Psychosocial factors associated with lower extremity re-injury risk in soccer players: Contribution of self- confidence, functional attention, and re-injury anxiety.

CONTEXT: Despite the availability of specialized assessment tools, psychological readiness is usually not considered when deciding to return to sport (RTS) after sport injury. Re-injury anxiety, self-confidence, and functional attention may be associated with sport re-injury, making it important to evaluate these factors before RTS.

OBJECTIVE: This study aimed to predict lower extremity re-injury in soccer players using self- confidence, functional attention, and re-injury anxiety as predictive variables.

DESIGN: Prospective cohort study.

SETTING: Laboratory.

PATIENTS OR OTHER PARTICIPANTS: Sixty-two male soccer players, who were older than 18 years of age, suffered from lower extremity injuries, had completed the rehabilitation program, and were ready to RTS.

MAIN OUTCOME MEASURES: Prior to returning to the sport, participants completed a pre-season questionnaire on their previous injuries, self-confidence, re-injury anxiety, and level of functional attention. The primary outcome measured was the risk of re-injury during the upcoming competitive season, and logistic regression was utilized to calculate odds ratios (OR) with 95% confidence intervals to determine the association between each risk factor and re- injury.

RESULTS: Overall re-injury rate was 5.56 injuries per 1000 hours of play. Self-confidence scores ≤ 47 increased the risk of re-injury by 2.26 times (relative risk, 2.26; 95% CI, 1.31-3.91; OR, 5.00; 95% CI, 1.56-16.04) and each unit increase in self-confidence score reduced the risk of re-injury by 10% (OR:0.90; CI: 0.82-0.99, p=0.03). Regarding re-injury anxiety, a score >22 was associated with 2.43 times the risk of re-injury (relative risk, 2.43; 95% CI, 1.44-4.13; OR, 6.46; 95% CI, 1.93-21.69) and each unit increase in re-injury anxiety score increased the risk of injury by 45% (OR:1.45; CI: 1.13-0.87, p=0.004).

CONCLUSIONS: Increased re-injury anxiety and decreased self-confidence are associated with higher odds of lower extremity re-injury in male soccer players. To reduce the risk of re-injury, athletic trainers and sport psychologists should take these psychological factors into account when evaluating the psychological readiness of soccer players with a history of lower extremity injury to RTS.