LIVRE JDG 2016

J.A. FELLER, K.E. WEBSTER

234

SYSTEMATIC REVIEW

A systematic review found that the literature

about the psychological response of athletes

returning to sport following injury and/or

surgery was relatively sparse and that there was

a high risk of bias for the included studies [2].

Nonetheless, the review found that as athletes

progress through the rehabilitation phase

towards a return to sport, there is a reduction of

the negative emotions which are associated

with the initial injury (such as depression,

anger and anxiety), and a shift towards more

positive emotions (such as confidence and

readiness to return to sport), providing the

period of rehabilitation has progressed as

anticipated.

ACL-RSI SCALE:

DEVELOPMENT

Given the apparent impact of psychological

factors on athletes returning to sport following

injury or surgery, it may be helpful to be able to

quantify some of these factors and also to

determine whether they have a predictive

value. The Anterior Cruciate Ligament Return

to Sport after Injury (ACL-RSI) scale was

designed to address these issues, given the

paucity of psychological measures specific to

sports injury rehabilitation [10]. The aim was

to develop a tool to specifically measure

psychological readiness to return to sport after

ACL reconstruction.

Items developed for the scale were centred on

three categories of psychological responses

identified in the literature as being associated

with returning to sport:

emotions, confidence

and risk appraisal

(see Table 1). For the

emotions category, an extensive search of the

literature identified fear of re-injury, frustration,

nervousness and tension as commonly reported

emotions experienced by athletes during

rehabilitation and the commencement of sport.

Five items (items 1-5) were therefore developed

to measure these emotions.

In the sports setting, confidence typically refers

to the amount of confidence the athlete has in

their ability to perform well at their sport.

However, in the case of ACL reconstruction, it

may also relate to the level of confidence the

athlete has in the function of their operated

knee. Five items (items 6-10) were therefore

generated to cover these two aspects of sport

confidence. Three (items 6-8) were developed

to target the athlete’s confidence in their knee

function and two (items 9, 10) were developed

to measure the athlete’s confidence in their

overall ability to perform well at their sport.

Finally, two items (items 11, 12) were included

to investigate the cognitive risk appraisal of the

athlete to re-injury. The second of these, item

12, was suggested by a patient group during

pilot testing of the scale for relevance.

The ACL-RSI scale was initially completed by

220 athletes who had undergone ACL

reconstruction between 8 and 22 months

(mean = 12 months) previously. The scale was

found to have high internal consistency

(Cronbach’s alpha = 0.96) and principal

components analysis confirmed the presence of

one underlying factor that accounted for 67.8%

of the total variance. It is important to note that

although the scale was designed around three

constructs, these constructs were all highly

related and a single score between 0-100 is

calculated for the scale where higher values

indicate a more positive psychological response

(see Table 1).

To validate the scale, the athletes were divided

in the following groups;

athletes who had

returned to full completion,

athletes who had

returned to training only,

athletes who had

not yet returned but planning to return to sport,

and

athletes who given up sport. Athletes

who had returned to full competition scored

significantly higher than the other three groups

and athletes who had given up sport scored

significantly lower [10].