Which psychosocial factors are associated with return to sport following concussion? A systematic review

Jacqueline van Ierssel; Kaleigh Ferdinand Pennock; Margaret Sampson; Roger Zemek; Jeffrey G Caron

doi:10.1016/j.jshs.2022.01.001

Which psychosocial factors are associated with return to sport following concussion? A systematic review

J Sport Health Sci. 2022 Jul;11(4):438-449. doi: 10.1016/j.jshs.2022.01.001. Epub 2022 Jan 10.

Authors

Jacqueline van Ierssel¹, Kaleigh Ferdinand Pennock², Margaret Sampson³, Roger Zemek⁴, Jeffrey G Caron⁵

Affiliations

¹ Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada. Electronic address: jminn044@uottawa.ca.
² Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5S 2W6, Canada.
³ Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.
⁴ Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada; Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada.
⁵ Faculty of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada; Center for Interdisciplinary Research in Rehabilitation, Montreal, QC H3S 1M9, Canada.

Abstract

Background: Psychosocial factors predict recurrent injury and return to preinjury level of performance following orthopedic injury but are poorly understood following concussion. Current management protocols prioritize physical measures of recovery. Therefore, the objective of this study was to describe the psychosocial factors associated with return to sport (RTS) and how they are measured in athletes who sustained a concussion.

Methods: MEDLINE, Embase, APA PsycINFO, CINAHL, and SPORTDiscus were searched through February 2, 2021. Eligible studies included original peer-reviewed publications describing psychosocial factors associated with RTS following a diagnosed concussion. The primary outcome was scales or measures employed and/or key thematic concepts.

Results: Of the 3615 studies identified, 10 quantitative cohort studies (Oxford Centre for Evidence-Based Medicine Level-3) representing 2032 athletes (85% male; high-school and collegiate collision/contact athletes) and 4 qualitative studies representing 66 athletes (74% male; 70% American football; aged 9-28 years) were included. We identified 3 overarching themes and 10 outcome measures related to psychosocial factors associated with RTS following concussion: (a) fear (e.g, of recurrent concussion, of RTS, of losing playing status); (b) emotional factors (e.g, depression, anxiety, perceived stress, mental health, disturbance mood); and (c) contextual factors (e.g, social support, pressure, sense of identity).

Conclusion: Although current medical clearance decisions prioritize physical measures of recovery, evidence suggests diverse psychosocial factors influence RTS following concussion. It remains unclear which psychosocial factors contribute to a successful RTS, including the influence of sex/gender and age. Future studies should evaluate the association of psychological readiness with physical measures of recovery at medical clearance, preinjury level of performance, and risk of recurrent concussion to support RTS clinical decision-making.

Keywords: Concussion; Recovery; Rehabilitation; Sport psychology; Sporting injuries.

Publication types

Review
Systematic Review

MeSH terms

Athletes
Athletic Injuries* / diagnosis
Brain Concussion* / diagnosis
Female
Football*
Humans
Male
Return to Sport