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. Reinjury anxiety, self-confidence, and functional attention may be associated with sport reinjury, making it important to evaluate these factors before RTS. Objective To predict lower extremity reinjury in soccer players using self-confidence, functional attention, and reinjury 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 Measure(s) Before returning to the sport, participants completed a preseason questionnaire on their previous injuries, self-confidence, reinjury anxiety, and level of functional attention. The primary outcome measured was the risk of reinjury during the upcoming competitive season, and logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) to determine the association between each risk factor and reinjury. Results The overall reinjury rate was 5.56 injuries per 1000 hours of play. Self-confidence scores of ≤47 increased the risk of reinjury 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 reinjury by 10% (OR = 0.90; CI, 0.82–0.99; P = .03). Regarding reinjury anxiety, a score of 22 was associated with 2.43 times the risk of reinjury (relative risk = 2.43; 95% CI, 1.44–4.13; OR = 6.46; 95% CI, 1.93–21.69), and each unit increase in reinjury anxiety score increased the risk of injury by 45% (OR = 1.45; CI, 1.13–0.87; P = .004). Conclusions Increased reinjury anxiety and decreased self-confidence are associated with higher odds of lower extremity reinjury in male soccer players. To reduce the risk of reinjury, 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.