Background: Psychological readiness to return to sports (RTS) may influence post-concussion recovery behaviors and subsequent injury outcomes.(1) Psychological readiness refers to an athlete’s mental and emotional preparedness – i.e., confidence – to return to sports following an injury. While RTS decisions post-injury are commonly based on physical assessments, considering psychological factors is also important.(2) The purpose of our study was to evaluate how psychological readiness to RTS changed between 2- and 8-weeks post-concussion-symptom-resolution, and whether readiness was associated with exercise volume/intensity during or after recovery and the occurrence of subsequent injury. Hypothesis: Psychological readiness would improve over time following symptom resolution, and lower Injury Psychological Readiness to Return to Sport (IPRRS) ratings, i.e., lower psychological readiness, would be associated with longer symptom resolution time and subsequent injury occurrence. Methods: We conducted a prospective cohort study of adolescents post-concussion. Participants were evaluated <21 days post-concussion (Visit 1 V1), 2-weeks post-symptom-resolution (Visit 2 V2), and 8-weeks post-symptom-resolution (Visit 3 V3). At V2 and V3, participants completed the IPRRS scale and reported sport-related injuries since the past visit (yes/no), average exercise volume (mins/week), and average exercise intensity (Borg Rating of Perceived Exertion) since the past visit. Paired samples t-tests assessed changes in outcomes between V2 and V3. Multivariable linear regression models evaluated associations between IPRRS ratings and predictor variables at each visit. Results: We enrolled 72 adolescents with a concussion (age=15.7±1.4 years; 50% female; V1=13.3+4.6 days post-concussion; V2=50.1±26.3 days post-concussion; V3=114.5±28.7 days post-concussion) . Exercise volume increased in the periods between V1-V2 and V2-V3 (217.8±194.9 mins/week vs. 321.3±216.5 mins/week; p<0.001 ) but intensity did not (Borg rating=13.7±2.1 vs. 14.1±2.7; p=0.39). Neither were significantly associated with IPRRS ratings. Mean IPRRS ratings improved from V2 to V3 (Figure). No variables examined were significantly associated with IPRRS ratings at V2 (Table). At V3, lower IPRRS ratings were associated with longer symptom resolution time, sustaining a sport-related injury during the V2-V3 period, and lower IPRRS ratings at V2 (Table). Conclusion: Though aerobic exercise is an established tool to manage symptom severity and duration following concussion, this study found no association between exercise volume/intensity and psychological readiness to RTS. Lower IPRRS ratings (lower psychological readiness) were associated with longer symptom resolution time and the occurrence of subsequent injury. These findings underscore the importance of facilitating timely symptom resolution and injury risk mitigation. Future work should seek to identify the associations between psychological readiness to RTS with long-term subsequent injury risk after concussion.
Richardson et al. (Mon,) studied this question.