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http://dx.doi.org/10.1123/jsr.2013-0148
2015 Human Kinetics, Inc.
189
190Arvinen-Barrow et al
Methods
Research Design and Setting
A cross-sectional research design was used to sample
participants from both the United States and Europe. The
US-based participants were collegiate athletes who were
recruited from 5 universities across the country. The European athletes were a mixture of collegiate, professional,
and recreational club athletes from the West and East
Midlands regions of the United Kingdom and Finland.
Participants
A total of 1283 athletes (62.4% male; 36.0% female; 1.6%
did not identify their sex) participated in the study. Age
ranges spread across the following categories (1.6% did
not specify their age): 12 to 17 (n = 67; 5.2%); 18 to 21
(n = 754; 58.8%); 22 to 25 (n = 234; 18.2%); 26 to 35 (n
= 101; 7.9%); 36+ (n = 107; 8.3%). Of the sample, 699
(54.5%) were classified as US athletes and 584 (45.5%)
were classified as European athletes (332 from the United
Kingdom and 252 from Finland; for more details on the
participant demographics, see Table 1). The vast majority
(752, or 58.6%) identified themselves as student-athletes,
with a smaller number (135, or 10.5%) indicating that
they had a college/university degree or other qualifications (30.9% nonresponse). Participants described their
highest level of competition as (1) collegiate/university
(705, or 54.9%); (2) recreational or not competing at
all (240, or 18.7%); (3) national (166, or 12.9%); (4) at
either county, regional, or state level (74, or 5.8%); (5)
international (38, or 3.0%); (6) professional (24, or 1.9%);
or (7) no indication (36, or 2.8%). The 3 most cited sports
were American football (216, or 16.8%), soccer (211, or
16.4%), and track and field (161, or 12.5%). A total of 373
(29.1%) reported having a past history of acute injuries,
128 (10.0%) indicated that they experienced chronic
injuries, and 501 (39.0%) had suffered both acute and
chronic injuries, whereas 281 (21.9%) reported having
no history of injuries. Of the participants, 821 (64.0%)
indicated that they had prior experience working with
SMPs, whereas 406 (31.6%) indicated that they had no
prior experience working with SMPs (4.4% nonresponse).
Age, y
1217
1821
2225
2635
36+
Total
United States
Male
Female
n
%
n
%
1
0.2
0
0.0
319 71.7
221 88.0
113 25.4
28 11.2
11
2.5
2
0.8
0
0.0
0
0.0
444 55.6
251 54.3
United Kingdom
Male
Female
n
%
n
%
2
0.9
0
0.0
90 42.7
55 53.4
23 10.9
7
6.8
22 10.4
15 14.6
74 35.1
26 25.2
211 26.4
103 22.3
Finland
Male
n
%
48 33.3
26 18.1
33 22.9
32 22.2
5
3.5
144 18.0
Female
n
%
16 14.8
43 39.8
29 26.9
18 16.7
2
1.9
108 23.4
Total
Male
n
%
51
6.4
435 54.4
169 21.2
65
8.1
79
9.9
799 62.4
Female
n
%
16
3.5
319 69.0
64 13.9
35
7.6
28
6.1
462 36.0
Measure
As part of a larger study on athletes expectations of
injury rehabilitation,21,22 participants were asked a series
of questions regarding their use of mental skills during
injury rehabilitation. These inquiries contained both
open-ended and closed-ended questions. More specifically, the first question participants were asked relative
to their use of mental skills in injury rehabilitation was
a closed-ended question: Have you ever used mental
skills as part of your sport rehabilitation? Question 2, an
open-ended question, allowed participants to list up to 3
mental skills they had used during their injury rehabilitation. Question 3, a closed-ended question, was: Did the
athletic trainer(s) teach you how to use the skills? The
fourth question, a follow-up to the previous question,
was open-ended: If no, who did? The final question
was closed-ended: Do you believe that the use of mental
skills helped you to rehabilitate faster?
The survey items were modified for the UK and Finnish sample to take into account cultural differences. For
the UK survey, the term, athletic trainer, was changed to
physiotherapist to reflect the differences in professional
titles used in these different cultural contexts. In Finland,
the original questions were translated into Finnish following a commonly employed back-translation procedure23,24
used in cross-cultural research:
1. The original questions were translated from English to Finnish by an independent sport psychology
researcher who is fluent in both languages. At this
stage, the term, athletic trainer, was also changed
and translated to physiotherapist to reflect the
differences in professional titles used in different
cultural contexts.
2. The Finnish translated version was then translated
back into English independent of the original questions by a sport psychology professional who is
fluent in both languages but was not involved in the
initial translations.
3. The differences in the content and meanings between
the back-translated and the original questions were
then identified.
4. Due to the simplicity of the questions, no items
displaying discrepancy in either content or meaning
were identified.
Procedure
After institutional review board approval and before
administration of the surveys, all of the participants
were given a cover letter informing them of the purpose
of the study. The surveys were administered in a range
of ways, depending on the country in which the data
were collected. Participants at the US and UK universities received the questionnaires in person, either before
or after practices or classes. Some of the athletes in the
United Kingdom received the survey via SurveyMonkey
Statistical Analyses
Descriptive statistical analyses (ie, percentages and frequencies) were calculated for the closed-ended questions.
For the open-ended questions, multiple response sets were
created and then frequencies were calculated. Finally, a
chi-square analysis was conducted (with both sex and
country as a categorical level variable) to determine if
significant cultural differences existed when using mental
skills during injury rehabilitation. The qualitative openended answers were coded based on the commonly-used
categorization of mental skills (eg, imagery, goal setting,
self-talk, relaxation techniques).
Results
Of the 1283 participants, 346 (27.0%) indicated that
they had applied mental skills during injury rehabilitation, whereas 880 (68.6%) stated that they had not used
mental skills during rehabilitation (4.4% nonresponse).
Among those who reported using mental skills, the top 4
mental skills used were (1) goal setting (162, or 46.8%),
(2) positive self-talk/positive thoughts (115, or 33.2%),
(3) imagery (110, or 31.8%), and (4) relaxation (84, or
24.3%). Table 2 displays the athletes use of specific
mental skills by country. Of the 346 athletes who used
mental skills, 249 (72.0%) indicated that the use of
mental skills helped them to rehabilitate faster, whereas
48 (13.8%) felt that using mental skills did not facilitate
the speed of their injury recovery (14.2% chose not to
answer this question).
A significant difference (2 = 20.08, df = 2, P < .001)
was obtained based on the athletes country (see Table
3). That is to say, a greater proportion of athletes from
the United States (33.4%) reported that they used mental
skills during rehabilitation compared with the proportion
of athletes from the United Kingdom (23.4%) and Finland
(20.3%). No significant difference (2 = 0.378, df = 2, P
> .05) was found between the percentage of use of mental
skills by males and females during injury rehabilitation.
Of the participants who reported using mental skills
as part of their sport injury rehabilitation, 96 (27.7%)
indicated that their SMPs (ie, athletic trainer, physiotherapist or equivalent) had taught them how to apply mental
192Arvinen-Barrow et al
Mental skill
Goal setting
Positive self-talk/positive thoughts
Imagery
Relaxation
Other
United States
(n = 222)
n
%
115
51.8
88
39.6
70
31.5
57
25.7
15
6.8
United Kingdom
(n = 74)
n
%
24
32.4
21
28.4
22
29.7
6
8.1
2
2.7
Finland
(n = 50)
n
%
23
46.0
6
12.0
18
36.0
21
42.0
1
2.0
Total
(N = 346)
n
%
162
46.8
115
33.2
110
31.8
84
24.3
18
5.2
Table 3 Use of Mental Skills During Sport Injury Rehabilitation by Country (N = 1226)
United States
(n = 664)
n
%
222
33.4
442
66.6
Use or nonuse
Use mental skills during injury rehabilitation
Do not use mental skills during injury rehabilitation
United Kingdom
(n = 316)
n
%
74
23.4
242
76.6
Finland
(n = 246)
n
%
50
20.3
196
79.4
Note: Due to missing variables, the number of participants in each country is different than as presented in the text.
Discussion
The primary purpose of this study was to determine what,
if any, mental skills athletes use during injury rehabilitation. Results indicated that 27.0% of athletes surveyed
reported using mental skills during injury rehabilitation.
Given that the use of mental skills in sport performance
has been supported by research for a long time,25 and that
these same skills are frequently being recommended by
SMPs for use in the rehabilitation setting,26,27 overall the
low number of athletes who reported using mental skills
during injury rehabilitation is a discouraging revelation.
According to Arvinen-Barrow and Walker,28 mental skills
are commonly underutilized during injury rehabilitation.
This may happen because athletes, and those who work
with them, are often unable to see a clear transfer of mental
skills from performance enhancement to sport injury
rehabilitation due to their limited knowledge on how to
use these mental skills when recovering from injury. Of
the athletes who did report using mental skills during
rehabilitation (n = 346, or 27.0%), goal setting (46.8%),
positive self-talk (33.2%), imagery (31.8%), and relaxation
techniques (24.3%) were listed as the 4 main strategies
employed. This is not surprising, because these skills are
among the most commonly used mental skills in sport,29
with goal setting being the most widely used by athletes
overall.30 Frequent use of goal setting is also supported by
studies conducted with SMPs. One study on SMPs attitudes about the effectiveness of mental skills used within
injury rehabilitation indicates that goal setting is perceived
as the most effective skill.14 Furthermore, results from 4
194Arvinen-Barrow et al
Conclusions
In conclusion, only 27.0% of the athletes in the sample
reported that they used mental skills during their injury
rehabilitation, and only ~3.0% had learned mental skills
from a sport psychologist. Given these findings, the
authors believe that more effort is needed to educate
athletes, coaches, and injury treatment professionals
about the beneficial effects of mental skills, and how
they could be incorporated into rehabilitation programs.
Sport psychology professionals can play a significant
role in education and treatment of athletes. Practical
ways in which mental techniques can be integrated
into rehabilitation should be examined and tested in the
field. Unfortunately, there appears to be limited access
to sport psychology services at this time. Additionally,
since athletic trainers and physiotherapists are in a unique
position to teach mental skills to athletes during injury
rehabilitation, it becomes even more imperative that these
professionals receive training on the basic principles of
sport psychology and how best to implement mental skills
to injured athletes.
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