Positive Reframing: An Important but Underutilized Coping Strategy in Athletes Undergoing Sport-Related Knee Surgery

Abstract

Context: It is unknown how specific coping strategies are associated with the short-term outcomes among athletes following knee surgery. Objective: 1) To determine whether specific coping strategies are associated with satisfaction, return to sport, self-reported knee function, or kinesiophobia following sports-related knee surgery. 2) To determine whether these associations vary by age, sex, or surgical procedure. Study design: Case series. Methods: Athletes (n=184 total; n=104 men, n=80 women; n=38 age <20 years, n=35 age 20–25, n=36 age 26–31, n=36 age 32–40, n=39 age >40) who underwent outpatient knee surgery were enrolled from a single center. Utilization of specific coping strategies (self-distraction, use of emotional or instrumental support, venting, positive reframing, and acceptance) was assessed pre-operatively with the Brief-COPE inventory. Relationship between coping strategies and post-operative satisfaction, return to sport, International Knee Documentation Committee-subjective (IKDC-S) and Tampa Scale for Kinesiophobia scores at median 10.7 months follow-up were determined with consideration for age, sex, and surgical procedure. Results: Return to prior level of sport was 72%, and satisfaction was 86%. Most coping strategies had age-specific utilization rates; positive reframing was utilized least frequently in ages <20 years. Satisfaction increased with greater positive reframing among ages <20 years and decreased with greater self-distraction among men. Return to sport was higher with greater positive reframing in ages <32 years. No coping strategies predicted IKDC-S scores. Greater positive reframing correlated with lower kinesiophobia in ages <20 years. Greater instrumental support correlated with lower kinesiophobia in ages >40 years. No other coping strategies were associated with outcomes. Surgical procedure was not related to association between coping strategies and outcomes. Conclusion: Coping strategies have age-specific associations with outcomes after knee surgery in athletes. Positive reframing is infrequently utilized in younger athletes. Greater use of positive reframing in this group may improve satisfaction, return to sport, and lower fear of re-injury.

Health-Related Quality of Life and Psychological Outcomes in Participants with Symptomatic and Non-Symptomatic Knees after ACL Reconstruction

“…It has been suggested that cognitive behavioral therapies and resilience training can improve coping strategies and decrease psychological distress in patients undergoing knee surgery. 47 This, in turn, may have positive effects on other psychological factors (e.g., fear avoidance), physical activity adherence, and HRQOL (Figure 1).…”

Coping habits as measured using self-report are sensitive to supernormality response bias.

“…Stress, defined as the body's response to any demand or threat, however, can pose a significant threat to one's emotional stability and overall mental well-being (Schneiderman et al, 2005). Nevertheless, not all stress is "bad" or inherently negative (Selye, 1973); depending on the circumstances, stressful or challenging experiences can foster personal and professional growth (Flanigan et al, 2021;Hughes et al, 2011;Robbins et al, 2019;Selye, 1973).…”