Psychological Aspects of Sport-Injury Rehabilitation

Abstract & Commentary

Synopsis: Health care providers should take into account psychological, as well as physical, factors when considering patients’ readiness for surgery.

Source: Udry E, et al. Psychological readiness for anterior cruciate ligament surgery: Describing and comparing the adolescent and adult experiences. Journal of Athletic Training. 2003;38(2):167-171.

This study is 1 of 5 comprising a Journal of Athletic Training special section on developmental differences in psychological aspects of sport-injury rehabilitation. The 2 objectives of this paper were to describe mood-disturbance levels and psychological readiness levels of preoperative ACL patients and to examine differences between adolescent and adult sports medicine patients’ psychological readiness for ACL surgery.

Sixty-seven subjects between 15 and 19 were considered adolescents, and 32 subjects who were 1 standard deviation older than the mean age of 21.6 (30 years of age or older) were considered adults. The subjects were assessed with 4 instruments: a modified version of Wong’s 30-item Processes of Change Questionnaire for Injury Rehabilitation; the perceived pros and cons associated with engaging in a rehabilitation program with a 15-item questionnaire by Marcus et al; a self-efficacy measure developed by Marcus et al and modified by Wong; and the short-form Profile of Mood States.

The subjects tended to perceive more pros than cons associated with ACL surgery, and they had relatively high levels of self-efficacy in anticipation of injury rehabilitation. The adolescents reported higher levels of mood disturbances, more pros associated with surgery and greater use of 5 of the 10 processes of change in comparison to the adults.

Comment by David H. Perrin, PhD, ATC

The finding that adolescents reported higher levels of mood disturbances yet more pros associated with surgery seems paradoxical. Perhaps their more effective use of the processes of change (ie, dramatic relief, environmental reevaluation, social liberation, helping relationships, and self-liberation) accounts for this paradox. A limitation of the study is that the level of mood disturbances in these adolescents before their injury is not known. Nevertheless, the implication for the practitioner is that the adolescent sports medicine patient might be more challenging to work with, but is likely to be more enthusiastic about undergoing ACL surgery and returning to pre-injury levels of physical activity.

Certainly, the physical parameters associated with readiness for ACL surgery in adolescent and adult patients are more straightforward than the psychological factors. Surgeons and sports medicine rehabilitation specialists are normally not trained psychologists, yet they should be cognizant that patients vary in their psychological readiness for surgery and rehabilitation. Moreover, the findings of this study suggest that clear differences exist between adolescent and adult sports medicine patients. A comprehensive sports medicine practice should include the presence or availability of a sport psychologist or other qualified professional in the event that referral, assessment, and potentially psychological intervention are indicated prior to ACL surgery.

Dr. Perrin is Dean, School of Health and Human Performance, University of North Carolina-Greensboro.