Psychosocial factors related to sports injury outcomes in elite female soccer players

Introduction and Purpose: The last ten years has seen significant national and international growth in elite female soccer participation. Injury rates in female soccer are reported to be between 1.4 injuries per 1000 hours training exposure and 18.5 per 1000 hours competition exposure (3). Return to sport (RTS) rates after severe injuries are poor and attributed in part to psychosocial factors (1). Systematic reviews have suggested a range of psychosocial factors that are associated with rehabilitation outcomes, whilst identifying females as an understudied population in sports medicine literature (2). Understanding female players’ injury experiences may serve to enhance rehabilitation outcomes for elite female soccer players. Therefore, the aim of this study was to identify and examine psychosocial factors of the sports injury rehabilitation experience in elite female soccer players, and how these relate to rehabilitation outcomes. Methods: Following institutional ethical approval, a total of eight UK based international female soccer players were purposively recruited (mean age of 29.63 ± 7.26 years, mean of 34 international caps). Each player had sustained a severe sports injury leading to a minimum 2 months time loss from sport. Injuries were anterior cruciate ligament (ACL) rupture (n=4), hamstring strain (n=1), lateral ankle sprain (n=1), mid-radial fracture (n=1) and Achilles tendinopathy (n=1). These injuries had led to mean 7.13 ± 4.51 months of time loss. At the time of data collection six players had RTS, one player was 15 months into ACL rehabilitation, and one player had retired through injury. Each player was retrospectively interviewed about their injury experience using auto driven photo elicitation interviews (PEI’s). PEI’s lasted a mean of 57.5 ± 7.16 minutes yielding 202 pages of single spaced text. Interview data was transcribed verbatim, and evaluated using thematic analysis principles. Rigour of the data was ensured through the use of member reflections, peer debrief, and multivocality. Results: All players faced numerous emotional, cognitive and motivational challenges during the RTS transition. Three core psychosocial contextual factors emerged from the transcribed data: (i) social support, (ii) personality and (iii) coping. These factors were related (either positively or negatively) to injury experiences and expectations during RTS transitions, and were associated with a variety of sports injury outcomes. Sports injury outcomes included RTS (though not return to performance), residual athletic changes, and retirement from sport. Social support was sought from many sport (club and international) and non-sport providers. Social support was important in addressing the numerous challenges of return to sport transitions. Perceptions of the quality and quantity of social support offered by club sports injury practitioners and technical coaches appeared most important. Personality factors including high standards, resilience, and autonomy were related with player’s ability to address return to sport transition challenges. For example, all players suffered injury setbacks where resilience was required. Players used various coping strategies during RTS transitions to deal with the numerous challenges. None of the players were offered education or intervention to help cope with the challenges of RTS transitions, and instead relied on self-developed strategies e.g. use of social models. Conclusions: The findings of this study add to our understanding of the potentially important psychosocial factors in an understudied population. Practitioners working with this population group should be empowered to regularly monitor quality of social support and coping needs of injured players throughout RTS transitions to enhance outcomes of sports injury. References (1)Ardern CL, Osterberg A, Tagesson S, et al. The impact of psychological readiness to return to sport and recreational activities after anterior cruciate ligament reconstruction. British Journal of Sports Medicine 2014; 48:1613–1619. (2)Forsdyke D, Smith A, Jones M et al. Psychosocial factors associated with outcomes of sports injury rehabilitation in competitive athletes: a mixed studies systematic review. British Journal of Sports Medicine; 50:537-544. (3)Gaulrapp H, Becker A, Walther M et al. Injuries in women’s soccer: a 1-year all players prospective field study of the women’s Bundesliga. Clinical Journal of Sport Medicine 2010; 20(4):264-271.