Developing a psychological support intervention to help injured athletes get Back in the Game
Authors: Ardern Clare L. , Hooper Nicholas , O’Halloran Paul , Webster Kate E. , Kvist Joanna 
Published: March 2021

AbstractBackgroundAfter serious knee injury, up to half of athletes do not return to competitive sport, despite recovering sufficient physical function. Athletes often desire psychological support to return to sport, but rehabilitation clinicians feel ill-equipped to deliver adequate support.ObjectiveTo design and develop an Internet-delivered psychological support programme for athletes recovering from knee ligament surgery.MethodOur work developing and designing the Back in the Game intervention was guided by a blend oftheory & evidence-basedandtarget population-basedstrategies to developing complex interventions. We systematically searched for qualitative evidence related to athletes’ experiences, perspectives and needs for recovery and return to sport after anterior cruciate ligament (ACL) injury. Two reviewers coded and synthesised the results using thematic meta-synthesis. We systematically searched for randomised controlled trials (RCTs) reporting on psychological support interventions for improving ACL rehabilitation outcomes in athletes. One reviewer extracted the data (including effect estimates); a second reviewer checked the data for accuracy. The results were synthesised descriptively. We conducted feasibility testing in two phases: (1) technical assessment, and (2) feasibility and useability testing. For phase 1, we recruited clinicians and people with lived experience of ACL injury. For phase 2, we recruited patients aged between 15 and 30 years, who were within 8 weeks of ACL reconstruction surgery. Participants completed a 10-week version of the intervention, and semi-structured interviews evaluating acceptability, demand, practicality and integration. The project was approved by the Swedish Ethical Review Authority (2018/45-31).ResultsThree analytic themes emerged from the meta-synthesis (n= 16 studies, 164 participants): (1) tools/strategies to support rehabilitation progress, (2) barriers and facilitators for physical readiness to return to sport, and (3) barriers and facilitators to psychological readiness to return to sport. Coping strategies, relaxation and goal setting may have a positive effect on rehabilitation outcomes after ACL reconstruction (n= 7 RCTs, 430 participants). There were no trials of psychological support interventions for improving return to sport. Eleven people completed phase 1 of feasibility testing (technical assessment) and identified 4 types of software errors that we fixed. Six participants completed feasibility and useability testing. Their feedback suggested the intervention was easy to access and addressed the needs of athletes who want to return to sport after ACL reconstruction. We refined the intervention to include more multimedia content, and support to access and use the intervention features.ConclusionThe Back in the Game intervention is a 24-week Internet-delivered self-guided programme comprising 7 modules that complements usual rehabilitation, changes focus as rehabilitation progresses, is easy to access and use, and includes different psychological support strategies.