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Psychological impairments can follow an anterior cruciate ligament (ACL) injury and can impact the rehabilitation process. Our aim was to investigate experiences of sports physical therapists (PTs) in addressing psychological impairments in patients after ACL injury. We conducted four focus group interviews with fourteen sports PTs. The PTs' experiences of working with psychological impairments after ACL injury were summarized in four main categories: (1) "Calling for a guiding light", where PTs stated that the most common method of acquiring knowledge on addressing psychological impairments was through discussions with colleagues, and, at the same time, PTs expressed an insufficient knowledge of how to address psychological impairments; (2) "Meeting the burden of psychological impairments" where PTs stated that psychological impairments are greater than physical; (3) "Trying to balance physical and psychological aspects" where patient education and assessments were reported to be important in order to understand psychological impairments during rehabilitation; and (4) "Goal setting: a helpful challenge" where sports PTs expressed a need for specific knowledge of the rehabilitation of psychological impairments following ACL injury. To help provide the current best practice, we encourage researchers to develop psychologically centered interventions for rehabilitation after an ACL injury, and PTs to stay up-to-date with the literature published on the subject, including to implement eventual interventions.

Injury is a serious setback for athletes and might jeopardize mental health. The aim of this study is to investigate if a mindfulness- and acceptance-based intervention can improve mindfulness (nonreactivity and acting with awareness), acceptance, and well-being, and decrease the level of symptoms of anxiety and depression. A single-case design with multiple, staggered, and nonconcurrent baselines was used. Six seriously injured athletes took part in an 8-week intervention and repeatedly completed questionnaires on all variables for the duration of the study. The results showed that, on average, there were significant clinical changes between phases in nonreactivity, well-being, and acceptance. No effect was seen in the two remaining scales. On an individual level, two participants showed effects in all scales, two participants in some of the scales, and two participants in the scale nonreactivity. Results are discussed in light of existing research, and implications for practitioners’ clinical methods are presented.

The authors of this paper share how they developed and validated an applied framework termed the career-long psychological support services in Swedish handball (CPS-H). The CPS-H is grounded in career research within Swedish handball and examples of efficient career assistance practice complemented by applied experiences of the first author. The authors used a heuristic approach to sketch the CPS-H initial version, which later was validated in three focus groups with end-users (handball players, coaches, and sport psychology practitioners) and transformed into the validated CPS-H. Promoting a combination of the proactive, educational, whole career, whole environment, and whole person approaches, the framework is structured as having interrelated parts addressing questions: where (changes in the contexts), when (ages, career stages), what (athletes’ needs and potential working issues), who (support providers), why (philosophy shared by the stakeholders), and how (forms of services) of psychological support. The authors further reflect on the CPS-H and its implementation and provide general and stage-specific recommendations for support providers. Although the CPS-H is contextualized in a specific sport and culture, some lessons can be applicable across countries and sport boarders. © 2020 The Author(s). Published with license by Taylor & Francis Group, LLC Additional funding: The Swedish Handball Federation

The aim of this study was to describe gender-specific career paths of Swedish professional handball players. A reanalysis of Ekengren et al. (2018) career interviews with nine male and nine female players led to creating two composite vignettes using the athletes’ own words, accounted for typical features in the male and female players’ career paths. Seven themes were identified in the analysis of the men’s transcripts and eight themes derived from the women’s transcripts. Further, the themes of both vignettes were aligned with career stages described in our previous study (Ekengren et al. 2018). The male players’ vignette is interpreted as a performance narrative congruent with elite handball culture that promotes performance success and profitable professional contracts. The female players’ vignette is more holistic, embracing handball, studies, motherhood, and how they ought to be as Swedish women. Recommendations for future research are provided. peerReviewed

Th is study aimed to explore whether a six-week intervention, based on participation in outdoor exercise, including activity-tracking devices and combined with individual consulting sessions, can both increase physical activity and yield positive changes in physiological and psychological health measures. A total of six participants, with a mean age of 41.2 (range 33-50 years), completed the ten-week study and the six-week intervention. Th e full study consisted of a four-week control/baseline and a six-week intervention period in which each participant acted as their own controls. Continuous measures of physical activity data were collected using a wrist-worn activity sensor during the ten-week study, along with pre- and post-measures of cardiovascular fi tness, upper-body strength, BMI, general health, and motivation to exercise. Th e intervention consisted of a resistance-training programme for an outdoor gym and three motivational interviewing sessions. Eff ect sizes (percentage) for changes pre- to post-training were calculated. Th e results, because of the small sample size, are presented as individual cases, but the group, as a whole, showed average increases from baseline (pre-) to post-measures in strength (maximum row; 15.33%), time to exhaustion (3.58%), number of steps per day (4%), and autonomous motivation (12%) and average decreases in body weight (-1.08%), fat percentage (-7.58%), strength (chest; -2.5%), and stress symptoms (-2.17%). Th e six-week intervention programme showed promising results regarding physical activity changes. Th is study contributes to the limited evidence of the impact of resistance training programmes using outdoor gyms, electronic tracker, and motivational interviewing on physical activity outcomes.

The field of sport and exercise psychology (SEP) has experienced a steady growth, and the professional practice and training of students has evolved over that time. Based on 2 past studies, the pur...

The successful implementation of injury prevention programs is reliant on athletes and coaches accepting, adopting, and complying with behaviors that reduce injury risk. Exploring factors, such as motivation and planned behavior, that might increase the frequency of these behaviors warrants investigation. The aim of the study was to investigate the complex interaction between perceived autonomy support, self-determined motivation, planned behavior, and how this relates to golfers self-reported intention injury preventative behavior. A total of 60 golfers completed questions on psychological measures of perceived autonomy support from coaches, autonomous motivation, and intentions of injury preventative behavior. A neural network model analysis was performed to investigate the strength of connection between covariates and construct a network structure. Analysis of results was performed by assessing edge strengths and node centrality to guide inference of the network topology. The most central node was autonomous regulation and the results showed one cluster comprising positive interactions between perceived autonomy support, effort of injury preventative behavior, and frequency of injury preventative behavior. When aiming to encourage injury preventative behavior, coaches should consider giving feedback that supports autonomous motivation since it is positively associated with effort and frequency of injury preventative behavior among high-level golfers. Injury prevention programs should include strategies to improve the athlete's autonomous motivation to carry out preventive activities.

In this paper we share how a career assistance program (CAP) was developed, implemented, and evaluated with a Swedish elite handball team. Within this case study the initial version of the CAP’s content was created based on the career-long psychological support services in Swedish handball framework and the first author’s applied experiences. During implementation the head coach terminated unexpectedly and the team appeared in a crisis. This transitional situation led to modification of the CAP to help the players cope with changes. Eighteen players took part in eight workshops dealing with various aspects of their sport and non-sport life (e.g., performance, training, lifestyle, recovery, future planning) with crisis-related issues (e.g., coping with uncertainty) incorporated. Mixed-methods evaluation revealed the players’ perceived increase in personal resources (awareness, skills) and decrease in stress and fatigue. Reflections on working in applied sport psychology from a holistic perspective in a dynamic real-life setting are provided. Som manuskript i avhandling / As manuscipt in thesisAdditional funding: The Swedish Handball Federation

The study was aimed at developing the empirical career model of Swedish professional handball players by means of exploring their career experiences in athletic and non-athletic developments throug...

Research has shown that high levels of stress and stress responsivity can increase the risk of injuries. However, most of the research that has supported this notion has focused on between-person relationships, ignoring the relationships at the within-person level. As a result, the objective of this study was to investigate if within-person changes in perceived stress symptoms over a 1-month time period could predict injury rates during the subsequent 3 months. A prospective design with two measurement points (Time 1-at the beginning of the season and Time 2-1 month into the season) was utilized. A total of 121 competitive soccer players (85 males and 36 females; M

This study examined (a) the developmental trajectories of student-athlete burnout perceptions and (b) the within-person relationship between achievement goals and burnout perceptions. A three-year ...

Aims Self-determined motivation has been found to be an important predictor of exercise behavior. Findings on gender and age differences are however mixed and previous research has called for studies to examine gender and age as potential moderating factors as they might influence how motivation quality affects exercise behavior. Methods Embedded in a controlled trial of a digital intervention aiming to promote exercise motivation, this study examined specific (longitudinal) pathways related to motivation quality, psychological need satisfaction and exercise behavior within the self-determination theory (SDT) process model in a sample of 318 adult employees. The participants completed web-based versions of Basic Psychological Needs in Exercise Scale, Behavioural Regulations in Exercise Questionnaire-2, and Leisure Time Exercise Questionnaire three times during a six weeks period. Results Moderation analyses revealed significant gender and age differences in the associations of motivation quality, basic psychological needs and exercise behavior over time. Several paths in the SDT-process model, linking psychological needs and motivation quality to exercise behavior, were moderated by gender and age. The stipulated mechanisms between exercise, motivation and psychological need satisfaction in the SDT-process model revealed to be stronger for women than for men, and stronger for older adults than for younger and middle-aged adults. The effect of amotivation on exercise was also significantly moderated by age in the full sample, by positively predicting light exercise for younger adults. Conclusions Future recommendations are related to the examination of potential differences in opportunities of autonomy support in the social context based on factors such as gender and age, and also to further examine these factors as potential moderators instead of statistically controlling them as default.

Objective: The primary aim of this study was to determine the prevalence and one-season incidence of symptoms of common mental disorders (CMD; distress, anxiety/depression, sleep disturbance, eating disorders, adverse alcohol use) among European professional football referees. A secondary aim was to explore the view of European professional football referees on consequences, support and needs related to these symptoms. Methods: An observational prospective cohort study with three measurements over a follow-up period of one season (2015-2016) was conducted among central or assistant professional football referees from Belgium, Finland, France, Germany, Norway, Russia, Scotland and Sweden. Using validated questionnaires to assess symptoms of CMD (self-reported and not clinically diagnosed), an electronic questionnaire in English and French was set up and distributed by the eight football federations involved. Results: A total of 391 referees (mean age of 33 years old; mean career duration of 7 years) were enrolled, of which 292 completed the follow-up period. Baseline 4-week prevalence rates were 6% for distress, 12% for anxiety/depression, 9% for sleep disturbance, 19% for eating disorders and 17% for adverse alcohol use. The one-season incidence of symptoms of CMD was 10% for distress, 16% for anxiety/depression, 14% for sleep disturbance, 29% for eating disorders and 8% for adverse alcohol use. Conclusion: While symptoms of CMD occur among professional football referees and can influence negatively refereeing performances, the development of specific support measures for referees are needed in order to manage properly these symptoms of CMD. © 2016 Informa UK Limited, trading as Taylor & Francis Group

The aim of the study was to examine how players perceptions of sociocultural factors and intra- and interpersonal aspects of sporting experiences may have influenced the emotions, cognitions, and behaviours of elite female soccer players prior to the occurrence of ACL injuries. The research questions guiding the study were: (a) how did female elite soccer players perceive that their psychosocial experiences were related to their cognitive, physiological, and emotional states prior to their ACL injuries, and (b) how did the players feel their perceived states influenced their behaviours prior to injury occurrence. The participants consisted of the total population of female players (N = 18) competing in the Swedish womens elite league, who incurred a total ACL tear during the 2012 season. Using a semi-structured interview guide, all players were interviewed post-season. We represented the data using a storytelling approach of aggregated creative nonfiction. The aggregated stories showed sociocultural rules and expectations of overtraining and placing pressure on athletes to play even if they were not physically or psychologically fit. Responding to pressures with potentially risk-increasing behaviours might raise the probability of becoming injured through a number of pathways. Team managers, coaches, and members of the medical team are recommended to develop environments that stimulate the players to engage in adaptive stress-recovery and risk-decreasing behaviours. Funding Agencies|Swedish Football Association

This single-subject case study adopted a narrative approach and focused on two objectives: (a) to explore an athlete’s career development, including the impact of injuries, and (b) to explore that athlete’s injury experiences in detail. The participant was a 26-year-old former elite handball player who had experienced two major anterior cruciate ligament injuries during his career. To guide the research process from the formulation of its objectives to the interpretation of the participant’s narratives, we followed the narrative-oriented inquiry framework. To collect the participant’s stories, a low-structured interview guide consisting of open questions and requests for information about the participant’s handball career and injury experiences was used. The holistic content analysis allowed us to conceptualise injuries as career transition processes embedded in the athlete’s career development. Moreover, the participant’s narratives made it possible to identify four phases of injury transition and the di...

This study is a description of a short-term digital exercise intervention based on the theoretical framework self-determination theory and tested in a controlled trial. The sample consisted of 318 adult women (n = 279) and men (n = 40) aged 23–67 years (M = 46.7; SD = 9.4) participating in a digital step contest provided by their employer. All participants completed study baseline measures via validated web-based versions of the following instruments: Basic Psychological Needs in Exercise Scale, Behavioural Regulations in Exercise Questionnaire-2, and Leisure Time Exercise Questionnaire. These measures were repeated twice, 3 weeks (post-intervention) and 6 weeks (follow-up) after study baseline. The experimental group had access to the intervention platform for three weeks. Data were analysed by analyses of covariance and mediation variable analysis. Results showed the intervention to affect exercise level and intensity as well as basic psychological need satisfaction and behavioural regulations. Intervention effects on amotivation post-intervention were found to mediate total exercise behaviour at follow-up. Moderation analyses showed intervention effects on light exercise to be stronger for those participants engaging in moderate or high levels of light activities at study baseline. Also, the effect on identified regulation was stronger for those with low levels of identified regulation at study baseline. This study adds to the knowledge on exercise motivation based on short-term intervention effects on level and intensity of exercise and physical activity. The use of mediating and moderating analyses uncover processes underlying the main intervention effects. Findings are discussed in relation to self-determination theory and previous research.

Several studies have suggested that psychosocial variables can increase the risk of becoming injured during sport participation.The main objectives of these meta-analyses were to examine (i) the effect sizes of relationships between the psychosocial variables (suggested as injury predictors in the model of stress and athletic injury) and injury rates, and (ii) the effects of psychological interventions aimed at reducing injury occurrence (prevention).Electronic databases as well as specific sport and exercise psychology journals were searched. The literature review resulted in 48 published studies containing 161 effect sizes for injury prediction and seven effect sizes for injury prevention.The results showed that stress responses (r = 0.27, 80 % CI [0.20, 0.33]) and history of stressors (r = 0.13, 80 % CI [0.11, 0.15]) had the strongest associations with injury rates. Also, the results from the path analysis showed that the stress response mediated the relationship between history of stressors and injury rates. For injury prevention studies, all studies included (N = 7) showed decreased injury rates in the treatment groups compared to control groups.The results support the model's suggestion that psychosocial variables, as well as psychologically, based interventions, can influence injury risk among athletes.

ObjectivesThe study aim was to explore the association of physical and psychosocial stressors (severe injuries, surgeries, recent life events, social support) with one-season onset of symptoms of common mental disorders (CMDs) among European professional football referees.MethodsAn observational prospective cohort study over a follow-up period of one season (2015–2016) was conducted among professional football referees from Belgium, Finland, France, Germany, Norway, Russia, Scotland and Sweden. Based on physical and psychosocial stressors as well as symptoms of CMD, an electronic questionnaire in English and French was set up and distributed by eight football federations involved.ResultsThe prevalence of symptoms of CMD ranged from 5.9% for distress to 19.2% for eating disorders. A higher number of severe injuries and a lower degree of satisfaction about social support were significantly related to the occurrence of symptoms of CMD with an OR of 2.63 and an OR of 1.10, respectively.ConclusionA higher number of severe injuries and a lower degree on satisfaction about social support were found to be significantly associated with the onset of symptoms of CMD among European professional football referees. Referees suffering from severe injuries were nearly three times more likely to report symptoms of anxiety and depression. Referees who reported a low satisfaction of social support were significantly more likely to report symptoms of eating disorder.

The main purpose of this study was to investigate relationships between self-report measures such as mood state, emotional recovery, and perceived exertion for a runner during a continental run. Se ...

The aim of the study was twofold, namely (i) to determine the prevalence of symptoms of common mental disorders (CMDs) among current and retired professional football and handball players and (ii) to explore the relationship of psychosocial stressors with the outcome measures under study. A total of 1155 players were enrolled in an observational study based on a cross-sectional design. Questionnaires based on validated scales were set up and distributed among current and retired professional football and handball players by the Danish football and handball players’ union. In professional football, the highest prevalence (4 weeks) of symptoms of CMDs was 18% and 19% for anxiety/depression among current and retired players, respectively. In professional handball, the highest prevalence (4 weeks) of symptoms of CMDs was 26% and 16% for anxiety/depression among current and retired players, respectively. For both the current and retired professional football and handball players, a higher number of severe injuries and recent adverse life events (LE) were related to the presence of symptoms of CMD. Players exposed to severe injuries and/or recent adverse LE were 20–50% times more likely to report symptoms of CMD. The results suggest that it is possible to recognize the population of professional athletes that are more likely to develop symptoms of CMD. This could create the opportunity to intervene preventively on athletes that suffered from severe injury and/or recent adverse LE that could lead to a faster and safer recovery and psychological readiness to return to play. © 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Andreas Ivarsson,1 Ulrika Tranaeus,2,3 Urban Johnson,1 Andreas Stenling 4 1Center of Research on Welfare, Health and Sport, School of Health and Welfare, Halmstad University, Halmstad, 2Performance and Training Unit, The Swedish School of Sport and Health Sciences (GIH), 3Musculoskeletal & Sports Injury Epidemiology Center, IMM, Karolinska Institutet, Stockholm, 4Department of Psychology, Umeå University, Umeå, Sweden Abstract: Previous research offers evidence that psychological factors influence an injured athlete during the rehabilitation process. Our first objective was to conduct a systematic review and meta-analysis of the results from all published studies that examined the relationships among negative affective responses after sport injuries, rehabilitation adherence, and return to play (RTP). The second objective was to use a meta-analytic path analysis to investigate whether an indirect effect existed between negative affective responses and RTP through rehabilitation adherence. This literature review resulted in seven studies providing 14 effect sizes. The results from the meta-analysis showed that negative affective responses had a negative effect on successful RTP, whereas rehabilitation adherence had a positive effect on RTP. The results from the meta-analytic path analysis showed a weak and nonsignificant indirect effect of negative affective responses on RTP via rehabilitation adherence. These results underline the importance of providing supportive environments for injured athletes to increase the chances of successful RTP via a decrease in negative affective responses and increase in rehabilitation adherence. Keywords: affective responses, rehabilitation behaviors, return to play, sport injuries

This review provides an overview of recent theoretical and empirical developments regarding psychosocial factors related to the prediction and prevention of sport injuries, and highlights some of the most interesting areas of investigation that have been carried out in the past few years. For instance, a systematic review of the most cited and used theoretical framework in the field has recently been performed, which supports the model's suggestion that psychosocial variables, as well as psychologically based interventions, can influence injury risk among athletes. Based on substantial empirical evidence it is also shown that changes in stress and perceived recovery appear to predict injury occurrence in sport. Current studies, focusing on overuse injuries, also suggest that cultural norms and rules can be seen as factors that can indirectly influence the risk of becoming injured. Future research directions are presented such as the need for interdisciplinary injury prevention programs based on a combination of physiological and psychological interventions.

The epidemiology of sport injuries is well documented. However, the costs are rarely discussed. Previous studies have presented such costs in specific sports or localization. No study has investigated the costs related to injuries in elite floorball. Thus, the aim of this study was to estimate cost of injuries in Swedish elite floorball players. During 1 year, 346 floorball players were prospectively followed. All time-loss injures were recorded. The injured players were asked to complete a questionnaire regarding their costs tied to the injury. Mean costs were calculated by multiplying the total resource use with the collected unit costs and dividing these total costs with the number of injuries as well as players. The results showed that the average cost per injury increased with the level of severity and ranged from 332 to 2358 Euros. The mild and moderate overuse injuries were costlier than the corresponding traumatic injuries. However, the severe traumatic injuries were associated with higher costs than overuse injuries. Knee injuries were the costliest. Our results indicate that there are costs to be saved, if floorball injuries can be avoided. They should be of interest to decision makers deciding whether to invest in preventive interventions.

Using a sample of student-athletes’ (N=64) first year (seventh grade) enrolled at a school with a sport profile, the aim of this longitudinal study was to investigate (a) levels and changes as regards to worry about sport performance, perception of peer climate, and perceived competence; and (b) the relationship in levels and changes between these studied variables. The primary results from latent growth models (LGMs) and parallel process LGMs revealed that, during their first year, the student-athletes’ level of worry and perceived ego-oriented peer climate increased, whereas perceived competence decreased. Further, the results showed that perceived competence was negatively associated with worry at the beginning of the students’ first year. The slope of perceived ego-oriented peer climate was positively associated with the slope of worry. Future research in relation to the findings is discussed, and recommendations for future actions are given.

Background Most of the research in the area of psychosocial factors in rehabilitation after sports injuries has focused on risk behaviors, while relatively few studies have focused on behaviors that facilitate rehabilitation. The objective of our study was to understand the psychosocial features that characterize elite female football players who express a resilient behaviour during rehabilitation after a first-time anterior cruciate ligament (ACL) injury and reconstruction. Methods A qualitative method was used based on individual in-person interviews and video communication of players who incurred a first-time ACL tear during the 2012 season of the Swedish Women’s Elite Football League. In total, 13 players had a first-time ACL and were interviewed post-season. The interviews were followed by a thematic content analysis. Based on this, eight players were identified as showing resilient behaviors during their rehabilitation and were included in the final analysis. Results Three core themes representing psychosocial factors that help players cope successfully with rehabilitation were identified: (I) constructive communication and rich interaction with significant others; (II) strong belief in the importance and efficacy of one’s own actions; and (III) the ability to set reasonable goals. Conclusions The findings suggest three core themes of psychosocial factors that characterize first-time ACL-injured elite female football players showing resilience during rehabilitation after ACL reconstruction. Suggestions for medical teams about ways to support communication, self-efficacy, and goal-setting during the rehabilitation process, are provided. © 2016 The Author(s). The study was financially supported by the Swedish Football Association (FA).