Sports Medicine Research: In the Lab & In the Field: The Importance of Positive Mental Outlook when Returning to Activity Following Hip Arthroscopy (Sports Med Res)
Friday, December 30, 2016

The Importance of Positive Mental Outlook when Returning to Activity Following Hip Arthroscopy

A Qualitative Assessment of Return to Sport After Hip Arthroscopy for Femoroacetabular Impingement

Tjong VK, Cogan CJ, Riederman BD, & Terry MA.  Orthop J Sports Med.  2016 Nov 17;4(11):2325967116671940

Take Home Message:  An optimistic outlook, positive coping strategies, and strong external social support are common characteristics found in individuals who returned to sport after hip arthroscopy for femoroacetabular impingement. 

Return to sport outcomes for femoro acetabular impingement (FAI) is relatively under researched as compared to that of anterior cruciate ligament reconstruction or shoulder instability.  To better understand the factors that influence a patient’s decision to return to sport after surgery for FAI, the authors conducted a qualitative study with 23 patients (18 and 60 years old) who underwent hip surgery for FAI.   An experienced interviewer conducted a 45-minute semi-structured interview with individuals who underwent hip surgery at least 2 years before and who participated in recreational sport prior to injury/surgery.  Thirteen participants returned to preinjury level of sport. Researchers continued enrollment until no new emerging themes were discovered.  They also compared interview data with validated patient-reported outcomes (modified Harris Hip Score, International Hip Outcome Tool, sport-specific subscale of the Hip Outcome Score, and a modified coping mechanism psychology score).  Interview data were coded and grouped into categorical commonalities. The authors found 3 key themes that influenced a person’s return to sport: self-efficacy, social support, and a resetting of expectations.  Participants who returned to play commonly cited an internal motivation to succeed, which was driven by innate characteristics such as optimism and determination along with the ability to use adaptive coping strategies (acceptance, humor, planning, and reframing).  Social support from family members, teammates, and healthcare providers was also an integral part of their ability to return to sport. Many people who never returned to sport discussed resetting their expectations. Participants who returned to sport also had better patient-reported outcomes. 

The findings from this study are important because clinical outcomes are mixed regarding return to activity for individuals recovering from FAI surgery.  Quantitative measurements have thus far yielded little explanation as to why some individuals are able to return to sport while others are not.  The authors found patient-reported differences that coincide with the patient-derived themes that emerged from the interviews. This suggests that psychosocial factors may play a large role in a patient’s ability to return to sport following hip arthroscopy for FAI. Hence, clinicians should adopt a holistic approach to treatment and consider if a patient is resetting their expectations. If an athlete wants to return to play then clinicians should encourage self-efficacy, positive coping strategies, and ensure they receive sufficient social support.

Questions for Discussion:  Do you notice a difference in your patients’ rehabilitative outcomes based upon personality/psychosocial characteristics?  What traits do you notice in your patients who achieve the best outcomes?  Is there some other factor you believe plays a role in return to sport after injury?

Reviewed by: Jeffrey Driban

Related Posts:
The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement
Time and Cost of Diagnosis for Symptomatic Femoroacetabular Impingement



Tjong, V., Cogan, C., Riederman, B., & Terry, M. (2016). A Qualitative Assessment of Return to Sport After Hip Arthroscopy for Femoroacetabular Impingement Orthopaedic Journal of Sports Medicine, 4 (11) DOI: 10.1177/2325967116671940

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