Dissertation

Psychological Readiness to Return to Play After Concussion

Crofts, Regan Melissa

2023

Overview

The sequelae of concussion may have psychological consequences that affect an athlete’s ability to return to play. While a lingering lack of confidence may decrease athletes’ performance and lead to fear, anxiety, and reinjury, confidence or other psychological measures are not currently monitored after a concussion. This study aimed to examine the acute and longitudinal effects of concussion on an athlete’s confidence (Aim 1), examine the relationship between standard clinical assessments and athlete confidence after concussion (Aim 2), and explore the interactions between symptoms, sex, sport type (contact vs. noncontact), and confidence after concussion (Aim 3). Forty-six collegiate athletes sustained a concussion, provided informed consent per an IRB-approved protocol, and completed the Injury Psychological Readiness to Return to Sport Scale (I-PRRS) at three time points: within 72 hours after a concussion (Acute) upon beginning the return-to-play (RTP) protocol (Pre-RTP), and after being cleared for nonrestricted return to competition (Post-RTP). The I-PRRS was modified to make it appropriate for concussion (e.g., “pain and/or symptoms”) and scored out of 60 possible points. Linear mixed models examined how concussion impacts confidence and how confidence changes over time. Athletes reported low confidence acutely (I-PRRS mean [SD] = 32.59[18.45], which improved over time [Pre-RTP mean [SD] = 52.11[9.60]; Post-RTP mean [SD] = 57.45[5.96]). Some athletes returned to competition (Post-RTP) with lingering confidence concerns (i.e., I-PRRS < 50; 95% CI [0.03, 0.26]). There was no relationship between clinical balance performance and confidence (p = 0.1760), but symptom severity acutely after concussion was associated with worse confidence longitudinally (p < 0.0001). Sex and sport type (contact vs. noncontact) similarly had no relationship with confidence (p = 0.4063, p = 0.3314, respectively). These results show that athletes have a lack of confidence acutely (within 72 hours of impact) following concussion. While confidence improves over time, those who report greater acute symptoms also exhibit decreased confidence, and some athletes are returning to play with lingering concerns about their confidence (I-PRRS < 50). These results support the growing evidence of the importance of psychological factors after injury, specifically concussions. This preliminary evidence of the decreased confidence following concussion encourages the assessment and monitoring of confidence throughout the return to play concussion protocol.

• Publisher: ProQuest Dissertations & Theses
• Subject: Kinesiology / Physical therapy / Sports Management
• ISBN: 9798380590921