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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,

Objective:To examine the relationship between self-reported use of psychological skills and rehabilitation adherence.Design:Prospective correlational design.Setting:Outpatient physical-therapy clinic specializing in sports medicine.Patients:Fifty-four patients (17 women and 37 men) undergoing rehabilitation after anterior-cruciate-ligament reconstruction.Main Outcome Measures:An abbreviated version of the Sports Injury Survey (Ievleva & Orlick, 1991) was administered approximately 5 weeks after surgery to assess use of goal setting, imagery, and positive self-talk. Four adherence measures were obtained during the remainder of rehabilitation: attendance at rehabilitation sessions, practitioner ratings of patient adherence at rehabilitation sessions, patient self-reports of home exercise completion, and patient self-reports of home cryotherapy completion.Results:Goal setting was positively associated with home exercise completion and practitioner adherence ratings. Positive self-talk was positively correlated with home exercise completion.Conclusions:Use of certain psychological skills might contribute to better adherence to sport-injury rehabilitation protocols.

Cognitive appraisal models of adjustment to sport injury hold that cognitive appraisals of the injury determine emotional responses to the injury, which in turn influence behavioral responses (e.g., adherence to rehabilitation). To test this model, recreational and competitive athletes undergoing rehabilitation following knee surgery (N = 31) appraised their ability to cope with their injury and completed a measure of mood disturbance. Adherence to rehabilitation was measured in terms of attendance at rehabilitation sessions and physical therapist/athletic trainer ratings of patient behavior during rehabilitation sessions. As predicted, cognitive appraisal was associated with emotional disturbance. Emotional disturbance was inversely related to one measure of adherence (attendance) but was unrelated to the other measure of adherence (physical therapist/athletic trainer ratings). The results of this study provide support for cognitive appraisal models and suggest that emotional disturbance may be a marker for poor adherence to sport injury rehabilitation regimens.

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