Psychological interventions used to reduce sports injuries: a systematic review of real-world effectiveness

Correspondence to Adam Gledhill, Carnegie School of Sport, Leeds Beckett University, Leeds LS6 3QS, UK; [email protected]

Introduction

The incidence of injury in sports ranges from 0.5 to 34 injuries/1000 hours,¹ with injury being one of the leading causes of early retirement from sport.² Sports injuries have significant psychosocial impacts on athletes that can influence the quality of return to sport (RTS), decrease the chance of RTS^{3 4} or increase the time taken to RTS.⁵ Injuries have financial⁶ and performance-related⁷ costs to teams. Injury prevention is a priority for sports injury practitioners (SIPs) and policymakers.⁸

Psychological factors are an intrinsic risk factor predisposing the athlete to injury, and should be considered for injury prevention programmes.^{8 9} As injury causation is multifactorial, it follows that injury prevention programmes should target each of the multiple causes. Psychological interventions have often been overlooked.^10–12 Consequently, a comprehensive systematic review would help form a knowledge base, providing SPIs with information regarding the effectiveness of psychosocial interventions for injury prevention and the quality of the evidence.

Psychosocial factors including attention disturbance, arousal levels, anxiety, stress, daily hassles and negative life events are predictive for sports injuries, and psychological intervention can help lessen the impact of these on individuals.^13–23 Psychosocial injury prevention strategies have been little used in sport.¹

Two recent systematic reviews concluded that psychological intervention strategies have the potential to reduce injury risk in broad populations of athletes.^{24 25} However, both reviews excluded studies that did not provide information that would allow them to complete the targeted statistical analyses.^{24 25} However, in the two previous systematic reviews, studies were excluded if they were not underpinned by the model of stress and athletic injury.²⁵ Consequently, these reviews may have excluded relevant evidence,³ and this could have implications for clinical decision-making.²⁶

In addition, the focus of both the most recent reviews has been evaluating the efficacy of psychological interventions, rather than their effectiveness. This is important as the effectiveness of systematic injury prevention involves examining efficacy, efficiency and compliance^{27 28} (see box 1 for key terms). Knowledge of intervention effectiveness will enhance understanding of sport psychology interventions in real-world environments.²⁹ Consequently, the research question...