Preference: Oral Presentation

Topic: REHABILITATION AND FUNCTIONAL RECOVERY

Title: HOW TO MANAGE THE FEAR AND ANXIETY OF RE-INJURY

Author: WALKER, N.C.

Affiliation: University of Bedfordshire, Luton, UK.

Introduction: Given the volume and severity of injuries that occur in football, the

quest for continued knowledge about maximising athletes’ psychosocial recovery and

enhancing their holistic return to training and competition is vital. A salient response

to injury that demands the mobilisation of a player’s coping resources is fear of re-

injury and/or re-injury anxiety (Walker, 2006). These fears and anxieties can cause

physiological and psychological changes within the injured player and can influence

rehabilitation performance, return to competition performance, and increase the risk

of actual re-injury (Heil, 1993; Pargman, 1999; Taylor & Taylor, 1997). Hawkins et

al. (2001) identified that re-injuries are accountable for 7% of all injuries sustained in

football, with rates as high as 30% previously being reported (Hawkins & Fuller,

1999).

Purpose: Given the incidence of re-injury and the potential negative implications it is

important to be able to measure this construct and for players to be able to manage the

symptoms. The aim of this research was twofold:

1. To explore the natural history of re-injury anxiety symptoms over the course of

rehabilitation and return to training/competition in a sample of elite professional

footballers;

2. To use the natural history data to determine appropriate periods to intervene with

a cognitive-behavioural intervention (CBT) to reduce re-injury anxieties.

Methods: A total of six injured participants were purposefully sampled using a

multiple baseline design. All participants were rehabilitating from a Grade II anterior

talofibular ligament injury. A homogeneous sample was utilised to control for

confounding influences, following the recommendations of Cupal (1998). The natural

history of re-injury anxiety was observed in a sample of control participants initially.

this included weekly measures of their re-injury anxieties using the Re-Injury anxiety

Inventory (Walker, Thatcher & Lavallee, 2010). These measures were taken

throughout their rehabilitation and on their return to training and competition.

Re-injury anxiety was then observed for each experimental participant for a period of

time without the introduction of an intervention (this provided the baseline phase

data) and then at staggered periods during each player’s rehabilitation programme the

CBT intervention was introduced whilst re-injury anxiety data continued to be

observed (this provided intervention phase data).

Data were analysed using the recommended visual inspection to observe potent

effects that are clear from simply visually inspecting the changes in re-injury anxiety

between the baseline and interventions phases (Kazdin, 1982). Changes in mean,

level, and trend were explored and also included exploration of latency of change and

the replication effect. Statistical analyses are less common in multiple baseline

designs but following the exploration of the baseline data the split-middle technique

with binomial analysis was conducted in addition to calculating confidence intervals.

Results: The results demonstrated the vital role that psychological skills can have in

the injury recovery process. The visual inspection analysis demonstrated a reduction

in both re-injury anxieties related to rehabilitation and return to play following the

introduction of the intervention. The statistical analyses that were conducted support
the visual inspection results and highlighted that there was a greater intervention

impact on re-injury anxieties regarding rehabilitation than return to play.

Conclusion: Despite the effectiveness of the intervention for reducing re-injury

anxieties during return to play, it was more effective for reducing anxieties related to

re-injury during rehabilitation. It could be that re-injury anxieties regarding re-entry

are more persistent and more difficult to challenge, particularly in a contact sport such

as football. This presents a particular challenge to the sports medicine team given the

potential impact on performance and re-injury risk. However, it should be noted that

multiple baseline designs have low external validity and therefore it is difficult to

generalise these findings to the whole population.