practice and in competitive settings. It is well known that sport has the potential for high levels of stress and anxiety, and that practicing and employing a range of psychological strategies can be beneficial in anxiety management. Equally, growing evidence also suggests that anxiety can play a role in sport injury prevention, occurrence, rehabilitation, and the return to sport process. The purpose of this paper is to provide current insights into sport-related anxiety. More specifically, it will provide the reader with definitions and theoretical conceptualizations of sport-related anxiety. This will be followed by making a case for considering the term “performance” to be broader than activities associated with sport-related performance in practice and competition, by including performance activities associated with sport injury prevention, rehabilitation, and the return to sport process. The paper will then highlight the importance of recognizing early signs and symptoms of anxiety, and the potential need for referral. Finally, the conclusions will emphasize the need for appropriate, client-specific, and practitioner competent care for athletes experiencing sport-related anxiety.
Objective
Reducing the incidence of hamstring strain injuries (HSIs) is a priority for soccer clubs. However, robust multifactorial predictive models are lacking and potential predictors such as sprint kinematics, performance fatigability, and psychological variables have been overlooked. Thus, the aim of this study was to develop a preliminary parsimonious multifactorial model to predict players at risk of HSI through preseason screening.
Materials and Method
Psychological, physiological, kinematic, performance fatigability and health-related variables were collected for 120 regional and national soccer players during the 2022 preseason. HSIs were prospectively recorded over the entire soccer season. After variable selection, logistic regressions with the Wald backward stepwise method were used to refine the model. The predictive abilities of the model and of the individual variables were determined using the area under the receiver operating characteristic curve (AUC).
Results
Twenty-nine players sustained an HSI during the follow-up period. The final model included eight variables: age, sex, HSI history, knee flexor performance fatigability, sprint performance (best sprint time and maximal theoretical velocity V0), perceived vulnerability to injury, and subjective norms in soccer. While its model was preliminary, it showed good fit indices and strong predictive performance (true positive rate: 79%, AUC = .82). None of the variables evaluated independently demonstrated satisfactory performance in predicting HSI (AUC≤.65).
Conclusion
Using a multidisciplinary approach and measurements of only a few variables during preseason screening, the current model tends to demonstrate high accuracy in identifying soccer players at risk of HSI.
Context
Shoulder pain is pervasive in swimmers of all ages. Yet due to a limited number of prospective studies, risk factors for injury in swimmers remain uncertain.
Objective
To determine the extent to which the risk factors of previous injury, poor movement competency, erroneous freestyle swimming technique, and low perceived susceptibility to sport injury were associated with non-contact musculoskeletal injury in college swimmers. We hypothesized each risk factor would be associated with increased odds of injury.
Design
Prospective cohort study.
Setting
College natatorium.
Patients or Other Participants
Thirty-seven Division III college swimmers.
Main Outcome Measures
Participants completed preseason questionnaires on previous injuries and perceived susceptibility to sport injury. At the beginning of the season, they completed the Movement System Screening Tool and Freestyle Swimming Technique Assessment. Logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals for the association between each risk factor and injury.
Results
Eleven of the 37 participants (29.7%) sustained an injury. Univariate analyses identified two risk factors: previous injury (OR = 8.89 [95% CI = 1.78, 44.48]) and cross-over hand positions during the freestyle entry phase (OR = 8.50 [95% CI = 1.50, 48.05]). After adjusting for previous injury, higher perceived percentage chance of injury (one item from the perceived susceptibility to sport injury questionnaire) decreased injury odds (adjusted OR = 0.11 [95% CI = 0.02, 0.82). Poor movement competency was not associated with injury (P > 0.05).
Conclusions
Previous injury, a cross-over hand entry position in freestyle, and low perceived percentage chance of injury were associated with increased injury odds. Ascertaining injury histories and assessing for cross-over may help identify swimmers with elevated injury risk and inform injury prevention strategies.
In a previous investigation of the factors that make for a satisfying “exit” from organized sport (Kleiber, Greendorfer, Blinde, & Samdahl, 1987), it was determined that the only predictor of life satisfaction in the years following departure from formal participation was whether one had sustained a career-ending injury. By examining degree of investment in playing professional sports and the academic orientation of that earlier sample, it was possible in the current study to refine the profile of those vulnerable to subsequent depression of well-being (as reflected in lower life satisfaction and self-esteem). Of athletes who had been injured, only those who had an investment in playing professional sport were likely to show lower selfesteem and life satisfaction 5 to 10 years later. The disruption to a “life narrative” that is suggested by these findings argues for a more interpretive approach to research on and treatment of injury and illness among athletes and others.
Goodness-of-fit (GOF) indexes provide "rules of thumb"—recommended cutoff values for assessing fit in structural equation modeling. Hu and Bentler (1999) proposed a more rigorous approach to evaluating decision rules based on GOF indexes and, on this basis, proposed new and more stringent cutoff values for many indexes. This article discusses potential problems underlying the hypothesis-testing rationale of their research, which is more appropriate to testing statistical significance than evaluating GOF. Many of their misspecified models resulted in a fit that should have been deemed acceptable according to even their new, more demanding criteria. Hence, rejection of these acceptable-misspecified models should have constituted a Type 1 error (incorrect rejection of an "acceptable" model), leading to the seemingly paradoxical results whereby the probability of correctly rejecting misspecified models decreased substantially with increasing N. In contrast to the application of cutoff values to evaluate each solution in isolation, all the GOF indexes were more effective at identifying differences in misspecification based on nested models. Whereas Hu and Bentler (1999) offered cautions about the use of GOF indexes, current practice seems to have incorporated their new guidelines without sufficient attention to the limitations noted by Hu and Bentler (1999).
7(1) : 62-74, 2014. The clinical presentation and recovery from a sports-related concussion has been well-documented in the sports medicine literature; however, the post-injury experience of the injured individual has been largely unexplored. Therefore, the purpose of this study was to examine collegiate student-athletes' lived experiences of an in-season concussion. Four NCAA Division I student-athletes who suffered an in-season concussion were interviewed utilizing an existential phenomenological approach to capture the lived experience of the injury. Five major themes developed from the participants' experiences: 1) symptoms and emotional response to injury, 2) experiences of concussion testing, 3) fear of failing to meet teammate expectations, 4) support from friends and family, and 5) effect on school. These results provide documented evidence of multiple clinical concerns and anecdotal reports of student-athletes unwillingness to report concussion symptoms, potential dishonesty in reporting post-injury symptoms, negative effects on academic performance, challenges of concussion assessment, and the need to monitor student-athletes activity levels outside athletics. The results of this study can help sports medicine clinicians improve their understanding of the injured student-athlete's perceptions following an in-season concussion.
Background:
There is a dearth of research on the current health of former collegiate athletes.
Purpose:
To examine the current health and related correlates in a cohort of former collegiate athletes who played in a diverse range of men's and women's sports with various levels of contact.
Study design:
Cross-sectional study; Level of evidence, 3.
Methods:
Former collegiate athletes (N = 3657) were asked to complete an online questionnaire addressing sports history, medical history, and demographics. The questionnaire also included the Veterans RAND 12-Item Health Survey (VR-12), which yielded 2 composite scores for physical (PCS) and mental (MCS) health. The VR-12 PCS and MCS scores were compared with published US normative data using t tests and analyses of variance.
Results:
Mean PCS and MCS scores of the 797 respondents with complete data (21.9% of target sample; average, 14.5 years since last played collegiate sport) were 53.0 ± 6.1 and 51.7 ± 9.4, respectively. When stratified by age and sex, PCS and MCS scores were similar to normative scores in the United States. Lower PCS scores were associated with sustaining ≥3 concussions, playing in collision sports during college, and sustaining a career-ending injury (all, P < .001). No association was found between concussion and MCS scores (P = .06). Among former collegiate athletes, prevalent medical conditions included anxiety (16.2%), hypercholesterolemia/high cholesterol (10.6%), and depression (10.4%). Additionally, 5.8% screened positive for alcohol dependence, and 5.8% screened positive for disordered eating (eg, binge eating, purging). These findings were more prevalent than those reported by the World Health Organization as representative of the US population. Conversely, there was a lower prevalence of depression, bipolar disorders, and attention deficit disorder, with or without hyperactivity (ADD/ADHD), than in the World Health Organization US population data sample.
Conclusion:
Former collegiate athletes appear similar to the general US population on many aspects of mental and physical health. However, observed health deficits associated with previous sports injuries warrant ongoing monitoring of the health and well-being of former collegiate athletes.
This article discusses the principles and practices that guide psychological intervention with injury, and encourages a psychological approach to injury for clinicians. Part 1 reviews the research literature, and serves as a foundation for the review of clinical practices in part 2. Examination of the research literature highlights 4 areas: (1) psychological factors influencing rehabilitation, (2) social factors affecting rehabilitation, (3) performance concerns among returning athletes, and (4) tools/inventories for assessing psychological readiness to return. A synopsis of an injury intervention plan is provided, and the influence of pain and fear in the rehabilitation process is described.
Monte Carlo computer simulations were used to investigate the performance of three χ–2 test statistics in confirmatory factor analysis (CFA). Normal theory maximum likelihood χ–2 (ML), Browne's asymptotic distribution free χ–2 (ADF), and the Satorra-Bentler rescaled χ–2 (SB) were examined under varying conditions of sample size, model specification, and multivariate distribution. For properly specified models, ML and SB showed no evidence of bias under normal distributions across all sample sizes, whereas ADF was biased at all but the largest sample sizes. ML was increasingly overestimated with increasing nonnormality, but both SB (at all sample sizes) and ADF (only at large sample sizes) showed no evidence of bias. For misspecified models, ML was again inflated with increasing nonnormality, but both SB and ADF were underestimated with increasing nonnormality. It appears that the power of the SB and ADF test statistics to detect a model misspecification is attenuated given nonnormally distributed data. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Prevention of injury in elite sport can have not only athlete health benefits but also potential positive performance gains. As the first step towards prevention, valid injury surveillance data is needed.
Provide injury epidemiology information on the British Cycling squad (road/track endurance; track sprint; MTB; BMX).
Longitudinal prospective surveillance study, recording injury data. Definitions for injury, time-loss and performance-restriction were used to identify the rate and severity of athlete injuries.
British Cycling National training centre, including domestic and international training/competition venues during the 2011/12-2012/13 seasons.
61 (16 female; 45 male) National team athletes.
Standardised report forms for injuries completed by medical staff.
Injury rate, severity and causes.
There were 95 injuries each lasting 16 days, equating 35% of the squad sustaining at least one injury per season. Training injuries were more prevalent (n=77; 30% vs. n=18; 11%), but competition injuries more severe (27d vs. 14d). The majority of competition injuries (83%) resulted in time-loss and training injuries (75%) in performance-restriction. Injury prevalence and severity was highest for the BMX squad and lowest for the endurance squad. Injuries to the lumbar spine (29%), knee (18%) and shoulder/clavicle (14%) were most common, with 17, 9, and 23 days lost per injury, respectively. Overuse (gradual/sudden onset: 58%) and recurrent (35%) were the most common causes of injury, with contact - static object (32d) most severe. Weight training related lumbar spine injuries in the sprint squad and road cycling related shoulder/clavicle and knee injuries in the endurance squad caused the greatest burden in terms of total days lost.
Prevention initiatives targeting common and severe injuries may be beneficial in reducing the number of athlete days lost to training/competition.
Ankle sprain is one of the most common musculoskeletal injuries, yet a contemporary review and meta-analysis of prospective epidemiological studies investigating ankle sprain does not exist.
Our aim is to provide an up-to-date account of the incidence rate and prevalence period of ankle sprain injury unlimited by timeframe or context activity.
We conducted a systematic review and meta-analyses of English articles using relevant computerised databases. Search terms included Medical Search Headings for the ankle joint, injury and epidemiology. The following inclusion criteria were used: the study must report epidemiology findings of injuries sustained in an observed sample; the study must report ankle sprain injury with either incidence rate or prevalence period among the surveyed sample, or provide sufficient data from which these figures could be calculated; the study design must be prospective. Independent extraction of articles was performed by two authors using pre-determined data fields.
One-hundred and eighty-one prospective epidemiology studies from 144 separate papers were included. The average rating of all the included studies was 6.67/11, based on an adapted version of the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) guidelines for rating observational studies. 116 studies were considered high quality and 65 were considered low quality. The main findings of the meta-analysis demonstrated a higher incidence of ankle sprain in females compared with males (13.6 vs 6.94 per 1,000 exposures), in children compared with adolescents (2.85 vs 1.94 per 1,000 exposures) and adolescents compared with adults (1.94 vs 0.72 per 1,000 exposures). The sport category with the highest incidence of ankle sprain was indoor/court sports, with a cumulative incidence rate of 7 per 1,000 exposures or 1.37 per 1,000 athlete exposures and 4.9 per 1,000 h. Low-quality studies tended to underestimate the incidence of ankle sprain when compared with high-quality studies (0.54 vs 11.55 per 1,000 exposures). Ankle sprain prevalence period estimates were similar across sub-groups. Lateral ankle sprain was the most commonly observed type of ankle sprain.
Females were at a higher risk of sustaining an ankle sprain compared with males and children compared with adolescents and adults, with indoor and court sports the highest risk activity. Studies at a greater risk of bias were more likely to underestimate the risk of ankle sprain. Participants were at a significantly higher risk of sustaining a lateral ankle sprain compared with syndesmotic and medial ankle sprains.
It is accepted that risk factors such a type of sport, equipment, and individual physical and psychological characteristics interact in the genesis of sport‐related injuries. The presented review provides an overview of theoretical approaches and empirical findings with regard to the psychosocial antecedents of sport injuries. It also provides an overview of intervention studies that have taken place within the last 15 years. During this period, different models for detecting injury outcome have been developed. It appears that psychosocial variables such as high competitive anxiety, low or high emotional state, high levels of life changes, low coping resources, and low levels of social support are directly or indirectly related to injury outcome. Moreover, empirical prevention studies demonstrate positive results in terms of a reduction in the number of injuries and, in most cases, improvements in mood and reduced stress levels. Many important research variables need further recognition for the advancement of the field. The review offers a selection of future research variables linked to theory and design as well as measurement and analysis. Moreover, implications for practice are also given.
This study focuses on the concept of perceived risk and its relations to behavioural intentions and behaviour. Most research on health related behaviour employs a measure of unconditional risk. Given the inconsistent findings concerning the relationship between perceived risk and behavioural measures in the health literature, we investigated the usefulness of a conditional risk estimate as an alternative measure. In total, 247 heterosexual visitors of a STD-clinic participated in this study. Hundred participants had private partners only, 147 engaged in prostitution contacts. The relationship between the unconditional measure of perceived risk and behavioural intentions was found to be dependent upon sample-differences. However, it appeared that when a conditional risk estimate was used, a significant positive relation with intention was observed, regardless of the risk-status of the sample. Given the results of the present study, and the closer resemblance of the conditional risk measure to the original concept of vulnerability or susceptibility, it is argued that a conditional risk measure is more useful than a relatively general, unconditional measure of perceived risk.
This simulation study compared maximum likelihood (ML) estimation with weighted least squares means and variance adjusted (WLSMV) estimation. The study was based on confirmatory factor analyses with 1, 2, 4, and 8 factors, based on 250, 500, 750, and 1,000 cases, and on 5, 10, 20, and 40 variables with 2, 3, 4, 5, and 6 categories. There was no model misspecification. The most important results were that with 2 and 3 categories the rejection rates of the WLSMV chi-square test corresponded much more to the expected rejection rates according to an alpha level of. 05 than the rejection rates of the ML chi-square test. The magnitude of the loadings was more precisely estimated by means of WLSMV when the variables had only 2 or 3 categories. The sample size for WLSMV estimation needed not to be larger than the sample size for ML estimation.
This study examined the relationships among three components of perceived risk of injury: (a) probability of injury, (b) worry/concern of being injured, and (c) confidence in avoiding injury. Participants were 434 athletes from 3 contact sports (hockey, soccer, and football). Correlations between the components showed a positive relationship between worry/concern and probability of injury, and negative relationships between worry/concern and confidence in avoiding injury as well as probability of injury and confidence in avoiding injury. Results also indicated that those athletes who had been previously injured perceived the highest probability of re-injury, demonstrated the greatest worry/concern of re-injury, and had the least amount of confidence in their ability to avoid re-injury. Additional gender differences and type of sport differences were found for certain subscales. When football was excluded from the analyses, a 2 (sport) by 2 (gender) by 2 (injury status) ANOVA demonstrated sport by gender interactions, a gender by injury interaction, and a sport by gender by injury interaction for certain subscales. Findings are discussed in light of self-efficacy and risk taking theory, and the potential effects of socialization on gender differences in perceived risk of injury.
This simulation study demonstrates how the choice of estimation method affects indexes of fit and parameter bias for different sample sizes when nested models vary in terms of specification error and the data demonstrate different levels of kurtosis. Using a fully crossed design, data were generated for 11 conditions of peakedness, 3 conditions of misspecification, and 5 different sample sizes. Three estimation methods (maximum likelihood [ML], generalized least squares [GLS], and weighted least squares [WLS]) were compared in terms of overall fit and the discrepancy between estimated parameter values and the true parameter values used to generate the data. Consistent with earlier findings, the results show that ML compared to GLS under conditions of misspecification provides more realistic indexes of overall fit and less biased parameter values for paths that overlap with the true model. However, despite recommendations found in the literature that WLS should be used when data are not normally distributed, we find that WLS under no conditions was preferable to the 2 other estimation procedures in terms of parameter bias and fit. In fact, only for large sample sizes (N = 1,000 and 2,000) and mildly misspecified models did WLS provide estimates and fit indexes close to the ones obtained for ML and GLS. For wrongly specified models WLS tended to give unreliable estimates and over-optimistic values of fit.
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A simulation study compared the performance of robust normal theory maximum likelihood (ML) and robust categorical least squares (cat-LS) methodology for estimating confirmatory factor analysis models with ordinal variables. Data were generated from 2 models with 2-7 categories, 4 sample sizes, 2 latent distributions, and 5 patterns of category thresholds. Results revealed that factor loadings and robust standard errors were generally most accurately estimated using cat-LS, especially with fewer than 5 categories; however, factor correlations and model fit were assessed equally well with ML. Cat-LS was found to be more sensitive to sample size and to violations of the assumption of normality of the underlying continuous variables. Normal theory ML was found to be more sensitive to asymmetric category thresholds and was especially biased when estimating large factor loadings. Accordingly, we recommend cat-LS for data sets containing variables with fewer than 5 categories and ML when there are 5 or more categories, sample size is small, and category thresholds are approximately symmetric. With 6-7 categories, results were similar across methods for many conditions; in these cases, either method is acceptable. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
The effects of fear appeals on persuasion were investigated in a factorial experiment that was designed to test a combined model of protection motivation theory and self-efficacy theory. As predicted, the probability of a threat's occurrence and the effectiveness of a coping response both had positive main effects on intentions to adopt a recommended preventive health behavior. More importantly, the findings provided support for self-efficacy expectancy as a fourth component of protection motivation theory: Self-efficacy had a direct influence on intentions and interacted with two other variables of protection motivation theory. The interaction effect was interpreted in terms of two new decision-making strategies that people use when confronted with a fear appeal: a precaution strategy and a hyperdefensiveness strategy. In addition, the results replicated previous findings on the relationship between self-efficacy expectancy and outcome expectancy. A model incorporating protection motivation theory and self-efficacy theory is presented as a possible general model of attitude change.
Most people have not returned to their preinjury level of sports participation at 12 months after anterior cruciate ligament (ACL) reconstruction surgery. Twelve months' follow-up may be too early to assess return-to-sport outcomes accurately.
This study was undertaken to evaluate the medium-term return-to-sport outcomes after ACL reconstruction surgery.
Case series; Level of evidence, 3.
A self-report questionnaire was used to collect data at 2 to 7 years after ACL reconstruction surgery regarding preinjury sports participation, postoperative sports participation, and subjective knee function. The main inclusion criteria were participation in regular sports activity before injury and the attendance at routine surgical follow-up appointments.
A total of 314 participants (mean age, 32.5 ± 10.2 years) were included at a mean 39.6 ± 13.8 months after ACL reconstruction surgery. At follow-up, 45% were playing sport at their preinjury level and 29% were playing competitive sport. Ninety-three percent of the study sample had attempted sport at some time after their ACL reconstruction surgery. Those who had not attempted their preinjury level of sport by 12 months after surgery were just as likely to have returned to preinjury level by 39 months after surgery as those who had played sport by 12 months (risk ratio, 1.1; 95% confidence interval, 0.76-1.6).
Less than 50% of the study sample had returned to playing sport at their preinjury level or returned to participating in competitive sport when surveyed at 2 to 7 years after ACL reconstruction surgery. Return to the preinjury level of sport at 12 months after surgery was not predictive of participation at the preinjury level in the medium term, which suggests that people who return to sport within 12 months may not maintain their sports participation.
Little is known about factors associated with perceptions of susceptibility to sport-related injuries. The purpose of the present study was to examine previous experiences with injury and personality factors as predictors of rugby players' perceived susceptibility to injury. In line with an individual-based approach, it was hypothesized that neuroticism and global self-esteem would be related to perceived susceptibility to sport injuries over and above previous experiences with injuries. Rugby players (N = 235) were asked to report about previous experiences with injury and were administered measures of neuroticism and global selfesteem. Multiple regression analysis revealed that previous experiences with injury were positively related to perceived susceptibility to sport-related injuries. Analyses also supported that neuroticism and global self-esteem are of crucial importance in colouring perceptions of susceptibility to sport-related injury, while statistically controlling for previous injuries. Of particular interest, neuroticism predicted perceived susceptibility, over and above global self-esteem and previous experiences with injury. This study is the first to focus on determinants of perceived susceptibility to sport-related injury and supports the potential role of personality factors and individual dispositions in shaping perceived susceptibility to health problems.
Behavioural and social science theories and models (BSSTM) can enhance efforts to increase health and safety behaviours, such as the uptake and maintenance of injury prevention measures. However, the extent to which they have been used in sports injury research to date is currently unknown. A systematic review of 24 electronic databases was undertaken to identify the extent to which BSSTM have been incorporated into published sports injury prevention research studies and to identify which theories were adopted and how they were used. After assessment against specific inclusion and exclusion criteria, the full text of 100 potentially relevant papers was reviewed in detail. These papers were classified as follows: (i) explicit - the use of BSSTM was a stated key aspect in the design or conduct of the study; or (ii) atheoretical - there was no clear evidence for the use of BSSTM. The studies that explicitly mentioned BSSTM were assessed for how BSSTM were specifically used. Amongst the 100 identified papers, only eleven (11% of the total) explicitly mentioned BSSTM. Of these, BSSTM were most commonly used to guide programme design/implementation (n = 8) and/or to measure a theory/construct (n = 7). In conclusion, very few studies relating to sport safety behaviours have explicitly used any BSSTM. It is likely that future sports injury prevention efforts will only be enhanced, and achieve successful outcomes, if increased attention is given to fully understanding the behavioural determinants of safety actions. Appropriate use of BSSTM is critical to provide the theoretical basis to guide these efforts.
Injuries can counter the beneficial aspects related to sports activities if an athlete is unable to continue to participate because of residual effects of injury. We provide an updated synthesis of existing clinical evidence of long-term follow-up outcome of sports injuries. A systematic computerized literature search was conducted on following databases were accessed: PubMed, Medline, Cochrane, CINAHL and Embase databases. At a young age, injury to the physis can result in limb deformities and leg-length discrepancy. Weight-bearing joints including the hip, knee and ankle are at risk of developing osteoarthritis (OA) in former athletes, after injury or in the presence of malalignment, especially in association with high impact sport. Knee injury is a risk factor for OA. Ankle ligament injuries in athletes result in incomplete recovery (up to 40% at 6 months), and OA in the long term (latency period more than 25 years). Spine pathologies are associated more commonly with certain sports (e.g. wrestling, heavy-weight lifting, gymnastics, tennis, soccer). Evolution in arthroscopy allows more accurate assessment of hip, ankle, shoulder, elbow and wrist intra-articular post-traumatic pathologies, and possibly more successful management. Few well-conducted studies are available to establish the long-term follow-up of former athletes. To assess whether benefits from sports participation outweigh the risks, future research should involve questionnaires regarding the health-related quality of life in former athletes, to be compared with the general population.
To provide an explanation of perceived susceptibility judgment that accounts for both inconsistencies among commonly used measures of perceived susceptibility (i.e., absolute risk, direct comparative risk, and indirect comparative risk) and their inconsistent relationships to disease risk factors. Inconsistencies are attributed to differential processing of general versus personal risk factors, coupled with the method of computation of the risk measures.
Study 1 characterized risk factors as general versus personal. In Studies 2 and 3, community-residing adult women (ns = 432 and 147, respectively) rated perceived susceptibility to osteoporosis, breast cancer, heart disease, and diabetes, rated risk factors, and reported personal medical history.
Correlations and regression analyses mainly supported our characterization of the source of inconsistencies among susceptibility measures and their relationships to risk factors.
Perceived susceptibility measures are not interchangeable and can lead to opposite conclusions about correlates of perceived susceptibility. Researchers are cautioned against using indirect comparative measures, computed as difference scores, and are encouraged to use other methods to compel participants to consider the risk of others when making comparative judgments.
Reporting practices in 194 confirmatory factor analysis studies (1,409 factor models) published in American Psychological Association journals from 1998 to 2006 were reviewed and compared with established reporting guidelines. Three research questions were addressed: (a) how do actual reporting practices compare with published guidelines? (b) how do researchers report model fit in light of divergent perspectives on the use of ancillary fit indices (e.g., L.-T. Hu & P. M. Bentler, 1999; H. W. Marsh, K.-T., Hau, & Z. Wen, 2004)? and (c) are fit measures that support hypothesized models reported more often than fit measures that are less favorable? Results indicate some positive findings with respect to reporting practices including proposing multiple models a priori and near universal reporting of the chi-square significance test. However, many deficiencies were found such as lack of information regarding missing data and assessment of normality. Additionally, the authors found increases in reported values of some incremental fit statistics and no statistically significant evidence that researchers selectively report measures of fit that support their preferred model. Recommendations for reporting are summarized and a checklist is provided to help editors, reviewers, and authors improve reporting practices.
With estimates in excess of 3 million injuries sustained each year in the United States by children and adults in sport and recreational activities (Bijur et al., 1995; Booth, 1987), sport injury has emerged as a serious public health concern. For injuries requiring rehabilitation, adherence to the prescribed regimen is considered important to achieve successful treatment outcomes (Taylor & Taylor, 1998). Depending on the particular measure of adherence used, adherence rates ranging from 40 to 91 % have been documented in sport injury rehabilitation settings (Brewer, 1999). Evidence of a positive relationship between adherence to sport injury rehabilitation programs and clinical outcome has been obtained in several studies (Brewer, Van Raalte, Cornelius, et al., 2000; Derscheid & Feiring, 1987; Hawkins, 1989; Meani, Migliorini, & Tinti, 1986; Satterfield, Dowden, & Yasamura, 1990).
Complex factors influence the likelihood of anterior cruciate ligament (ACL)-injured athletes to return to sports. For example, a systematic review from 20141 found weak evidence that higher quadriceps strength, less effusion, less pain, greater tibial rotation, higher Marx Activity score, higher athletic confidence, higher preoperative knee self-efficacy, lower kinesiophobia and higher preoperative self-motivation were associated with returning to sport after ACL reconstruction. Another recent systematic review2 found that hopping performance, younger age, male gender, participation in elite sport and having a positive psychological response favoured returning to the preinjury level of sport. Similarly, a systematic review3 of level II and III studies found that the following factors contributed to better functional outcomes after ACL reconstruction: male gender, age less than 30 years, reconstruction within 3 months and high baseline activity level. Outcome after rehabilitation was negatively affected …
The sport medicine clinician is faced with return-to-play (RTP) decisions for every patient who wants to return to activity. The complex interaction of factors related to history, physical examination, testing, activity and baseline characteristics can make RTP decision-making challenging. Further, when reasoning is not explicit, unnecessary conflict can arise among clinicians themselves, or among clinicians and patients. This conflict can have negative health consequences for the patient. In 2010, a transparent framework for RTP decisions was proposed. However, some have identified limitations to the framework and found difficulties in its implementation. This paper presents a revised framework that addresses the limitations, and provides concrete examples of how to apply it in simple and complex cases.
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Athletes routinely use psychological skills and interventions for performance enhancement but, perhaps surprisingly, not always to assist in recovery from injury. This book demonstrates the ways in which athletes and practitioners can transfer psychological skills to an injury and rehabilitation setting, to enhance recovery and the well-being of the athlete.
Drawing on the very latest research in sport and exercise psychology, this book explores key psychological concepts relating to injury, explaining typical psychological responses to injury and psychological aspects of rehabilitation. Using case studies in every chapter to highlight the day-to-day reality of working with injured athletes, it introduces a series of practical interventions, skills and techniques, underpinned by an evidence-base, with a full explanation of how each might affect an athlete’s recovery from injury.
The Psychology of Sport Injury and Rehabilitation emphasises the importance of an holistic, multi-disciplinary approach to sports injury and rehabilitation. No other book examines the psychological aspects of both sports injury and the rehabilitation process, and therefore this is an essential resource for students, scholars and practitioners working in sport psychology, sports therapy, sports medicine or coaching.
This study examined the relationships among perception of risk of injury, worry/concern of injury, and confidence in avoiding injury. Participants were 154 athletes from three non-contact/limited contact sports (swimming, track, and baseball). Measures included the Perception of Risk of Injury Scale (RISSc; Kontos, Feltz, & Malina, 2000), Worry about Injury in Sports Scale (WISSc; Short et al., 2005), Confidence in Avoiding Injury in Sports Scale (CAISSc; Short et al., 2005), and The Marlowe-Crowne Social Desirability Scale (Crowne & Marlowe, 1960). Correlations between the measures indicated a positive relationship between the fear of injury and probability of injury and a negative relationship between fear of injury and confidence in avoiding injury. There was also a negative relationship between the probability of injury and confidence in avoiding injury. Significant gender differences were only found for the worry in avoiding uncontrollable injuries, with males fearing injury more than females. In regard to previous injury, if an athlete was previously injured, they reported more fear of reinjury and a higher probability of reinjury. Results also showed that if an athlete reported more than one injury in the past 12 months, the more perceived risk of reinjury and reduced confidence an athlete had. With this knowledge, it may be possible to create programs capable of decreasing the negative perceptions and changes in behavior that often increase the fear of injury.
Aim of the study was to access how individual's motives for participation in sports impact on self-reported outcomes 2 years after an anterior cruciate ligament injury. Based on a longitudinal cohort study, this secondary analysis present data from the Knee Anterior Cruciate Ligament, Nonsurgical versus Surgical Treatment (KANON) study, a randomized controlled trial. At baseline, 121 patients recorded in an initial questionnaire that their motives for sports participation fell into four categories: achievement, health, social integration, or fun and well-being. These four categories were used as variables in the analyses. All 121 subjects completed the 2-year follow-up. The largest improvement was seen in the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale sports and recreation function, with an effect size of 2.43. KOOS sports and recreation function was also the subscale score best predicted by the motives for sports participation. Baseline motives achievement and fun and well-being predicted worse levels of pain and function 2 years after the injury, even after adjusting for age, gender, treatment and baseline scores. Psychological aspects, such as motives for participation in sport, can be factors in predicting of patient-reported outcomes 2 years after injury. Evaluating motives for sports participation may help predict the outcome 2 years after ACL injury.
As the importance of social psychological factors in health has been increasingly recognized, a premium has been increasing
recognized, a premium has been placed on the elucidation of theoretical models of preventive health behavior. Two of the more
comprehensive and extensively investigated models advanced are the Health Belief oodel and Protection Motivation Theory. In
the present article, the organization and research of the two frameworks are compared. In addition, several interesting features
of Protection Motivation Theory that have been highlighted by recent research are discussed.
To counter the narrow scope and atheoretical nature of early research, Andersen and Williams (1988) developed a multi-component theoretical model of stress and injury. The model proposes that athletes with a history of many stressors, personality characteristics that exacerbate the stress response, and few coping resources will. when placed in a stressful situation, be more likely to appraise the situation as stressful and to exhibit greater physiological activation and attentional disruptions. The severity of the resulting stress response is the mechanism proposed to cause the injury risk. The model also proposes interventions for reducing injury risk. For the last decade. this stress-injury model has helped to provide the impetus and theoretical base for much of the psychosocial injury research. The present article examines research support for the different components of the model. The article concludes with suggestions for potential changes to the model and future research needs.
This paper reviews literature on the psychological and sociological dynamics of response to sport injury. An integrated model is illustrated which provides a synthesis of existing conceptual models depicting the dynamic process of psychological response to sport injury. This integrated model encompasses personal and situational moderating factors. as well as cognitive, emotional. and behavioral responses of athletes to sport injury. Empirical research on the cognitive appraisals and emotional responses associated with sport injury is reviewed and general themes are summarized. As the cultural context of sport has a major influence on these cognitive appraisals and emotional responses, sociological literature on sport injury is also highlighted. Concluding recommendations are made for future research on the psychological and sociological dimensions of sport injury.
There has been relatively little systematic investigation of the effect of the number of variables on measures of model fit in structural equation modeling. There is conflicting evidence as to whether measures of fit tend to improve or decline as more variables are added to the model. We consider 3 different types of specification error: minor factors, 2-factor models, and method errors. Using a formal method based on the noncentrality parameter (NCP), we find that root mean squared error of approximation (RMSEA) tends to improve regardless of the type of specification error and that the comparative fit index (CFI) and Tucker-Lewis Index (TLI), generally, though not always, tend to worsen as the number of variables in the model increases. The formal method that we develop can be used to investigate other measures of fit and other types of misspecification.
Construct Validation: A Multiple Perspective ApproachData and EstimationModel Evaluation and Goodness of FitSubstantive Applications of Confirmatory Factor Analysis and Structural Equation ModelingConclusion
Prevalence of InjuriesModel of Stress and Athletic InjuryPsychosocial Influences on the Stress ResponseInterventions to Reduce Injury VulnerabilitySummary of Future Research Needs and DirectionsImplications for the Practitioner
Hamstring muscle strain-type injuries are common in sports that involve sprinting,1 acceleration, deceleration, rapid change in direction and jumping.2 ,3 Occurring in both recreational and professional sports, these injuries can result in substantial time lost from sport and commonly recur.4 ,5
In the Australian Football League (AFL), hamstring muscle strain-type injuries have displayed a high incidence rate, with a 10 year mean of 6.1 new injuries per club each year and a 23% average recurrence rate.6 A recurrence rate of 17% has been reported in elite soccer players7 with hamstring injuries also recorded as the most common injury accounting for 12% of all injuries and resulting in an average of four missed games per injury.8
The high incidence of hamstring muscle strain-type injuries and potential associated costs has resulted in a substantial amount of research into the factors related to such injuries. Two recent systematic reviews have been completed in an attempt to collate the evidence around risk factors for hamstring injuries.9 ,10 Both reviews identified hamstring muscle weakness and thigh muscle imbalance, muscle flexibility, previous hamstring injury, other previous injury and age as potential risk factors; however, these reviews concluded that single variables were inconsistently identified as associated factors. Both reviews provided a qualitative synthesis of the literature and included risk factor studies as well as intervention studies, where a potential risk factor was modified with a training programme. The inclusion of intervention studies may potentially complicate risk factor analyses, as such studies assume that the factor being modified is associated with the injury and that the factor can be modified by the treatment programme.
The aim of the current review was to assemble all available knowledge and data to identify the intrinsic and extrinsic risk factors associated with …
This article examines the adequacy of the “rules of thumb” conventional cutoff criteria and several new alternatives for various fit indexes used to evaluate model fit in practice. Using a 2‐index presentation strategy, which includes using the maximum likelihood (ML)‐based standardized root mean squared residual (SRMR) and supplementing it with either Tucker‐Lewis Index (TLI), Bollen's (1989) Fit Index (BL89), Relative Noncentrality Index (RNI), Comparative Fit Index (CFI), Gamma Hat, McDonald's Centrality Index (Mc), or root mean squared error of approximation (RMSEA), various combinations of cutoff values from selected ranges of cutoff criteria for the ML‐based SRMR and a given supplemental fit index were used to calculate rejection rates for various types of true‐population and misspecified models; that is, models with misspecified factor covariance(s) and models with misspecified factor loading(s). The results suggest that, for the ML method, a cutoff value close to .95 for TLI, BL89, CFI, RNI, and Gamma Hat; a cutoff value close to .90 for Mc; a cutoff value close to .08 for SRMR; and a cutoff value close to .06 for RMSEA are needed before we can conclude that there is a relatively good fit between the hypothesized model and the observed data. Furthermore, the 2‐index presentation strategy is required to reject reasonable proportions of various types of true‐population and misspecified models. Finally, using the proposed cutoff criteria, the ML‐based TLI, Mc, and RMSEA tend to overreject true‐population models at small sample size and thus are less preferable when sample size is small.
A number of authors have proposed that determining an adequate sample size in structural equation modeling can be aided by considering the number of parameters to be estimated. While this advice seems plausible, little empirical support appears to exist. A previous study by Jackson (2001), failed to find support for this hypothesis, however, there were certain limitations to the study that likely led to the lack of findings. This study revisits the issue with a design modified to be more sensitive to practically significant effects of sample size to parameter estimate ratio. Consequently, some support was found for this hypothesis, notably among overall fit measures and tests. Results indicate that higher values of the observations per parameter ratio had a positive effect for some measures of fit. However, the overall effect was small relative to absolute sample size
Drawing upon both heuristic- and threat-based approaches, we sought to examine whether perceived similarity with injury-prone people and perceived control over injury occurrence would directly contribute to perceived risk and whether these variables would mediate the previous injury-perceived risk relationship. Judokas (n = 207) reported the number of injuries experienced in the past year and then completed measures of perceived similarity, perceived control, and injury risk perception. Analyses revealed that perceived similarity and perceived control directly contributed to perceived risk of injury; only perceived similarity acted as a partial mediator of the injury-perceived risk relationship. These findings are discussed in relation to the potential influence of the sport context, which universally involves the acceptance of a high risk of injury.
Whether individuals take steps to protect themselves against sport-related injury may depend on their perceived susceptibility to injury (Williams-Avery & MacKinnon, 1996). However, little is known about the determinants of perceived susceptibility to sport-related injury. The purpose of the present study is to identify the relations of previous experiences with injury, neuroticism, and passion with perceived susceptibility to sport-related injury among competitive runners. One hundred and seventy competitive runners reported the number of injuries sustained during the last year and completed the neuroticism scale of the NEO-PIR and the Passion Scale. Separate regression analysis revealed that previous experiences with injury, neuroticism, and obsessive passion were significant positive predictors of perceived susceptibility, whereas harmonious passion was significantly and negatively related to perceived susceptibility. When considered simultaneously, previous experiences, neuroticism, and obsessive passion explained unique variance in perceived susceptibility to sport-related injury. This study revealed that perceived susceptibility to sport-related injury is dependent on several distinct variables. Thus, to be effective, injury preventive actions aimed at runners' behaviour modification need to take into account that runners' perceived susceptibility to sport has multiple predictors.
This consensus statement summarizes key contemporary research themes relevant to understanding the psychology and socioculture of sport injury. Special consideration is given toward high-intensity sport in which elite athlete training and performance efforts are characterized by explosive physical speed and strength, mental fortitude to push physical limits, and maximum effort and commitment to highly challenging goals associated with achieving exceptional performance. Sport injury occurrence in high-intensity sport is an adverse and stressful health event associated with a complex multitude of risks, consequences and outcomes. A biopsychosocial (Engel, 1980) view is advocated which contextualizes an understanding of the psychological aspects of sport injury in light of influential sociocultural, ethical, and biomedical issues. Outcomes related to athlete health and performance excellence are of equal importance in considering how psychological scholarship, expertise and services can be used to improve efforts focused on the prevention and management of sport injury among high-intensity athletes. The consensus view is that psychology and socioculture do affect sport injury risk, response and recovery in high-intensity athletes, and that continued efforts in psychological research and professional practice are needed to protect athlete physical and mental health and contribute toward performance excellence and career longevity.
In-line skating is increasing in popularity with a concomitant raise in the number of injuries associated with this activity. Studies have emphasized the value of protective gears in reducing the incidence of injuries and the subsequent need to identify the factors and processes involved in decision making about safety gear-wearing. The present study examined the contribution of the theory of planned behaviour (TPB) variables, and perceived susceptibility to and perceived severity of skating injury on the safety gear-wearing intention of adult skaters.
Skaters (n=181) completed a questionnaire assessing the constructs of the TPB, perceived susceptibility to and perceived severity of skating injuries, and intention to wear safety gear.
Hierarchical regression analyses revealed significant contributions of instrumental attitude and subjective norm to the prediction of safety gear-wearing intention. In addition, perceived susceptibility to and perceived severity of injuries enhanced the prediction of intentions to wear safety gear over and above the contribution of TPB components.
As the TPB focuses only on behavioural evaluation, it seems promising to include threat perceptions in this theory as another aspect of health-related cognitions motivating intention formation about safety gear use. Practical implications for future campaigns and countermeasures are discussed.