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Introduction
The prime focus of research on sports injuries has been on physical factors. 1 This is despite our understanding that when an athlete sustains a sports injury it has psychosocial impacts. 2 3 A common assumption has been that physical and psychosocial recovery occurs at the same time. Recently, it has been recognised that physical and psychological readiness to return to sport after injury do not always coincide. 4 This means that athletes may return to training and competition when they are physically but not psychologically ready.
Many athletes do not return to their preinjury level of activity, and even less return to competition. 5 6 Competitive athletes may be less likely to return to a preinjury level of performance than recreational athletes. 6 As rehabilitation takes place within social contexts involving many people, a key to effective rehabilitation may lie with psychosocial factors. 7 Psychosocial factors can be described as 'pertaining to the influence of social factors on an individual's mind or behaviour, and to the interrelation of behaviour and social factors'. 8 These factors have been identified as being important prognostic influences in a range of sports pathologies. 5 9-11
Psychosocial factors are also present within a number of models that have been applied or developed within this area. 2 12 13 These draw on stage-based, cognitive appraisal or biopsychosocial approaches and give a conceptual framework to work from, although no single approach predominates the evidence. 4
Three major systematic reviews have been published within this area. 14-16 These have addressed the need for transparency, methodological rigour and non-biased perspectives in reporting the empirical evidence. 17 Of the three reviews, two are exclusively focused on psychosocial factors influencing anterior cruciate ligament (ACL) rehabilitation. 15 16 While ACL injury has high personal impact, 18 this represents a narrow perspective and precludes any generalisation of the findings. To reduce injury-related bias there is a need to include other injuries which have the same prevalence, severity and chronicity (eg, high-grade lateral ankle sprain, rotator cuff tendinopathy). All of these reviews agree that psychosocial factors influence rehabilitation outcomes. However, differences in constructs were apparent across the reviews. Prominent factors highlighted in these reviews include motivation, self-efficacy, perceived control; 15 autonomy, relatedness, competence; 14 and affect, cognition,...