title: Psychosocial factors associated with outcomes of sports injury rehabilitation in competitive athletes: a mixed studies systematic review.
abstract: BACKGROUND
  The prime focus of research on sports injury has been on physical factors. This is despite our understanding that when an athlete sustains an injury it has psychosocial as well as physical impacts. Psychosocial factors have been suggested as prognostic influences on the outcomes of rehabilitation. The aim of this work was to address the question: are psychosocial factors associated with sports injury rehabilitation outcomes in competitive athletes?
  
  
  METHODS
  Mixed studies systematic review (PROSPERO reg.CRD42014008667).
  
  
  METHODS
  Electronic database and bibliographic searching was undertaken from the earliest entry until 1 June 2015. Studies that included injured competitive athletes, psychosocial factors and a sports injury rehabilitation outcome were reviewed by the authors. A quality appraisal of the studies was undertaken to establish the risk of reporting bias.
  
  
  RESULTS
  25 studies were evaluated that included 942 injured competitive athletes were appraised and synthesised. Twenty studies had not been included in previous reviews. The mean methodological quality of the studies was 59% (moderate risk of reporting bias). Convergent thematic analysis uncovered three core themes across the studies: (1) emotion associated with rehabilitation outcomes; (2) cognitions associated with rehabilitation outcomes; and (3) behaviours associated with rehabilitation outcomes. Injury and performance-related fears, anxiety and confidence were associated with rehabilitation outcomes. There is gender-related, age-related and injury-related bias in the reviewed literature.
  
  
  CONCLUSIONS
  Psychosocial factors were associated with a range of sports injury rehabilitation outcomes. Practitioners need to recognise that an injured athlete's thoughts, feelings and actions may influence the outcome of rehabilitation.
authors.affiliation: Applied Human Sciences Department, Faculty of Health and Life Sciences, York St John University, York, UK.
authors.forename: Dale
authors.identifier: http://orcid.org/0000-0003-4283-4356
authors.initials: D
authors.lastname: Forsdyke
authors.affiliation: Faculty of Health and Life Sciences, York St John University, York, UK.
authors.forename: Andy
authors.initials: A
authors.lastname: Smith
authors.affiliation: School of Sport, Health, and Social Sciences, Southampton Solent University, Southampton, UK.
authors.forename: Michelle
authors.initials: M
authors.lastname: Jones
authors.affiliation: School of Clinical and Applied Science, Faculty of Health and Social Sciences, Leeds Beckett University, Leeds, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Gledhill
mesh_terms: D000367:Age Factors; D001007:Anxiety; D056352:Athletes / Q000523:psychology*; D001265:Athletic Injuries / Q000523:psychology* / Q000534:rehabilitation*; D015982:Bias; D003071:Cognition; D004644:Emotions; D005239:Fear; D005260:Female; D006801:Humans; D008297:Male; D012737:Sex Factors; D016896:Treatment Outcome
keywords: Injury; Review; Sports