Introduction The various kinds of injuries sustained by the sports persons have tremendous impacts on the performers physical health conditions and performance. In addition, the injuries sustained also bear great consequences on the persons psychological and emotional conditions which consequently affects their performances over time. Common injuries in sports are often associated with immediate imbalances and disruptions in the psychological lives of the injured athletes reducing their athletics potentials considerably (Braskamp, 1986). Under extreme conditions, however, such injuries can result in permanent deformation or even death of the affected persons. The psychological effects of injuries sustained during sports bear serious psychological impacts associated with the feelings that the said athletes will not perform to their potential ever again. These feelings not only disturb the athletes mental conditions but also affects the physical health status of the persons. Coping measures to these varied kinds of injuries, therefore, is a called for the aspect that psychological studies seek to address. Due to these increasing needs for appropriate intervention mechanisms, research has suggested that injury rehabilitation measures ought to incorporate measures for psychological recovery as a critical perspective towards preventing and reducing the negative impacts and psychological consequences associated with these injuries. Moreover, such rehabilitation programs inserted into the medication procedures for the injured athletes can help the affected athletes to return their normal sporting activities upon recovery. Commensurate with these needs, research is underway to try and develop as well as implement the psychological interventions programs for use in rehabilitating the injured athletes and other sportsmen and women. One of the most common and highly devastating injuries that athletes sustain and endure in their career is the anterior cruciate ligament injury, commonly referred to as the ACL (McVeigh & Pack, 2014). A lot of research has focused on the different aspects of the ACL and athletes including the modes of sustaining the injuries as well as the treatment procedures adopted under clinical conditions. Basing on these researches, athletes who sustain these injuries are often treated and can return to the field to carry on with their career. However, while they are deemed fit for sporting after treatment, the emotional, as well as psychological impacts of the sustained ACL injuries, tend to remain a scar that affects their performances throughout their career in athletics (Benight & Bandura, 2004). Despite these evident psychological conditions, these facts are often overlooked by the trainers, coaches or the associated teams thus pose serious dangers to the athletes performances over time. The major causative factor for anterior cruciate ligament injury is the sudden twists of motions occurring on the knee of the athletes during landing or stepping. The anterior cruciate ligament plays a very big role in stabilizing the knee during running to prevent the anterior gliding of the tibia upon the femur (Benight & Bandura, 2004). During active sporting activities, the anterior cruciate ligaments often rapture thus inflicting serious injuries to the concerned sportspersons. Surgical reconstruction of the ruptured ligaments is the immediate form of treatment for this kind of injury. The post-operative goals of these surgical reconstructions aim to return the injured athletes back to the field within the first nine to twelve months following the completion of the operations (Shaw, 2002). Even though these operational procedures have been upgraded and more advanced in the recent past to allow the athletes to return to their active participation within four to six months following the operation, the psychological impacts of the injuries remain a tussle to battle (Shaw 2002). A lot of the literature focusing on the physiotherapy in rehabilitating the athletes who have incurred the ACL injuries have mainly focused on the physical treatment aspects (McArdle, 2010; Carson & Polman, 2008; Maddison et al., 2011). Investigations on the psychological aspects of these recoveries have received very little attention. As a result, a lot of emphasis has been laid on the rehabilitation programs that focus on the physical aspects while tending to ignore the psychological aspects. These critical ignorance are evident despite the athletes future sporting career obligations and aspirations being minimized and dashed by the incurred injuries. It is based on these reasons that effective rehabilitation programs for the injuries ought to give attention to the psychological processes that are involved in the recovery processes in the injured athletes. The most common psychological issues associated with the occurrence of ACL in athletes include depression, anxiety, and other generalized psychologically distressing conditions. Developing mechanisms for improving the psychological coping of the concerned athletes, therefore, is a critical factor that treatment procedures of adopted for the affected athletes needs to address effectively. Problem Statement Purpose Statement The purpose of the proposed Delphi study will be to gain consensus from an expert panel of coaches and athletic trainers on the most effective way to incorporate the psychological components of recovery into rehabilitation programs for college athletes who undergo ACL surgery. A Delphi panel is an assembly of a panel of experts who converge on their opinions and recommendation for recovering athletes to cope with the psychological symptoms of their injury, which prevents them from returning to play. Integrating the psychological component to address mental health issues could encourage athletes to return to play and compete in their sports. A purposive sample of 100 college and university coaches and athletic trainers will be recruited to participate in answering questionnaires for four rounds. The purpose of the questionnaires will be to gain coaches and athletic trainers perceptions and ideas for integrating a psychological component into rehabilitation programs for athletes who had ACL surgery. Importance of the study Delphi studies are suitable for gathering data from a convergence of opinions from a panel of experts. The Delphi study will also contribute to examining those interventions that are yet to be utilized to assist the recovering players to cope with the psychological symptoms of their injuries that hinder them from returning to sports. The Delphi study approach will allow the collection of data in the context of the programs used by athletic trainers and coaches as they work with injured athletes. The methodology involved in Delphi studies will consist of a panel of coaches and athletic trainers from colleges and universities who will be asked to answer questionnaires. The Delphi study, also known as the Delphi technique, is a well-accepted method for consensus-building. The method includes a feedback process which allows the respondents to reassess their previous answers to the questionnaires. Thus, data will be collected using this method from a panel of coaches and athletic trainers from colleges and universities. Qualitative analysis methods shall be used to analyze the data collected. The questionnaire responses shall be analyzed using the Statistical Package for Social Scientists (SPSS) to draw the correlations between the various aspects probed in the study. Research questions and hypotheses The Delphi study will explore how to integrate a psychological component to recovery for collegiate athletes returning to sports post ACL reconstructive surgery. The research questions stated below will guide this study: What is the level of consensus on how coaches and athletic trainers can incorporate psychological components into rehabilitation to address the mental health symptoms after ACL injuries? Theoretical framework The primary determinant of good performance in athletics is the level of motivation that an athlete has compared to the others on the same track. These arguments stem from the fact that every individual athlete is considered unique in their capacities and thus expresses different levels of ability in the field. Motivation comes from the knowledge of ones self-confidence in handling the field events in which they participate (Braskamp, 1986). These motivational needs in athletes as propelling factors to excel in athletics resonate effectively with the personal investments theory. Due to these, the affected athletes need to have a proper understanding of their medical conditions to assure themselves that they would get well and carry on with their normal activities. Based on these association facts, this research shall be guided under the premises of the personal investment theory. Personal investment theory The personal investment theory is grounded on the premise that meaning is centrally associated with the respective persons having the personal ability to make choices that affect their lives based on the sense (meaning) that these choices make to them. The theory is supported by various propositions that attempts to approve and derive their relevance to application. For instance, the theory argues that since personal motivations cannot be seen or measured, motivation can only be inferred. In this essence, the personal behavior patterns that replicate their motivation are referred to as personal investments. The personal investments include all things that a person does such as the performance in activities, expression of intensities of certain kinds of behavior, the persistence to commit to certain patterns of behavior and the specific results for the choices to become engaged in certain activities. All these factors constitute personal investments and vary from one person to another depending on the motivational inputs. Braskamp (1986) identified four key goals that influence motivation, especially among college students. These are discussed and described in Table 1 below. Table 1: Four principle factors that influence motivation Intrinsic factors Extrinsic factors Task-focused factors Ego-focused factors Social solidarity factors Extrinsic rewards factors £ Urge to understand something £ Experiencing adventure/ novelty £ Drive to do better than others £ Drive to winning £ Drive to please others £ Drive to make others happy £ Urge to win a prize £ Urge to make more money Every individual has personal goals that define their paths based on what they consider achieving in the future. Goals are defined by the aspirations based on what the individuals perceive as either attractive or unattractive at different points of their lives. These goals define what the athletes seek to invest their talent and treasures. Achieving personal goals are the key motivators to the athletes due to the rewards attained at the end. The prioritization of the goals is driven by personal incentives. The personal goals, incentives, and motivators in athletes are pegged on their talents and strengths, which enables them to prioritize and achieve the goals in the end. The Personal Investment Theory understand strength on the basis of self. These factors relate the personal values and purposes in life as the drives to achieving the goals and aspirations. The athletes self-knowledge and personal awareness regarding their strengths. The people who build on their personal strengths are more likely to be successful in the various activities they engage themselves or seek to pursue. Talents development are closely connected the theoretical foundations exemplified on the basis of positive psychological conditions (Gardner, Csikszentmihalyi & Damon, 2001). Good work: When ethics and excellence meet. New York: Basic Books.). Based on these realizations, it is important that athletes maintain a considerably apt psychological perspective for them to achieve the best results in their athletics activities. ACL injuries gravely affect the psychological standings of the respective individuals by inflicting feelings such as distress, anxiety and depression among others. These factors resonate negatively with the athletes ability to achieve the best results from their activities. It is, therefore, important for the recovery mechanisms to eliminate the psychological distortions that are evident in athletes who suffer anterior cruciate ligament injuries. Building a good psychological perspective helps the affected athletes to gain more courage, confidence and become well-equipped with strength and talent to achieve the best results. Scope, limitations, and delimitations This study is informed by the decreasing number of athletes returning to active sports after suffering anterior cruciate ligament injuries. This worrying trend has caused panic in the athletics communities as the impact is greatly increasing. The major reason is related to the psychological effects noted in the affected athletes and which consequently affect their perceptions towards their participation in sports. As a result, emerging studies have proposed the incorporation of psychological components in the rehabilitation process for the athletes who have suffered anterior cruciate ligament injuries. Based on these facts, this research study seeks to establish the level of consensus on methods for incorporation of psychological components into rehabilitation to address the discouragement college athletes feel after ACL injuries. Additionally, the study will concentrate its focus on determining the level of consensus on how coaches and athletic trainers can incorporate psychological components into rehabilitation to address the mental health symptoms after ACL injuries. In this regard, the study will analyze the various methods that incorporate the psychological aspects into the rehabilitation process for the athletes following ACL injuries. Based on these analyses, a consensus will be developed based on the level of agreement on their suitability. As such, the study will not focus on the methods that do not apply the psychological aspects in their rehabilitation programs but rather limit its boundary to the respective methodological procedures. The key participants in the research will be limited to athletic trainers and coaches whose views and perceptions shall be gathered regarding the various methodologies. The perceptions will then be used to develop the level of consensus. The scope of the study in terms of the target variables will be limited only to athletes in colleges and institutions of higher learning and not for commercial sportsmen and women. Further, the sample of the coaches and athletics trainers that shall be incorporated into the study shall be limited to 20. This choice if depended on the available time for which the research shall be conducted and the amounts of resources available for the study. Even though Ritchie & Lewis (2003) argues that the samples used in such researches as this should be wider to allow the generation of a standardized and harmonious agreement, time and resources available for research are major limiting factors when it comes to choosing representative sample frames. However, in-depth questionnaires and interviews shall be used to probe greater and in-depth details on the matters in order to generate dependable and reliable results. Moreover, the sampled coaches and athletics trainers shall be acquired from as wider location as possible to allow for uniformity and representativeness of the findings gathered. These measures shall compensate for the small sample size that will be used to gather the relevant data. Research Assumptions The core purpose of this research study is to evaluate the psychological impacts of the injuries caused as a result of the anterior cruciate ligaments due to which athletes hesitate to return to sports. In this respect, the study seeks to design recovery programs or interventions to address both physical and emotional components (Olofsson, Fjellman-Wiklund & Soderman, 2010). Accurate measures for psychological conditions of individuals is often a difficult and daunting task for psychological researches. It is assumed that the responses generated from the respondents will be well illustrated, in-depth and address all the study demands to enable comprehensive development of the research objectives to arrive at conclusive decisions. Like any other researches, this study shall also be guided by a set of assumptions that are illustrated in the succeeding sections. To begin with, it is assumed that the entire activities that shall be conducted to achieve the desired effects for the study will be managed and accomplished successfully within the set durational limit of 3 months. This period is expected to be fit for data gathering, analysis, and interpretation and for writing the final report. It is expected that no spill-over of activities or events shall be registered that would probably stretch the length of time indicated to accomplish all study demands. Additionally, it is also assumed that the study needs shall be catered for effectively and sufficiently within the set budget limit of $ 5,000. These funds shall cater sufficiently for research activities such as equipment and supplies, travel expenses, salaries and stipends for research associates and other related costs. It is expected that there will be no spillover in work schedules that would demand additional funds and that the amounts dedicated to the work and the contingency funds of $1,000 will cater for every research needs Summary and conclusion Anterior cruciate ligament injuries are a common occurrence among athletes in the sporting arena presently. These injuries bear serious consequences on the athletes future career as they affect the physical and emotional faculties of the affected athletes upon the following surgery to correct them. The major cause of the anterior cruciate ligament injury is the sudden twists of motions occurring on the knee of the athletes during landing or stepping. The role of the anterior cruciate ligament in the body I to stabilize the knee to keep it in position during movement. In competing athletes, the anterior cruciate ligament plays a very big role, especially during stepping or landing. The most common role is in stabilization of the knee when the athlete is in motion to prevent the anterior gliding of the tibia upon the femur. Upon rapture, this role is interfered with thus the anterior gliding of the tibia on the femur is made possible. These gliding motions are associated with severe pains in the affected athletes. The injury can be corrected surgically by reconstructing the ligament structure enabling it to play its role effectively. However, even after the surgical correction, it is evident that the number of the affected athletes returning to the field has continued to deteriorate through time. This low return rate is associated with the psychological effects that these injuries bear on the athletes. Such include depression, anxiety, stress and other associated psychological impacts. Unfortunately, the available surgical reconstructions of the raptured ligaments do not give consideration to the psychological fractures that are associated with the injuries. It is based on these realizations that this study seeks to develop a treatment program that would address the physical and psychological challenges that would cater for the psychological and physical effects resulting from anterior cruciate ligament injuries among athletes. References Ardern, C.L., Taylor, N.F., Feller, J.A., Webster, K.E., (2011). Return to the pre-injury level of competitive sport after anterior cruciate ligament reconstruction surgery: two-thirds of patients have not returned by 12 months after surgery. Am J Sports Med, 39(3):538??543. Ardern, C., Webster, K., Taylor, N., & Feller, J. (2011). Return to sport following anterior cruciate ligament reconstruction surgery: a systemic review and meta-analysis of the state of play. British Journal of Sports Medicine, 596-606. Ardern, C.L., Taylor, N.F., Feller, J.A., Webster, K.E., (2012). Return-to-sport outcomes at 2 to 7 years after anterior cruciate ligament reconstruction surgery. Am J Sports Med, 40(1):41 484. Ardern, C. et al. (2014). The impact of psychological readiness to return to sport and recreational activities after anterior cruciate ligament reconstruction. British Journal Sports Medicine, 48(22), 1-23. Ardern, C. L., Taylor, N. F., Webster & Whitehead, T. S. (2015). Sports Participation 2 Years after Anterior Cruciate Ligament Reconstruction in Athletes Who Had Not Returned to Sport at 1 Year: A Prospective Follow-up of Physical Function and Psychological Factors in 122 Athletes. American Journal of Sports Medicine, 43(4), 848-856. Benight, C.C., & Bandura, A., (2004). Social cognitive theory of post-traumatic recovery: the role of perceived self-efficacy. Behaviour Research and Therapy, 42, 1129-1148. Braskamp, L. (1986). The Motivation Factor: A Theory of Personal Investment. Retrieved May 24, 2016, from <https://www.researchgate.net/publication/232449585>. Carson, F., & Polman, C. J. (2008). ACL Injury Rehabilitation: A Psychological Case Study of A Professional Rugby Union Player. Journal of Clinical Sport Psychology, 2, 71-90. Gardner, H. M. Csikszentmihalyi, M., & Damon, W. (2001). Good work: When ethics and excellence meet. New York: Basic Books. Lentz, T. A. (2015). The psychology of returning to sports after ACL surgery. Retrieved from The psychology of returning to sports after ACL surgery Maddison, R. et al. (2011). Guided imagery to improve functional outcomes post-anterior cruciate ligament repair: randomized-controlled pilot trial. Scandinavian Journal of Medicine & Science in Sports, 1-6. Doi: 10.1111/j.1600-0838.2011.01325.x McArdle, S. (2010). Psychological Rehabilitation from Anterior Cruciate Ligament??Medial Collateral Ligament Reconstructive Surgery: A case study. Sports Health. 2010 Jan; 2(1): 73??77. DOI: 10.1177/1941738109357173. McVeigh, F., & Pack, S. M. (2015). An Exploration of Sports Rehabilitators and Athletic Rehabilitation Therapists Views on Fear of Re-injury After Anterior Cruciate Ligament Reconstruction. Journal of Sport Rehabilitation, 24(2), 140-150. Olofsson, L., Fjellman-Wiklund, A., &Soderman, K. (2010). From Loss towards Restoration: Experiences from Anterior Cruciate Ligament Injury. Advances in Physiotherapy, 12(1), 50-57. Ritchie, J. & Lewis, J., (2003). Qualitative Research Practice: A Guide for Social Science Students and Researchers. SAGE White, K., Di Stasi, S. L., Smith, A. H., & Snyder-Mackler, L. (2013). Anterior Cruciate Ligament- Specialized Post-Operative Return-To-Sports (ACL-SPORTS) Training: A Randomized Control Trial. BMC Musculoskeletal Disorders, 14(1), 1-10. Wierike, S. M., Sluis, A., Elferink-Gemser, M. T., &Visscher, C. (2013). Psychosocial Factors Influencing the Recovery of Athletes with Anterior Cruciate Ligament Injury: A Systematic Review. Scandinavian Journal of Medicine & Science in Sports, 23(5), 527-540.
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