The implementation of a model for the rehabilitation of sports injuries

Van Heerden, Jacobus C. (Jacobus Christoffel) (2000-12)

Dissertation (PhD)--University of Stellenbosch, 2000.

Thesis

ENGLISH ABSTRACT: The present study was undertaken with the aim of developing and implementing a model for the rehabilitation of sports injuries. Injury is, without a doubt, one of the most significant obstacles to athletic performance. Very few, if any, athletes escape injury and it seems that regardless of experience and ability, all physically active individuals are prone to injury at some stage of their careers. The ability to resist injury and to rehabilitate well when injury does occur is fundamental to longevity in sport. Previous injury rehabilitation interventions commonly addressed only the physiological dimensions of injury, excluding the psychological dimensions. Only very recently has there been a shift in focus to include psychological principles in the treatment procedures, with Heil (1993) and Pargman (1993a) some of the first authors to publish works on the subject. A comprehensive literature review was done. In the first chapter attention was paid to the role of personality in injury occurrence and rehabilitation outcome, with special emphasis on the model of stress and athletic injury of Andersen and Williams (1993). An extension to this model, taking into account the role of personality, coping resources, cognitions, interventions and other injury and treatment related factors in the rehabilitation process was added by Grove (1993). The next chapter was devoted to the causes and stresses of sports injuries. Topics that were covered include the over-training syndrome, understanding injuries from the athlete's, physician's and psychologist's points of view and a study of what exactly the stresses involved in athletic injury are. Special attention was paid to the concept of pain and all its dimensions, the social well-being of the injured athlete and the impact of injury on the athlete's self-concept and identity. In the following chapter psychological adjustment to athletic injury was discussed. The concepts of loss and grief and applicability of grief response models in particular were discussed. In response to grief response models, cognitive appraisal models (Brewer, 1994) and an integrated model by Wiese-Bjomstal et al. (1998) were also discussed. Attention was given to the factors associated with rehabilitation adherence with particular remarks on malingering athletes. Peer modelling as a coping strategy in injury rehabilitation also came under scrutiny, as did the role and effect of social support. The next chapter focused on the development of the service-provider model for sports injury rehabilitation. From the initial literature review it was clear that of all the treatment providers involved with injured athletes, physiotherapists and biokineticians (athletic trainers) are probably those who spend the most time with them. In the development of the model for injury rehabilitation, special emphasis was therefore placed on the role of the physiotherapist and biokineticians. As a basis for developing the model, the traditional medical model was used, but it was adapted to incorporate psychological principles. A computer program was written to assist physiotherapists and biokineticians in treating injured athletes through the use of psychological principles. This program was constructed using psychological instruments that already exist, but they were adapted to be used as non-pen and paper tests. The tests used were the Emotional Responses of Athletes to Injury Questionnaire (ERAIQ), the Incredibly Short POMS (ISP), a Pain Drawing Instrument, a Visual Analogue Scale and the Affective subscale of the McGill Pain Questionnaire. Provision was made for handouts to be included in the program which can then be given to patients after each therapy session. To be able to determine whether the program was successful in assisting physiotherapists and biokineticians in their treatment of injured athletes, the program was evaluated in the next chapter. Feedback from both patients, physiotherapists and biokineticians using the program were received. Two short questionnaires were used for this purpose. Finally, conclusions were drawn from the information received from the program and recommendations based on these conclusions were made. Key words: Sports injuries, injury rehabilitation.

AFRIKAANSE OPSOMMING: Die doel van die huidige studie was die ontwikkeling en implementering van 'n model vir die rehabilitasie van sportbeserings. Beserings is, sonder twyfel, van die belangrikste struikelblokke in die weg van sportprestasie. Baie min, indien enige, atlete spring beserings vry. Dit wil ook voorkom of alle fisiek aktiewe individue, ongeag hulle ondervinding en vermoë, op een of ander stadium van hulle loopbane 'n besering opdoen. Fundamenteel aan volgehoue deelname aan sport, is die vermoë om beserings te vermy en om atlete suksesvol te rehabiliteer indien 'n besering welopgedoen word. In die verlede het rehabilitasie-intervensies hoofsaaklik die fisieke dimensies van beserings aangespreek sonder inagname van die sielkundige dimensies. Slegs on1angs het daar 'n klemverskuiwing begin plaasvind deurdat daar begin is om sielkundige beginsels in te sluit in behandelingsprosedures. Heil (1993) en Pargman (1993a) was van die eerste skrywers wat werke oor hierdie onderwerp gepubliseer het. 'n Uitgebreide literatuuroorsig is onderneem. In die eerste hoofstuk was aandag geskenk aan die rol wat persoon1ikheid speel in die voorkoms van beserings en die suksesvolle rehabilitasie daarvan, met spesiale klem op Andersen en Williams (1993) se model van stres en sportbeserings. Hierdie model is deur Grove (1993) uitgebrei deur inagname van die rol van persoon1ikheid, hanteringsvaardighede, kognisies, intervensies en ander beserings- en behandeling-verwante faktore in die rehabilitasieproses. Die volgende hoofstuk was gewy aan die oorsake van, en die stres verbonde aan, beserings. Onderwerpe wat aangespreek is, het ingesluit die ooroefeningsindroom, begrip van beserings soos gesien vanuit die atleet, medikus en sielkundige se oogpunte, asook presies watter faktore stres tydens beserings veroorsaak. Spesiale aandag is aan die konsep van pyn en al sy dimensies, die sosiale welstand van die beseerde atleet en die impak van beserings op die selfkonsep en identiteit van die atleet geskenk. In die volgende hoofstuk is die sielkundige aanpassing by beserings bespreek. Die konsepte van "verlies" en ''rou'' en die toepaslikheid van rouresponsmodelle in besonder, is bespreek. In antwoord op rou responsmodelle is kognitiewe waarderingsmodelle (Brewer, 1994) en die geïntegreerde model van Wiese-Bjornstal et al. (1998) bespreek. Aandag is ook geskenk aan faktore wat 'n rol in volgehoue deelname aan rehabilitasieprosedures speel, met klem op atlete met skynsiektes. Navolging van voorbeelde deur eweknieë as 'n hanteringsvaardigheid is ondersoek, asook die rol en effek van sosiale ondersteuning. Die volgende hoofstuk het gefokus op die ontwikkeling van die diensleweraar-model vir sportbeseringrehabilitasie. Vanuit die aanvanklike literatuuroorsig het dit geblyk dat van al die persone betrokke by die behandeling van beseerde atlete, dit waarskynlik fisioterapeute en biokinetici is wat die langste by hulle betrokke is. Tydens die ontwikkeling van die model vir rehabilitasie van beserings, is as basis die tradisionele mediese model gebruik, maar met sekere aanpassings om sielkundige beginsels in te sluit. 'n Rekenaarprogram is geskryf om fisioterapeute en biokinetici te ondersteun in die behandeling van beseerde atlete. Die program het gebruik gemaak van bestaande psigometriese toetse, maar dit was aangepas om as nie-potlood-en-papiertoetse gebruik te kan word. Die toetse wat gebruik is, is die Emotional Responses of Athletes to Injury Questionnaire (ERAIQ), die Incredibly Short POMS (ISP), 'n pyntekeninginstrument, 'n visueelanaloogskaal en die affektiewe subskaal van die McGill Pain Questionnaire. Voorsiening is gemaak na afloop van elke behandelingsessie om uitdeelstukke aan pasiënte beskikbaar te stel. Om te bepaal of die program suksesvol was om fisioterapeute en biokinetici tydens behandeling van beseerde atlete te ondersteun, is die program in die volgende hoofstuk kortliks geëvalueer. Terugvoer vanaf beide die pasiënte, fisioterapeute en biokinetici wat die program gebruik het, is verkry. Twee kort vraelyste is vir dié doel gebruik. Laastens is gevolgtrekkings op grond van die terugvoer gemaak en aanbevelings vir aanpassings is gedoen. Sleutelwoorde: Sportbeserings, rehabilitasie

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