تصویر و خودکارآمدی در زمینه مصدومیت Imagery and self-efficacy in the injury context

Injuries play a pivotal role in the careers of many athletes by causing both physical and psychological harm. How athletes manage their injuries can have a sizeable impact on their psychological and rehabilitation outcomes. Successful athletic injury rehabilitation is enhanced through proper adherence to a prescribed rehabilitation program (Bassett, 2006; Brewer et al., 2000). Further, previous research has shown that higher levels of selfefficacy are significantly associated with better adherence to such a program (Brewer et al., 2003; Milne, Hall, & Forwell, 2005; Woodgate, Brawley, & Weston, 2005). Therefore, self-efficacy may play an important role in an injured athlete’s motivation to recover, subsequent adherence to a prescribed rehabilitation program, and treatment outcome. A variable related to self-efficacy in rehabilitation is an injured athlete’s imagery use (Milne et al., 2005; Wesch et al., 2011). Imagery has been described as “an experience that mimics real experience, and involves using a combination of different sensory modalities in the absence of actual perception” (Cumming & Ramsey, 2008, p.5). Injured athletes report using four types of imagery (Driediger, Hall, & Callow, 2006; Rossman, 2002; Sordoni, Hall, & Forwell, 2002). Cognitive imagery is used to rehearse rehabilitation exercises, and motivational imagery is used to set goals, control arousal levels and increase self-confidence. Healing imagery entails imagining the physiological processes taking place during rehabilitation (e.g., tissue and/or bone healing), whereas pain management imagery involves images of pain dissipating or images that can help the athlete cope with the pain associated with an injury. Milne et al. (2005) investigated the relationships between injured athletes’ use of cognitive, motivational, and healing imagery and both task efficacy (confidence in one’s ability to perform the fundamental aspects of a task in a specific situational context) and coping efficacy (confidence in one’s ability to perform a task under challenging conditions or to overcome social, personal and environmental constraints). Imagery was assessed using the Athletic Injury Imagery Questionnaire (AIIQ-2; Sordoni et al., 2002) and self-efficacy was measured with the Athletic Injury SelfEfficacy Questionnaire (AISEQ; Milne et al., 2005; Sordoni et al. 2002). The questionnaires were administered in an outpatient physiotherapy clinic to 270 injured athletes, and cognitive imagery was found to be significantly associated with task efficacy but no other significant relationships emerged. A limitation of the AIIQ-2 and consequently research that has employed it (e.g., Milne et al. 2005) is that cognitive, motivational and healing imagery are assessed but not pain management imagery. Pain is the most pervasive and debilitating obstacle to effective rehabilitation experienced by injured athletes. It has significant physical and psychological effects in almost every aspect of recovery (Arvinen-Barrow & Walker, 2013; Heil, 1993). Therefore, pain management imagery may be an important resource for athletes involved in injury rehabilitation. Further, qualitative analysis does highlight that injured athletes use this type of imagery (e.g., Driediger et al., 2006). Thus, pain management imagery needs to be measured in order to overcome the limitation of the AIIQ-2 and previous injury-related imagery research that has used it. Consequently, in Study 1, the AIIQ-2 was adapted to include a pain management imagery subscale and the factorial validity tested. The aim of Study 1 was to develop a measure reflecting a broader range of types of imagery that injured athletes report using, which could then be used in Study 2. Another limitation of the imagery rehabilitation research is the lack of intervention studies conducted in this context. Given injured athletes report using imagery extensively during rehabilitation (Driediger et al., 2006; Evans, Hare, & Mullen, 2006) and that imagery interventions have proven to be effective in both sport and exercise (e.g., Duncan, Rodgers, Hall, & Wilson, 2011; MunroeChandler, Hall, Fishburne, Murphy, & Hall, 2012), it is somewhat surprising that only a limited number of imagery interventions have been conducted in the injury rehabilitation context. Strong support for an imagery intervention in injury rehabilitation is provided from a randomized-controlled trial (Cupal & Brewer, 2001), which examined the effect of guided imagery and relaxation on knee strength, re-injury anxiety, and pain among patients undergoing surgical reconstruction of the anterior cruciate ligament reconstruction. Results demonstrated significantly greater knee strength and significantly less re-injury anxiety and pain at 24-week post-surgery among the intervention compared with the placebo and control conditions. The only imagery intervention study considering self-efficacy was recently conducted by Maddison et al. (2011). The aim of this study was to evaluate the effectiveness of a guided imagery and relaxation program on improving functional outcomes postanterior cruciate ligament repair delivered over nine individual sessions as an adjuvant treatment to standard rehabilitation. A randomized controlled trial was conducted. Participants were randomized to guided imagery and standard rehabilitation or standard rehabilitation alone (control). The primary outcome was knee strength 6-month post-operatively, but other variables were also examined including knee laxity and self-efficacy. Following the intervention, the groups did not differ on knee strength but the intervention group demonstrated a significant positive effect for knee laxity. In addition, there was a significant group by time interaction for self-efficacy. Although self-efficacy decreased over time for both groups, in the intervention group it remained fairly stable between weeks 6 and 12 compared with the control group. However, the study by Maddison et al. (2011) has several limitation worthy of identification. Specifically, the intervention combined imagery and relaxation, thus it is not possible to partial out the independent influence of imagery on the outcome variables. In addition, a composite score for task and coping efficacy was used rather than examining each separately. Despite the limitations of this study, theoretically it is understandable that imagery may maintain or even enhance self-efficacy. Indeed, Bandura (1997) states that self-efficacy beliefs are constructed from four principle antecedents: enactive mastery experience, vicarious experience, verbal persuasion, and physiological and affective states, with imagery increasing self-efficacy via these antecedents. Related to the present context, for example, by using cognitive imagery (e.g., prior to performing a rehabilitation exercise, I am able to image myself completing it perfectly) injured athletes could gain enactive mastery experiences which may increase task efficacy. Given the paucity of intervention research in the injury context, and that research highlights changes in imagery use across early, mid and late phases of injury rehabilitation (Hare, Evans, & Callow, 2008) it would be prudent to conduct more research in this area, and to focus on one phase of rehabilitation. Further, the research investigating imagery use and self-efficacy have done so while the patients have been undergoing physiotherapy, rather than prior to commencing treatment, yet self-efficacy is proposed to be important for patients about to commence a rehabilitation program (cf. Lox, Martin Ginis, & Petruzzello, 2014). Thus, using a multiplebaseline single-subject design, Study 2 applies an imagery intervention in an attempt to improve the psychological state of five patients about to commence physiotherapy treatment through the use of imagery and its effects on task and coping efficacy. Based on the theoretical rationale that imagery enhances self-efficacy via its antecedents, it was hypothesised that the imagery intervention would result in higher task and coping efficacy in comparison to baseline.