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Psychological Readiness to Return to Sport: Fear of Reinjury Is the Leading Reason for Failure to Return to Competitive Sport and Is Modifiable
Abstract
Many of our patients are athletes, and an ultimate goal is to help these athletes return to their preinjury level of activity or sport. Generally, we focus on patients' injuries and treatments, but there are modifiable factors that can improve patient outcomes independent of surgical technique. A factor frequently ignored is psychological readiness to return to sport. In patients including athletes, particularly teenagers, chronic, clinical depression is a prevalent and pathologic condition. In addition, in nondepressed patients (or in patients who are situationally depressed because of injury), the ability to deal with stressors may still govern clinical outcomes. Specific psychological traits of significance have been identified and defined, including self-efficacy; locus of control; resilience; catastrophizing; kinesiophobia; and fear of reinjury. (Fear of reinjury is the leading reason for failure to return to competitive sport, reduced activity levels after sports injury, and greater reinjury rates.) The traits may overlap and may be modifiable. Thus, like strength and functional testing, we should evaluate for signs or symptoms of depression, and we should measure psychological readiness to return to sport. With awareness, we can intervene or refer as indicated. Psychological readiness to return to sport represents an underexamined domain in which we can help our patients achieve best outcomes.
... 6,8,9 Previous studies have shown that psychological barriers, such as fear of reinjury and reduced confidence in performance, can significantly impact the RTS rate after ACLR. 8,10,11 In this context, depressiondwhich affects approximately 1 in 10 adults in the United States 12,13 demerges as a potentially significant contributor. This association becomes even more relevant when considering that a substantial proportion of primary and secondary ACL injuries occur within the age range of 17 to 35 years, 14 which is the same age group exhibiting the highest incidence of depression. ...
... Recent literature highlights that psychological readiness to RTS is an important and underexamined factor affecting outcomes after ACLR. 11 Clinical depression is common among patients, especially teenagers, and may negatively impact recovery. Additional psychological traits such as low self-efficacy, external locus of control, poor resilience, catastrophizing, and fear of reinjury can also affect RTS after ACLR. ...
... Additional psychological traits such as low self-efficacy, external locus of control, poor resilience, catastrophizing, and fear of reinjury can also affect RTS after ACLR. 11 In fact, fear of reinjury is one of the main reasons athletes do not RTS. 11 Psychological readiness to RTS can be measured with tools such as the ACL-RSI scale, and patients with low readiness scores may need intervention to improve outcomes. ...
... There are also social and psychological benefits associated with exercise including reduced anxiety and depression, and improved overall wellbeing (Eime, Young, Harvey, Charity, & Payne, 2013). However, sport carries a risk of injury, with incidence rates in adolescent sport being reported at 2.64 per 1000 h (Schaffer et al., 2022) and 46% over a 12 month period in organised sport (Sheean, Lubowitz, Brand, & Rossi, 2023). Previous injury is one of greatest predictors of future injury in sport (Friden, Ekenros, & von Rosen, 2023), and recurrent injury increases the likelihood of premature drop out from sport (Iadevaia, Roiger, & Zwart, 2015b). ...
... Injury and burn out throughout adolescence remains one of the primary drivers of premature drop out from sport and therefore it is fundamental to explore the experience of adolescents with injuries and their difficulties and successes in returning to sport (DiFiori et al., 2014). Research in adolescent sport has traditionally focused on the physical burden of injury, quantified through prevalence, incidence and re-injury data (Costa, Teles, & Fragoso, 2022;Piussi et al., 2022;Sheean et al., 2023). Research involving adult athletes and their injury experience is more holistic, (Anderson et al., 2022;Clement, Arvinen-Barrow, & Fetty, 2015;Leahy et al., 2023;Wilson et al., 2021) suggesting that the impact of injury is profound, affecting both physical and psycho-social constructs. ...
Returning to sport after anterior cruciate ligament reconstruction (ACLR) can be a challenging and complex process for the athlete, with the rate of return to the pre-injury level of sport observed to be less than athlete expectations. Of the athletes that do return to sport (RTS), knee re-injury rates remain high, and multiple studies have observed impaired athletic performance upon RTS after ACLR as well as reduced playing time, productivity, and career lengths. To mitigate re-injury and improve RTS outcomes, multiple RTS after ACLR consensus statements/clinical practice guidelines have recommended objective RTS testing criteria to be met prior to medical clearance for unrestricted sports participation. While the achievement of RTS testing criteria can improve RTS rates after ACLR, current criteria do not appear valid for predicting safe RTS. Therefore, there is a need to review the various factors related to the successful return to the pre-injury level of sport after ACLR, clarify the utility of objective performance testing and RTS criteria, further discuss safe RTS decision-making as well as present strategies to reduce the risk of ACL injury/re-injury upon RTS. This article provides a practical review of the current RTS after ACLR literature, as well as makes medical recommendations for rehabilitation and RTS decision-making after ACLR.
Purpose
This study evaluated differences between adolescent athletes who sustained a surgical anterior cruciate ligament (ACL) re‐injury, or contralateral ACL injury following return to sports bridge programme participation (Group 1) compared to those that did not (Group 2).
Methods
At 19.9 ± 7 years of age, 198 athletes participated in this study. Groups were compared for time postsurgery, preprogramme and postprogramme Knee Outcome Survey Sports Activity Scale (KOS‐SAS) and global rating of knee function (GRKF) during sports activities, postprogramme lower extremity physical function test performance and perceived sports performance compared to preinjury level.
Results
By 6.0 ± 3.2 years postsurgery, 11 (5.6%) sustained another ACL injury. Group 1 was younger (17.3 ± 1.7 years vs. 20.1 ± 6.8 years, p < 0.001). Postprogramme re‐evaluation revealed that Group 1 had a greater GRKF compared to their programme initiation GRKF than Group 2 (32.6 ± 38 vs. 20.0 ± 23, p = 0.04). Group 1 also had a greater mean preprogramme to postprogramme GRKF change than Group 2 (51.3 ± 31 vs. 35.5 ± 21, p = 0.02) (effect size = 0.73). More Group 1 subjects also had a GRKF difference that exceeded the overall mean than Group 2 ( p = 0.04). Group 1 had moderately strong relationships between preprogramme and postprogramme GRKF score change and the postprogramme GRKF score ( r = 0.65, p = 0.04) and between preprogramme and postprogramme KOS‐SAS score change and postprogramme GRKF score ( r = 0.60, p = 0.04).
Conclusion
Global rating scores had a stronger influence among adolescent athletes that sustained either surgical ACL re‐injury or contralateral ACL injury. Since group physical function and neuromuscular control factors were similar, clinicians need to increase their awareness and understanding of other factors that may influence surgical ACL re‐injury or contralateral ACL injury risk.
Level of Evidence
Level III, retrospective cohort study.
Unlabelled:
Female athletes represent a unique population of competitors who face distinct stressors when compared with male athletes. These include sport inequities, violence, abuse, body image concerns, disordered eating, relative energy deficiency, family planning challenges, hormonal challenges, and mental distress. When combined with sports injuries, these stressors can negatively impact the mental health of female athletes as well as their injury recovery and return to sports. It is essential for orthopaedic surgeons to be familiar with the unique aspects inherent to being a female athlete, along with the psychological aspects of sports injuries. By integrating questions about female athletes' psychological well-being into their routine practice and collaborating with a multidisciplinary team, orthopaedic surgeons can better address these unique stressors, support female athletes in achieving optimal outcomes, and enhance return to sport rates.
Level of evidence:
V, expert opinion.
Purpose
To reduce the length of the SIRSI scale and determine the predictive validity of the short version compared with the original form.
Methods
This study included patients who underwent an arthroscopic Bankart repair or a open Latarjet procedure between 2017 and 2019. One group was used for the Shoulder Instability Return to Sport Injury (SIRSI) scale reduction process, and a second group was used to test the predictive validity of the proposed short SIRSI scale. Cronbach alfa was used to evaluate internal consistency. Validity was determined by calculating the Pearson correlation coefficient with the Western Ontario Shoulder Instability Index (WOSI) scale. Predictive validity was assessed using receiver operating characteristic (ROC) curve statistics.
Results
A total of 158 patients participated in the scale reduction process, and 137 patients participated in the predictive validation. The short-scale was successfully reduced to a 5-item scale constructed by one underlying factor accounting for 60% of the variance. The short version showed good internal consistency (Cronbach alfa= 0.82), and was highly correlated with the WOSI scale and the long version. The short SIRSI scores were significantly different in those who returned to sports from those who did not. The SIRSI scale had excellent predictive ability for return-to-sport outcomes (Short version: area under ROC curve= 0.84; 95% CI: 0.7-0.9); Long version: area under ROC curve= 0.83; 95% CI: 0.7-0.9)
Conclusion
A valid 5-item short version of the SIRSI scale was successfully developed in our patient population. The short version was found to be as robust as the long scale for discriminating and predicting return to sports outcomes.
PurposePsychological readiness may play an important role in the return to sport (RTS) process following hip arthroscopy (HA), but there are limited tools for the measurement of this construct. The aim of this study was to modify the Swedish version of the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale for use in HA patients and evaluate its psychometric properties.Methods
Content validity of a modified version of the Swedish ACL-RSI (Hip-RSI) was evaluated through 127 HA patient responses and relevance ratings by an expert panel (35 patients, 9 surgeons, 11 physiotherapists). Items with low relevance were omitted. Construct validity was assessed by the association of Hip-RSI scores to hip-related sporting function (HAGOS sport) and quality of life (iHOT12). Hip-RSI scores were compared between patients who had not returned, or returned to sport participation, previous sport, and sport performance.ResultsItem reduction resulted in a 6-item Hip-RSI scale with adequate content validity for the target population. Construct validity of the full and the item-reduced scale was demonstrated by correlation to HAGOS sport and iHOT12 (r 0.631–0.752). A gradient increase in Hip-RSI scores was found for patients returning to sport participation, previous sport, and sport performance.Conclusion
The short version of the Swedish Hip-RSI is a valid tool for the assessment of psychological readiness to RTS and can be recommended to be used in HA patients. Higher psychological readiness to RTS, assessed by the Hip-RSI, is found with increasing levels of return to sports following HA.Level of evidenceIII.
Objectives
To synthesise the available evidence on interventions designed to improve individual resilience.
Design
A systematic review and meta-analysis
Methods
The following electronic databases were searched: Ovid Medline, Ovid EMBASE, PsycINFO, Ovid Cochrane and WHO Clinical Trials Registry in order to identify any controlled trials or randomised controlled trials (RCTs) examining the efficacy of interventions aimed at improving psychological resilience. Pooled effects sizes were calculated using the random-effects model of meta-analysis.
Outcome measures
Valid and reliable measures of psychological resilience.
Results
Overall, 437 citations were retrieved and 111 peer-reviewed articles were examined in full. Seventeen studies met the inclusion criteria and were subject to a quality assessment, with 11 RCTs being included in the final meta-analysis. Programmes were stratified into one of three categories (1) cognitive behavioural therapy (CBT)-based interventions, (2) mindfulness-based interventions or (3) mixed Interventions, those combining CBT and Mindfulness training. A meta-analysis found a moderate positive effect of resilience interventions (0.44 (95% CI 0.23 to 0.64) with subgroup analysis suggesting CBT-based, mindfulness and mixed interventions were effective.
Conclusions
Resilience interventions based on a combination of CBT and mindfulness techniques appear to have a positive impact on individual resilience.
Background
The Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale was developed to measure an athlete’s psychological readiness to return to sport after anterior cruciate ligament (ACL) injury and reconstruction surgery. The scale is being used with increasing frequency in both research and clinical settings.
Purpose
To generate and validate a short version of the ACL-RSI scale.
Study Design
Cohort study (diagnosis); Level of evidence, 2.
Methods
The ACL-RSI scale was administered to 535 patients who had undergone ACL reconstruction surgery. Reliability (Cronbach alpha) was determined and factor analysis of the full scale was undertaken along with a process of item selection and elimination. A second group of 250 patients participated in a predictive validation analysis. This group completed the ACL-RSI scale at 6 months and reported return-to-sport outcomes 12 months following ACL reconstruction surgery. The predictive validity of both scales (full and short versions) was assessed by use of receiver operating characteristic (ROC) curve statistics.
Results
The scale was found to have high internal consistency (Cronbach alpha, 0.96), which suggested that item redundancy was present. After an item selection process, the scale was reduced to a 6-item format. Cronbach alpha for the short version was 0.92, and factor analysis confirmed the presence of 1 factor accounting for 71% of the total variance. Scores for the short version were significantly different between patients who had and those who had not returned to sport. Six-month ACL-RSI scores for both the full and short versions had fair to good predictive ability for 12-month return-to-sport outcomes (full version: area under ROC curve, 0.77 [95% CI, 0.7-0.8]; short version: area under ROC curve, 0.75 [95% CI, 0.7-0.8]).
Conclusion
A 6-item short version of the ACL-RSI scale was developed from a large cohort of patients undergoing ACL reconstruction. The short version appears to be as robust as the full version for discriminating between and predicting return-to-sport outcomes. The short version of the ACL-RSI may be of use in busy clinical settings to help identify athletes who may find return to sport challenging.
Recovery following anterior cruciate ligament reconstruction is an arduous process that requires a significant mental and physical commitment to rehabilitation. Orthopaedic research in recent years has focused on optimizing anterior cruciate ligament surgical techniques; however, despite stable anterior cruciate ligament reconstructions, many athletes still never achieve their preinjury ability or even return to sport. Psychological factors associated with patient perceptions and functional outcomes following anterior cruciate ligament reconstruction are important to acknowledge and understand. Issues related to emotional disturbance, motivation, self-esteem, locus of control, and self-efficacy can have profound effects on patients' compliance, athletic identity, and readiness to return to sport. The psychological aspects of recovery play a critical role in functional outcomes, and a better understanding of these concepts is essential to optimize the treatment of patients undergoing anterior cruciate ligament reconstruction, particularly those who plan to return to sport. Identifying at-risk patients, encouraging a multidisciplinary approach to patient care, and providing early referral to a sports psychologist may improve patient outcomes and increase return-to-play rates among athletes.
Copyright 2015 by the American Academy of Orthopaedic Surgeons.
Purpose of the study:
In examining the ability of resilience, or the ability to navigate adversity in a manner that protects well-being, to buffer the impact of chronic disease onset on disability in later life, the authors tested 2 hypotheses: (a) People with greater levels of resilience will have lower levels of disability and (b) resilience will moderate the association between the onset of a new chronic condition and subsequent disability.
Design and methods:
This study used a sample of 10,753 Americans between the ages of 51 and 98, derived from 3 waves of the Health and Retirement Study (2006-2010). Ordinary least squares regression was used to estimate the impact of resilience on changes in disability (measured as difficulty with activities of daily living [ADLs] and instrumental activities of daily living [IADLs]) over a 2-year period using a simplified resilience score.
Results:
Resilience protects against increases in ADL and IADL limitations that are often associated with aging. Resilience mitigates a considerable amount of the deleterious consequences related to the onset of chronic illness and subsequent disability.
Implications:
Our results support our hypotheses and are consistent with claims that high levels of resilience can protect against the negative impact of disability in later life.
Today, we who treat athletes are able to effect immediate, significant improvement in anterior cruciate ligament (ACL) patient outcomes, regardless of surgical technique, by careful determination of when an athlete is ready to return to sport. "Prehabiliation," bracing, time after surgery to various rehabilitation activities, time after surgery until return to sport, functional testing, strength testing including limb symmetry indices, psychological readiness, age, gender, and type of sport are all factors influencing successful return to sport after ACL injury and treatment. Age and gender are not modifiable, and for some athletes, type of sport may be nonnegotiable. However, each of these factors could be thoughtfully considered before returning an athlete to sport after ACL treatment. All the other factors listed above, from prehab to bracing to strength to psychological readiness, may be modifiable.
Purpose
To determine whether preoperative psychological status before outpatient knee surgery is influenced by athletic status, symptom chronicity, or prior surgical history.
Methods
International Knee Documentation Committee subjective scores (IKDC-S), Tegner Activity Scale scores, and Marx Activity Rating Scale scores were collected. Psychological and pain surveys included the McGill pain scale, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia 11, Patient Health Questionnaire 9, Perceived Stress Scale, New General Self-Efficacy Scale, and Life Orientation Test–Revised for optimism. Linear regression was used to determine the effects of athlete status, symptom chronicity (>6 months or ≤6 months), and history of prior surgery on preoperative knee function, pain, and psychological status after matching for age, sex, and surgical procedure.
Results
In total, 497 knee surgery patients (247 athletes, 250 nonathletes) completed a preoperative electronic survey. All patients were age 14 years and older and had knee pathology requiring surgical treatment. Athletes were younger than nonathletes on average (mean [SD], 27.7 [11.4] vs 41.6 [13.5] years; P < .001). The most frequently reported level of play among athletes was intramural or recreational (n = 110, 44.5%). Athletes had higher preoperative IKDC-S scores (mean [SE], 2.5 [1.0] points higher; P = .015) and lower McGill pain scores compared to nonathletes (mean [SE] 2.0 [0.85] points lower; P = .017). After matching for age, sex, athlete status, prior surgery, and procedure type, having chronic symptoms resulted in higher preoperative IKDC-S (P < .001), pain catastrophizing (P < .001), and kinesiophobia scores (P = .044).
Conclusions
Athletes demonstrate no difference in symptom/pain and function scores preoperatively when compared to nonathletes of similar age, sex, and knee pathology, as well as no difference in multiple psychological distress outcomes measures. Patients with chronic symptoms have more pain catastrophizing and kinesiophobia, while those who have had prior knee surgeries have slightly higher preoperative McGill pain score.
Level of Evidence
Level III, cross-sectional analysis of prospective cohort study data.
Purpose
The purpose of this study was to examine the factors commonly used to determine readiness for RTS in the ACL-R patient population and assess which were most influential to successfully returning to sport and avoiding re-tear.
Methods
The PUBMED, EMBASE and Cochrane Library databases were queried for studies related to RTS in ACL-R. Inclusion and exclusion criteria were applied to identify studies with greater than 1-year outcomes detailing the rate of return and re-tear given a described RTS protocol. Data of interest was extracted and studies were stratified based on level of evidence and selected study features. Meta-analysis and/or subjective synthesis of appropriate studies was used to assess over 25 potentially significant variables effecting RTS and re-tear.
Results
After initial search of 1503 studies, 47 articles were selected for inclusion in the final data analysis including a total of 1432 patients (31.4% females, 68.6% male). A meta-analysis of re-tear rate for included Level of Evidence 1 studies was calculated to be 2.8%. Subgroups including protocols containing a strict time until RTS, strength testing, and ≥2 dynamic tests demonstrated decreased RTS and re-tear heterogeneity from the larger group. Time to RTS, strength testing, dynamic functional testing, and knee stability were also found to be among the most prevalent reported criteria in RTS protocol studies.
Conclusion
This study suggests a multifactorial clinical algorithm for successful evaluation of RTS. The “critical criteria” recommended by the authors to be part of the postoperative RTS criteria include time since surgery of 8 months, use of >2 functional tests, psychological readiness testing, and quadriceps/hamstring strength testing in addition to the modifying patient factors of age and female gender.
Level Of Evidence
Level IV, Systematic Review of Level IV or better investigations
Purpose
The purpose of this study was to determine whether the preoperative diagnosis of depression predicted worse postoperative outcomes, including physical therapy (PT) compliance, return-to-sport, and PROs using the Patient-Reported Outcomes Measurement Information System (PROMIS) after ACL reconstruction.
Methods
A multi-surgeon series of consecutive patients who had undergone ACL reconstruction with minimum 2 year follow up were included. Chart review was conducted to determine depression diagnosis status, demographic data, rehabilitation physical therapy (PT) compliance, return to sports and patient reported outcomes data using PROMIS. Patients who met the PROMIS threshold for mild depression, but did not carry a clinical diagnosis of depression were classified as "situationally depressed."
Results
Ninety-five of 115 consecutive patients (81%) met inclusion criteria with an average follow-up of 34±1.9 months. Fourteen patients (15%) had a preoperative diagnosis of depression while 21 (22%) were considered situationally depressed. Clinically depressed patients had a higher rate of PT non-compliance (33.2%±17.6% vs. 21.9%±12.6%; p=0.02) and a lower postoperative PROMIS Physical Function (50.8±7.7 vs. 57.8±11.0; p=0.03 compared to patients without depression. Situationally depressed patients had lower preoperative physical function (35.4 vs. 42.5; p=0.04) with no differences in postoperative outcomes scores compared to the non-depressed cohort.19/21 (90.5%) of situationally depressed patients had postoperative resolution of their depressive symptoms.
Conclusion
Situationally depressed patients without a clinical diagnosis of depression can expect significant improvements in both pain and function, as well as a resolution of their depressed mood based on PROMIS scores as they progress through recovery after ACL reconstruction. Clinically depressed patients also experience significant improvements however their rate of achieving the MCID for PROMIS outcomes may be less than their non-depressed or situationally depressed counterparts.
Purpose:
The main goal of this study was to propose and validate a tool to quantify the psychological readiness of athletes to return to sport following traumatic shoulder instability and conservative or surgical management.
Methods:
«Knee» was replaced by the term «shoulder» in the Anterior Cruciate Ligament-Return to Sport after Injury scale. This pilot test of the Shoulder Instability-Return to Sport after Injury scale (SIRSI) was performed in a group of athletes who underwent surgery for post-traumatic chronic anterior shoulder instability. The final version was then validated according to the international COSMIN methodology. A retrospective study was performed including all rugby players who had reported an episode of instability between 2012 and 2013. The WOSI and the Walch-Duplay scales were used as reference questionnaires.
Results:
Sixty-two patients were included, mean age 26 ± 5.2 years old, 5 women/57 men. Patients were professional or competitive athletes (70.9%) and followed-up for 4.6 ± 1.6 years after the first episode of shoulder instability. Shoulder surgery was performed in 30/62 (48.4%) patients, a mean 1.6 ± 1.2 years after the first episode of instability. The SIRSI was strongly correlated with the reference questionnaires (r = 0.80, p < 10(-5)). The mean SIRSI score was significantly higher in patients who returned to play rugby (60.9 ± 26.6% vs 38.1 ± 25.6%, p = 0.001). The internal consistency of the scale was high (α = 0.96). Reproducibility of the test-retest was excellent (ρ = 0.93, 95% CI [0.89-0.96], p < 10(-5)). No ceiling/floor effects were found.
Conclusion:
The SIRSI is a valid, reproducible scale that identifies patients who are ready to return to the same sport after an episode of shoulder instability, whether they undergo surgery or not.
Level of evidence:
III.
The importance of physical performance measures and their influence on predicting future disability has been suggested; however, the association between resilience and physical performance measures in older women needs further study. The purpose of this research study was to investigate the resilience level in a convenience sample of older women who happened to be Roman Catholic nuns. The relationships of resilience with specific physical performance measures, self-perceived physical and mental health status, and depressive symptoms were also explored.
Descriptive correlational cross-sectional design was used. Data from 54 volunteer Roman Catholic nuns, aged 55-94 were collected beginning with self report questionnaires followed by physical performance tests. Self-report measures included the Resilience Scale, Short-Form revised (SF-12v2) Health Survey, and Patient Health Questionnaire (PHQ-9). The 12-point Short Physical Performance Battery (SPPB) and fast gait speed were the physical performance tests measured.
This sample of nuns had moderate levels of resilience. Those with fewer depressive symptoms and better health had higher resilience levels. Fast gait speed was positively associated with resilience.
The positive relationship between resilience and gait speed is an important finding of this study because it reinforces the connection between physical and emotional health. Future studies should examine if resilience and gait speed can serve as predictors of disability in a broader sample of older adults or if resilience can be targeted as a means of improving physical performance.
Maintaining functional ability and recovering when physical injury is experienced is of great importance in older adults. It is reasonable for physical therapists to consider both resilience and physical performance measures when attempting to identify older women at risk for poor outcomes. Resilience may play a role in helping older adults recover from a physical injury.
The potential influence of age and aging on the psychological functioning of people with disabilities is surprisingly complex. In people with spinal cord injury or multiple sclerosis, depression is highly prevalent. The limited research in this area indicates that older age and greater time span since disability onset may be associated with less self-reported depressive symptoms. Posttraumatic growth (PTG) and benefit finding (BF) are also common in people with disabilities. Older age tends to be associated with less BF and PTG. Studies that use longitudinal designs and examine multiple age-related factors simultaneously are needed. Potential mediators of age-related effects, such as historical trends, life-cycle events, maturity, and declining health, also need to be examined. There are many interesting theoretic and empiric concepts from aging research that can inform future research on the psychological aspects of aging with disability.
This study aimed to determine (1) the relationship between life satisfaction, mental disorders, and aging in the female community and (2) to identify the impact of vulnerability factors, personal (resilience, self-esteem), and social resources on life satisfaction and distress.
A stratified random sample of the German female population (N = 2,540) was investigated using standardized questionnaires of life satisfaction (Questions on Life Satisfaction), depression, anxiety (Patient Health Questionnaire), resilience scale (RS-11), and self-esteem (Rosenberg Self-Esteem Scale).
When participants were divided into six age groups (18-30, 31-40, 41-50, 51-60, 61-70, and >70 y), we found lower life satisfaction, satisfaction with partnership, and sexuality beyond the age of 50 years. Satisfaction with health was decreased already at early adulthood. Although the importance of partnership/sexuality was reduced around midlife, the importance of health increased. Depression was highest in the oldest group, whereas anxiety remained fairly stable across the cohorts. Life satisfaction was strongly associated with resilience, a good household income, the presence of a partnership, absence of anxiety and depression, lack of unemployment, positive self-esteem, religious affiliation, and-least-age.
Personal and social resources and the absence of anxiety and depression are of crucial importance for the maintenance of life satisfaction in aging women.
The purpose of this study was to develop a scale to measure the psychological impact of returning to sport after anterior cruciate ligament (ACL) reconstruction surgery.
Three types of psychological responses believed to be associated with resumption of sport following athletic injury--emotions, confidence in performance, and risk appraisal--were incorporated into a 12-item ACL-Return to Sport after Injury (ACL-RSI) scale.
Two hundred and twenty participants who had undergone ACL reconstruction completed the scale between 8 and 22 months following surgery.
The scale was shown to have acceptable reliability (Cronbach's alpha=0.92). Participants who had given up sport scored significantly lower on the scale (reflecting a more negative psychological response) than those who had returned or were planning to return to sport (p<0.001).
It was concluded that the decision to return to sport after ACL reconstruction is associated with a significant psychological response. Preliminary reliability and validity was found for the ACL-RSI scale. This scale may help to identify athletes who will find sport resumption difficult.
When less is more: Designing patient reported outcome measures that have high clinical utility and minimum responder burden
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