Psychological Interventions Can Reduce Injury Risk in Athletes: A Critically Appraised Topic

Clinical Scenario: Injury prevention programs are becoming standard practice for reducing sports-related injuries, but most programs focus on musculoskeletal elements. Psychological factors can be strong predictors of sports-related injuries and there is recent evidence that suggests psychological interventions can be effective at reducing injury risk. It is unclear if injury prevention programs that focus on psychological factors are an important inclusion for athletic trainers/therapists. Athletes can be exposed to different psychological factors based on sport type including team or individual sports, which can increase their risk of injury. While psychological interventions can reduce injuries by addressing psychological symptoms, it is unclear if the interventions are effective for at-risk athletes in addition to athletes who are not suffering from any psychological factors. Currently, there are no guidelines or recommendations for athletic trainers/therapists to address psychological factors with the purpose of injury prevention. Clinical Question: Are psychological intervention programs effective in reducing sports-related injury risk and are they clinically relevant to athletic trainers/therapists for implementation in all settings? Summary of Findings: The authors searched the literature for studies investigating the use of psychological intervention programs to reduce sports-related injuries in an athletic population. The search returned 6 possible papers (2 systematic reviews without meta-analysis, 1 systematic review with a meta-analysis, 2 meta-analyses, and 1 randomized control trial not included in the systematic reviews). The authors narrowed our appraisal to one systematic review and one randomized controlled trial. The review contained all the studies from the previous review papers including 3 studies which performed screening procedures. The collection of evidence demonstrates positive effects associated with implementing psychological intervention techniques to reduce sports injury rates in all athletes; at-risk athletes, not at-risk athletes, and individual and team-sport athletes. Bottom Line: There is sufficient evidence supporting the use of a psychological-based intervention by athletic trainers/therapists to effectively reduce the number of injury occurrences in the athletic population. Direct comparisons of effectiveness between team and individual sports was not conducted in the research, but a substantial representation of both sport types existed. The current evidence includes a variety of athletic populations, at-risk and not at-risk, different sport types, and competition levels. Athletic trainers/therapists should consider the integration of psychological disciplines in current injury prevention practices to address the psychological concerns which put athletes at additional risk for injury. Strength of Recommendation: Grade B evidence exists to support the use of psychological intervention strategies in a well-developed injury prevention plan. Sports medicine practitioners can help athletes reduce stress, increase mindfulness, and be more aware of mental health practices which helps reduce injury risk.

Keywords: at-risk athletes; injury prevention; mindfulness; stress.

PMID: 34525450 DOI: 10.1123/jsr.2020-0315