Athletic Injury Experience: A Qualitative Focus Group Approach.

The current theory on response to injury is based on an appraisal process in which the athlete makes an interpretation of the meaning of the injury. The purpose of this study was to describe the athletic injury experience, focusing on the meaning of the injury from the perspective of injured athletes and student athletic trainers. The qualitative focus group method was utilized, with the main data coming from the transcribed interactions of participants (Morgan, 1997; Stewart & Shamdasani, 1990). There were four focus groups: two groups of student athletic trainers (N=8) and two groups of injured intercollegiate athletes (N=7). The interview data were inductively analyzed following procedures outlined by Tesch (1990). Seven categories of responses were identified from the data, including personal factors, effects on relationships, sociological aspects, physical factors, daily hassles, feelings associated with injury, and rehabilitation. Conclusions focused on the results in relationship to theoretical models, limitations, and possible future directions.

An injury can be one of the most difficult experiences in an athlete's career. A serious injury and subsequent rehabilitation time period could alter the athlete's mood state and elevate stress levels. Brewer and Petrie (1995) found that injured college football players had higher depression and life stress scores than uninjured players. These results are consistent with previous research demonstrating an increase in mood disturbance for injured athletes (Grossman & Jamieson, 1985; Leddy, Lambert, & Ogles, 1994; Smith et al., 1993). For these reasons, sport psychology research has focused on the psychological consequences of injuries sustained by athletes (Heil, 1993; National Athletic Trainers' Association, 1998; Pargman, 1999; Ray& Wiese-Bjornstal, 1999; Taylor & Taylor, 1997).

The current model to explain how athletes respond to an injury is based on how the injury is perceived by the athlete (Brewer, 1994; Wiese-Bjornstal, Smith, Shaffer, & Morrey, 1998). This "cognitive appraisal" approach suggests that an interaction between personal factors made up of injury aspects and individual characteristics, and situational factors made up of sport related factors, social aspects, and environmental conditions influence the thought process the athletes have about the injury (Wiese-Bjornstal & Shaffer, 1999). This cognitive response then influences the emotional response (e.g., anger, denial, depression, shock, etc.), and the behavioral outcomes (e.g., adherence to rehabilitation, use of social support networks, use of coping skills, etc.). The Wiese-Bjornstal et al. (1998) version of this model also emphasizes that the response to injury is dynamic and can change over time.

A number of research projects have supported aspects of the cognitive appraisal model, with a large number of variables hypothesized to be related to how an athlete will respond to an injury (See reviews by Wiese-Bjornstal et al., 1998; Wiese-Bjornstal, Smith and LaMott, 1995). The majority of these studies utilized traditional quantitative research methodologies, however, some authors have argued that this approach may not capture the entire injury experience, or fail to illustrate the complexity of the phenomenon (Evans & Hardy, 1995). One of the strengths of the cognitive appraisal approach is the explanation made for the individual differences in response to the injury, which may not emerge from traditional methodologies (Brewer, 1994). The response to injury is different for each athlete, with a number of factors contributing to the overall experience. Qualitative methodologies might be more successful in explaining the experience of athletes dealing with injuries.

There have been a couple of qualitative studies conducted that allowed athletes or performers to talk about their experiences. Rose and Jevne (1993) used a grounded theory methodology with a variety of athletes (amateur, collegiate, and professional) to document the process of the injury experience. They found a four-phase process: 1) getting injured, 2) acknowledging the injury, 3) dealing with the impact, and 4) achieving a physical and psychosocial outcome. Shelley (1999) found similar results with a study that utilized a phenomenological research design. Results from this study indicated that athletes' perceptions about injury change over the course of the injury process and emphasized the importance of the influential significant others (e.g., coaches and teammates) on the emotional response.

A major qualitative research project was conducted focusing on the psychology of injuries among skiers on the United States Ski team (Gould, Udry, Bridges & Beck, 1997a; Gould, Udry, Bridges & Beck, 1997b; Udry, Gould, Bridges & Beck, 1997a; Udry, Gould, Bridges & Tuffey, 1997b). This project consisted of in-depth interviews with 21 elite skiers who sustained season ending injuries. The investigators found a number of general dimensions associated with psychological response: perceived benefits of the injury, stress sources associated with rehabilitation, coping strategies, and social ties with significant others. Bianco, Malo, and Orlick (1999) also interviewed elite skiers from the Canadian Alpine Ski Team. They found that the injury process took place over three distinct phases (injury-illness phase, rehabilitation-recovery phase, and return to full activity phase), each of which was characterized by a set of events that influenced the emotional and cognitive responses.

The purpose of the current study was to provide a description of intercollegiate athletes' experiences with and response to, injury. This study differs from previous research, by compiling a dual perspective of the injury experience: injured athletes and student trainers. Examining the points of view from both perspectives can help draw a more complete picture of athletic injures. A qualitative approach was chosen because of the number and complexity of factors contributing to the overall experience. Potentially, the information from this study can provide further explanations on the athletes' response to injury.