Fear of reinjury, negative affect, and catastrophizing predicting return to sport in recreational athletes with anterior cruciate ligament injuries at 1 year postsurgery.

Tripp, Dean A.; Stanish, William D.; Ebel-Lam, Anna; Brewer, Britton W.; Birchard, John

doi:10.1037/0090-5550.52.1.74

Cited by 119 publications

(110 citation statements)

References 51 publications

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“…5 • Researchers have concluded that fear of reinjury was the unique predictor of return to sport even in a sample of participants that reported very little or almost no pain at all. 9 • A critical appraisal of the literature revealed that imagery as a therapy is an effective intervention in reducing the fear of reinjury and confidence building. Furthermore, mental imagery is suggested to assist with a reduction in anxiety, pain, and tension, while promoting healing.…”

Section: Focused Clinical Questionmentioning

confidence: 99%

Reducing Fear of Reinjury and Pain Perception in Athletes With First-Time Anterior Cruciate Ligament Reconstructions by Implementing Imagery Training

Rodríguez¹,

Marroquin²,

Cosby³

2019

Journal of Sport Rehabilitation

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Clinical Scenario: The anterior cruciate ligament is one of the major stabilizing ligaments of the knee joint by preventing anterior translation of the femur in the closed kinetic chain. A ruptured anterior cruciate ligament may require reconstructive surgery for patients who wish to return to physical activity. For the most part, surgeries are successful at repairing the ruptured ligament and restoring ligamentous function; the percentage of athletes that return to a competitive level of physical activity is only 44%, and 24% of patients report a main factor of preventing their return is fear of reinjury and pain. Most physiotherapy and rehabilitation research has focused on the physical treatment and is limited on the psychological aspects of recovery. Imagery has been suggested to be effective at reducing anxiety, tension, and pain, while promoting and encouraging healing after an injury. Imagery is defined as a process of performing a skill in one's mind using the senses (touch, feel, smell, vision, etc) without any overt actions. Clinical Question: In athletes who are first-time anterior cruciate ligament reconstruction patients, does imagery training in combination with standard physical therapy reduce the fear of reinjury and pain perception? Summary of Key Findings: Previous research has primarily looked at the physical treatment aspect, and few studies have focused on the psychological factors affecting recovery. Researchers concluded that fear of reinjury was the unique predictor of return to sport even in a sample of participants that reported very little or almost no pain at all. Imagery as a therapy is an effective intervention in reducing fear of reinjury and confidence building. Furthermore, mental imagery is suggested to assist with a reduction in anxiety, pain, and tension, while promoting healing. Clinical Bottom Line: Based on the strength of recommendation taxonomy, there is a combination of level A and B evidence proposing that imagery, in combination with traditional physical therapy, can be effective at reducing psychological distress such as fear of reinjury and pain perception in first-time anterior cruciate ligament reconstruction patients.Keywords: knee joint, psychology, rehabilitation, sport psychology Clinical ScenarioInjuries are an inevitable part of competitive sports as well as recreational activities. Research shows that one of the most common musculoskeletal complaints that accounts for approximately 48 out of 1000 patients is knee-related injury. 1 As noted, approximately 9% of these knee complaints are related to anterior cruciate ligament (ACL) injuries. 2,3 The ACL is commonly injured in contact sports by a noncontact action, such as planting, cutting, landing on a hyperextended knee, or pivoting and sudden deceleration. 4 Typically, athletes report feeling immediate pain and hearing a pop, resulting in progressive knee swelling and difficulty ambulating. The ACL is one of the major ligaments that provides stability to the knee joint by preventing anterior translation of t...

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Section: Focused Clinical Questionmentioning

confidence: 99%

Reducing Fear of Reinjury and Pain Perception in Athletes With First-Time Anterior Cruciate Ligament Reconstructions by Implementing Imagery Training

Rodríguez¹,

Marroquin²,

Cosby³

2019

Journal of Sport Rehabilitation

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“…Fear of re-injury and psychological readiness are common barriers to returning to pre-injury sport after ACLR (Ardern et al, 2012b;Ardern, Taylor, Feller, Whitehead, & Webster, 2013;Kvist et al, 2005;Lentz et al, 2015;McCullough et al, 2012;Tripp et al, 2007). In fact, the contribution of psychological factors to an individual's decision to return to sport may be of greater importance than physical limitations, such as pain and instability (Ardern, Webster, Taylor, & Feller, 2011b;Gobbi & Francisco, 2006;Warner, Smith, Wright, Matava, & Brophy, 2011).…”

Section: Discussionmentioning

confidence: 99%

“…Psychological impacts of ACL rupture and subsequent reconstructive surgery are heightened during the acute postoperative period Heijne, Axelsson, Werner, & Biguet, 2008;Langford et al, 2009;Tripp, Stanish, Ebel-Lam, Brewer, & Birchard, 2007) and may persist for years following ACLR with potential to influence longer-term outcomes (Ardern et al, 2012a;Wierike et al, 2013). Studies have found that patients who do not return to pre-injury sport at one year after ACLR, and three to four years later, report more fear of reinjury, negative emotions and lower confidence than those who do return to sport (Kvist, Ek, Sporrstedt, & Good, 2005;Webster, Feller, & Lambros, 2008).…”

Section: Psychological Outcomesmentioning

confidence: 99%

“…Functional and objective knee measures have been found to be inaccurate predictors of return to sport following ACLR (Ardern et al, 2011a). On the other hand, psychological measures of fear of re-injury, mood and knee confidence are known to be related to an individual's decision to return to sport following ACLR (Ardern et al, 2014b;Ardern et al, 2011a;Kvist et al, 2005;McCullough et al, 2012;Tripp et al, 2007). These study conclusions are in line with the key theme described in Chapter 7, where individuals with a high desire to return to sport who did not do so due to fear of re-injury described negative impacts on QOL.…”

Section: Return To Sportmentioning

confidence: 99%

“…Furthermore, emotional disturbances were reported by individuals who had not returned to sport at 6 and 12 months after ACLR, compared to those who had returned to sport, despite no differences in knee function and symptoms (Langford et al, 2009). Fear of re-injury is a very common psychological manifestation experienced by individuals after ACLR (Ardern et al, 2014a;Gignac et al, 2015;Kvist et al, 2005;Tripp et al, 2007) and higher levels of fear of re-injury have been associated with worse knee-related QOL (Kvist et al, 2005). Additionally, psychological factors assessed prior to undergoing ACLR are predictive of postoperative outcomes (Everhart, Best, & Flanigan, 2015).…”

Section: Psychological Outcomesmentioning

confidence: 99%

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Long-term quality of life following anterior cruciate ligament injury and reconstruction

Filbay¹

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The anterior cruciate ligament (ACL) serves to stabilise the knee complex and prevent intraarticular knee structures from sustaining damage during multiaxial, high impact movement. An ACL rupture most commonly occurs in adolescents and young adults taking part in competitive sports and causes substantial disruption to the knee joint. Anterior cruciate ligament reconstruction (ACLR) is the most common treatment offered to ACL-ruptured individuals worldwide. Individuals undergoing this surgery often have high expectations that rarely match surgical outcomes. Return to sport rates are low, re-injury fears are widespread and many individuals develop knee osteoarthritis within ten years of ACLR. This mismatch between expectations and actual outcomes has great potential to impact longer-term quality of life (QOL). The primary aims of this thesis were to: (i) generate a detailed picture of longer-term QOL following ACLR, and (ii) identify factors related to longer-term QOL in people with knee pain, symptoms or functional limitations following ACLR.The first study in this thesis is a systematic review that revealed impaired knee-related QOL at 5 to 20 years after ACLR. However, it became evident that research into factors impacting upon QOL in this population was scarce. The systematic review found that having a subsequent knee injury, an additional knee surgery after ACLR, and developing severe radiographic osteoarthritis were associated with worse QOL outcomes. The second study in this thesis is a systematic review that investigated QOL more than five years after ACL rupture in individuals who remained ACL-deficient (did not undergo ACLR) and compared QOL between ACLdeficient and ACL-reconstructed groups. This systematic review found that ACL-deficient individuals reported comparable QOL outcomes to those who underwent ACLR 5 to 25 years previously. All studies that reported QOL after ACLR included asymptomatic participants without knee difficulties, which may underestimate the degree of QOL impairment experienced by people with ongoing knee difficulties.The third study in this thesis used a cross-sectional design to describe QOL outcomes in 162 individuals with knee pain, symptoms or functional limitations 5 to 20 years following ACLR.It showed that individuals who did not return to sport after ACLR reported poorer knee-related and health-related QOL, compared to people who returned to pre-injury levels of sport. Higher body mass index (BMI) and subsequent surgery were also related to worse QOL after ACLR.This was the first study to show that return to sport was associated with QOL impairment more than five years after ACLR. However, quantitative assessment of QOL may overlook important considerations with regard to an individual's life priorities, expectations, values and concerns.To provide a detailed understanding of QOL following ACLR, qualitative interviews were performed with 17 individuals with knee difficulties 5 to 20 years following ACLR. This was the first qualitative study to explore QOL following...

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A meta‐analysis of the associations of elements of the fear‐avoidance model of chronic pain with negative affect, depression, anxiety, pain‐related disability and pain intensity

Rogers

Farris

2022

European Journal of Pain

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Background and objective: Biopsychosocial conceptualizations of clinical pain conditions recognize the multi-faceted nature of pain experience and its intersection with mental health. A primary cognitive-behavioural framework is the Fear-Avoidance Model, which posits that pain catastrophizing and fear of pain (including avoidance, cognitions and physiological reactivity) are key antecedents to, and drivers of, pain intensity and disability, in addition to pain-related psychological distress. This study aimed to provide a comprehensive analysis of the magnitude of the cross-sectional association between the primary components of the Fear-Avoidance Model (pain catastrophizing, fear of pain, pain vigilance) with negative affect, anxiety, depression, pain intensity and disabilities in studies of clinical pain. Databases and data treatment:A search of MEDLINE and PubMed databases resulted in 335 studies that were evaluated in this meta-analytic review, which represented 65,340 participants. Results:Results from the random effect models indicated a positive, medium-to large-sized association between fear of pain, pain catastrophizing, and pain vigilance measures and outcomes (pain-related negative affect, anxiety, depression and pain-related disability) and medium-sized associations with pain intensity.Fear of pain measurement type was a significant moderator of effects across all outcomes.Conclusions: These findings provide empirical support, aligned with the components of the fear-avoidance (FA) model, for the relevance of both pain catastrophizing and fear of pain to the pain experience and its intersection with mental health. Implications for the conceptualization of the pain catastrophizing and fear of pain construct and its measurement are discussed.

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Fear of reinjury, negative affect, and catastrophizing predicting return to sport in recreational athletes with anterior cruciate ligament injuries at 1 year postsurgery.

Cited by 119 publications

References 51 publications

Reducing Fear of Reinjury and Pain Perception in Athletes With First-Time Anterior Cruciate Ligament Reconstructions by Implementing Imagery Training

Reducing Fear of Reinjury and Pain Perception in Athletes With First-Time Anterior Cruciate Ligament Reconstructions by Implementing Imagery Training

Long-term quality of life following anterior cruciate ligament injury and reconstruction

A meta‐analysis of the associations of elements of the fear‐avoidance model of chronic pain with negative affect, depression, anxiety, pain‐related disability and pain intensity

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