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Leatherman, Lindsey, "Multidisciplinary approach to injury rehabilitation: The D1 college athlete
perspective" (2024). Graduate Theses, Dissertations, and Problem Reports. 12582.
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Multidisciplinary approach to injury rehabilitation: The D1 college athlete perspective
Lindsey Leatherman, B.S., B.A.
Thesis submitted
to the College of Applied Human Sciences
at West Virginia University
School of Sport Sciences
in partial fulfillment of the requirements for the degree of
Master of Science in
Sport, Exercise, and Performance Psychology
Samuel Zizzi, Ed.D., Chair
Ashley Coker-Cranney, Ph.D.
Julie Partridge, Ph.D.
School of Sport Sciences
Morgantown, West Virginia
2024
Keywords: Injury, multidisciplinary model of care, collegiate student-athletes, social support
Copyright: 2024 Lindsey Leatherman
ABSTRACT
Multidisciplinary approach to injury rehabilitation: The D1 college athlete perspective
Lindsey Leatherman, B.S., B.A.
Sport injuries continue to be unavoidable disruptions in student-athletes’ athletic careers
with over 200,000 injuries estimated to be reported each year in college sport (Kerr et al., 2015).
Researchers continue to emphasize the importance of an interprofessional approach to
rehabilitation to help athletes manage the adverse psychological and emotional reactions to
injury (Appaneal et al., 2009; Gervis et al., 2020; Putukian, 2016). The purpose of this study was
to extend and replicate the research of Clement and Arvinen-Barrow (2021) by incorporating
perspectives of Division I US student-athletes. The current study describes 321 NCAA Division I
collegiate athletes’ experiences of receiving interprofessional care during injury rehabilitation. A
secondary purpose of the study was to explore perceptions of, and access to, sport psychology
professionals during rehabilitation. Participants were asked to complete a multidisciplinary team
categorization tool (e.g., primary vs. secondary), a modified version of the Social Support Survey
(Corbillon et al., 2008), open-ended questions, injury details, and demographic variables. After
several rounds of email and in-person recruitment lasting approximately three months, 321
Division I student-athletes across 16 NCAA conferences participated in the cross-sectional study.
Athletes placed athletic trainers, athletic coaches, and strength and conditioning coaches most
commonly on the primary rehabilitation team. Additionally, athletic coaches, strength and
conditioning coaches, and physicians were most frequently identified as secondary rehabilitation
team members. Overall, mental health supports were the most missed services identified by
participants. For those that did work with one of these professionals, the main themes that
emerged were helpfulness of a safe space and feeling supported beyond sport. This study
provided support for the use of the multidisciplinary model of sport injury rehabilitation within
the context of collegiate athletics.
College Athlete Perspective iii
Table of Contents
Multidisciplinary approach to injury rehabilitation: The D1 college athlete perspective..... 1
Methods.......................................................................................................................................... 5
Design ......................................................................................................................................... 5
Participants.................................................................................................................................. 5
Procedure .................................................................................................................................... 6
Measures..................................................................................................................................... 7
Demographics..................................................................................................................... 7
Multidisciplinary Team Categorization .............................................................................. 7
Modified Social Support Survey......................................................................................... 8
Open-ended questions......................................................................................................... 8
Data analysis............................................................................................................................... 9
Results.......................................................................................................................................... 10
Demographics........................................................................................................................... 10
Primary and Secondary Team Categorizations......................................................................... 11
Perceptions of Social Support During Rehabilitation............................................................... 12
Effect of Sport Type and Rehabilitation Length on Social Support Perceptions ..................... 13
Sport Type Categorizations............................................................................................... 13
Length of Rehabilitation ................................................................................................... 13
Qualitative Analyses of Open-Ended Responses...................................................................... 14
Rehabilitation Team Members’ Categorizations.............................................................. 14
Identification of Missing Professionals ............................................................................ 15
Experiences Working with Either an SPC or LMHP........................................................ 15
Discussion .................................................................................................................................... 16
Limitations................................................................................................................................ 22
Conclusions............................................................................................................................... 23
References.................................................................................................................................... 25
Tables........................................................................................................................................... 32
Table 1 ...................................................................................................................................... 33
Demographic Information on the Participants Who Provided Their Information................... 33
Table 2 ...................................................................................................................................... 34
Injury Descriptives of Participants........................................................................................... 34
Table 3 ...................................................................................................................................... 35
Identified Members of Injury Rehabilitation Process and Perceptions of Support.................. 35
Table 4 ...................................................................................................................................... 36
College Athlete Perspective iv
Means, Standard Deviations, and Results of Mixed Analyses of Variance Regarding Variables
Influencing Social Support Scores............................................................................................ 36
Figures.......................................................................................................................................... 37
Figure 1 ..................................................................................................................................... 38
Frequencies of professionals/individuals identified as either the primary or secondary sport
injury rehabilitation team. ........................................................................................................ 38
Figure 2 ..................................................................................................................................... 39
Social Support Means and Sport Type...................................................................................... 39
Figure 3 ..................................................................................................................................... 40
Social Support Means and Rehabilitation Length: Currently Completing Rehabilitation....... 40
Figure 4 ..................................................................................................................................... 41
Social Support Means and Rehabilitation Length: Previous Completion of Rehabilitation.... 41
Figure 5 ..................................................................................................................................... 42
Frequencies of different categories of professionals/individuals distributed between the
primary and secondary sport injury rehabilitation teams........................................................ 42
Figure 6 ..................................................................................................................................... 43
Structure of multidisciplinary team to rehabilitation: primary and secondary teams ............. 43
43
Appendix A: Extended Literature Review ............................................................................... 44
Introduction............................................................................................................................... 44
Psychological Factors Influencing Sport Injury ....................................................................... 45
Psychosocial Responses of Injury Rehabilitation............................................................. 45
Psychological/Emotional Responses to Sport Injury............................................ 49
Professionals Involved in Injury Rehabilitation ....................................................................... 52
Athletic Trainer................................................................................................................. 52
Education .............................................................................................................. 52
Current Usage and Understanding of Sport Psychology Interventions ............... 55
Perceptions of Interprofessional Practice Model to Injury Rehabilitation .......... 57
Sport Psychology Consultant............................................................................................ 60
Education and Competencies................................................................................ 60
Perceptions Toward Interprofessional Approach to Injury Rehabilitation.......... 61
Athlete............................................................................................................................... 62
Perceptions and Responses of Psychological Interventions During Injury.......... 62
College Athlete Perspective v
Attitudes and Perceptions Towards Multidisciplinary Approach......................... 65
Proposed Professional Practice Models for Injury Rehabilitation............................................ 66
Summary................................................................................................................................... 69
References.................................................................................................................................... 72
College Athlete Perspective 1
Multidisciplinary approach to injury rehabilitation: The D1 college athlete perspective
Sport comprises a large part of society and remains popular with people of all age levels.
The National Federation of State High School Association reported over 7.5 million youth
participating in high school athletics during the 2021-2022 academic year, and in continuation,
528,627 athletes were reported to be participating across all divisions within the National
Collegiate Athletic Association (NCAA: 2021). Considering the high number of athletes
involved in sports, it is expected that many will encounter injuries during their careers.
Injuries continue to be an unavoidable reality encompassing complex components that
athletes must overcome during the recovery process. Along with the physical detriments,
emotional consequences of injuries can emerge in many different forms such as frustration,
anxiety, and depression (Appaneal et al., 2009; Putukian, 2016). Numerous factors can impact
the way an athlete perceives an injury and how that individual approaches the rehabilitation
process. The Integrated Model of Response to Sport Injury (Wiese-Bjornstal et al., 1998)
provides a comprehensive framework for understanding the sport injury experience, identifying
involvement of both personal factors (e.g., athletic identity, self-motivation, and motivational
orientation) and situational factors (e.g., social support, rehabilitation environment, and sport
culture) that influence athlete cognitions, emotions, and behaviors, in turn affecting treatment
outcomes. Previous researchers have identified that an injured athlete’s personal and situational
factors are likely to affect risk behaviors (e.g. overadherence and inclination to prematurely
return to sport) and beliefs following injury (Podlog et al., 2013). The most frequently reported
emotional responses to more severe athletic injuries, that require at least 8 weeks out of sport, are
depression and anxiety (Gervis et al., 2020). With the wide array of both physiological and
emotional factors that can present during an athlete’s injury recovery process, and their ultimate
College Athlete Perspective 2
impact on treatment outcomes, it is imperative to understand the comprehensive impact of these
injuries on athletes’ overall well-being.
In rehabilitation, a diverse team of professionals may be involved to address the various
physical and psychological aspects of the injury recovery process. Within college athletics,
certified athletic trainers (ATCs) are recognized by both themselves and other professionals as
the directors of an athlete’s injury rehabilitation process (Arvinen-Barrow & Clement, 2015;
Kraemer et al., 2019). Along with providing essential social support to the athlete for a
successful recovery and return to sport (Bianco, 2001; Clement et al., 2015), ATCs also refer to
and collaborate with other professionals as needed.
While athletic trainers are well-educated and highly trained in addressing the physical
aspects of injuries, they often receive limited training regarding the emotional ramifications of
injury (CAATE, 2020). Nonetheless, many ATCs recognize the importance of providing
psychological support to injured athletes (Clement et al., 2013; Cormier & Zizzi, 2015). In a
study by Cormier and Zizzi (2015) assessing ATCs’ abilities to identify psychological concerns
and make appropriate referral decisions, 43% of the 326 respondents believed it was their
responsibility to implement psychosocial interventions during injury rehabilitation, despite other
research indicating a lack of training and confidence in this domain (Arvinen-Barrow et al.,
2010; Zakrajsek et al., 2017). Furthermore, Cormier and Zizzi (2015) found that while ATCs
showcased a strong ability to recognize psychological concerns, many struggled to match
suitable interventions with varying levels of distress. Thus, when an injured athlete presents with
potential mental health concerns, it may be appropriate for an ATC to refer or consult with other
professionals, such as sport psychology professionals or licensed mental health providers
(LMHP), who are better equipped to provide psychosocial interventions. These mental
College Athlete Perspective 3
performance or mental health professionals can assist throughout the injury rehabilitation process
by addressing important components of psychological readiness regarding athletes returning to
sport such as focus, confidence, and realistic expectations (Donald et al., 2024).
Interprofessional collaboration, defined as a “mutually beneficial and well-defined
relationship entered into by two or more [professionals] to achieve common goals” (Mattessich
& Monsey, 1992, p. 7), is essential within college sport injury rehabilitation. For instance, an
ATC may collaborate with a physician, sport psychology consultant, registered dietitian, certified
strength coach, or any other necessary professional to facilitate comprehensive care for the
injured athlete. Research indicates that ATCs recognize the importance of interprofessional
collaboration in the successful rehabilitation of injured athletes (Arvinen-Barrow & Clement,
2017). Additionally, Zakrajsek and colleagues (2016) documented many ATCs already engaging
in interprofessional practice within the collegiate setting.
Further research has examined the perspectives of sport psychology consultants (SPCs),
other professionals involved in interprofessional practice within injury rehabilitation. ArvinenBarrow and Clement (2017) explored the experiences and views of 62 SPCs regarding
interprofessional care teams based on the proposed multidisciplinary team approach to sport
injury rehabilitation (Clement & Arvinen-Barrow, 2013) through an online survey. The study
revealed substantial support for the importance of injured athletes’ access to an interprofessional
care team during injury rehabilitation, with approximately 95% of SPCs endorsing each
individual listed in the conceptual multidisciplinary care team model (Clement & ArvinenBarrow, 2013) as being integral to the interprofessional rehabilitation approach (Arvinen-Barrow
& Clement, 2017).
College Athlete Perspective 4
Despite being central to the injury rehabilitation process, there are fewer documented
cases attempting to capture athletes’ perspectives within interprofessional practice. Clement and
Arvinen-Barrow (2021) retrospectively explored the experiences of 182 former high school
athletes regarding their involvement in interprofessional care during injury rehabilitation.
Participants were asked to complete both a blank multidisciplinary team diagram and draw a
sociogram, visually depicting the communication patterns among care team members during
their rehabilitation. Notably, athletes more frequently included coaches and family as part of the
primary care team than the secondary team, which differed from the proposed model. However,
no research has examined multidisciplinary teams through the lens of college-level athletes.
Recently, the NCAA has mandated Division I schools to provide mental health services
to athletes, either directly through their athletic departments or through campus services (Brutlag
Hosick, 2019). However, the extent to which these services have been integrated and utilized
within the injury context has not been explored. While the current literature on interprofessional
approaches to injury rehabilitation demonstrates the perspective of high school athletes, athletic
trainers, sport psychology consultants, and team dynamics, the viewpoints of collegiate athletes
are notably absent.
The purpose of this study was to replicate elements of Clement and Arvinen-Barrow’s
(2021) research within the collegiate athlete population while simultaneously expanding
knowledge surrounding current athlete experiences within a multidisciplinary approach to injury
rehabilitation. Therefore, the research questions were: 1a) Who do college athletes interact with
during their injury rehabilitation? 1b) Do injured collegiate athletes’ experiences align with the
multidisciplinary sport injury rehabilitation team model? 2a) How satisfied are injured athletes
with support received during rehabilitation? 2b) Does sport type or rehabilitation length
College Athlete Perspective 5
influence support perceptions? 3a) Who did athletes wish to interact with during rehabilitation
but did not, and why? 3b) What are injured collegiate athletes’ experiences with sport
psychology consultants or licensed mental health professionals during rehabilitation?
Methods
This section outlines the methodological approach including research design, participant
selection, data collection procedures, and data analysis methods. The objective was to explore
the experiences and perspectives of collegiate student-athletes regarding their interprofessional
rehabilitation teams, using a comprehensive approach to gather both qualitative and quantitative
data.
Design
A multimethod cross-sectional survey design was used to collect descriptive data
exploring college athletes’ experiences of the injury rehabilitation process. This approach was
grounded in Clement and Arvinen-Barrow’s framework, facilitating comparison with the
multidisciplinary model of care for sport injuries and across the variables of sport type and
rehabilitation length. Descriptive research is used to identify the how, when, and where of a
particular situation by attempting to identify characteristics, frequencies, trends, and/or
categories to provide surrounding context (Baumgartner et al., 2021).
Participants
Participants were purposively recruited from NCAA Division I collegiate institutions
across the United States. The inclusion criteria for schools selected included (1) the institution
was an NCAA DI school and (2) a secondary team member was available to injured athletes
from at least one professional (e.g. sport psychology consultant and/or licensed mental health
provider). The researcher determined if institutions met the inclusion criteria by accessing
College Athlete Perspective 6
athletic department websites or upon correspondence with a professional employed within the
athletic department at targeted schools. The second level of sampling occurred for Division I
student-athletes currently enrolled at the recruited NCAA DI institutions. To be included in the
study, participants had to 1) be current student-athletes, 2) be either currently completing injury
rehabilitation at their current institution or have previously completed injury rehabilitation during
their time at their current institution and 3) the reported injury required time out of sport as
prescribed by either a certified athletic trainer or medical doctor.
Procedure
Following Institutional Review Board approval in the Fall of 2023, the researcher
recruited participants by visiting undergraduate classes at one institution. Upon arrival to the
classroom, the researcher introduced the study (i.e., purpose, potential benefits, time
commitments) and provided a QR code for interested participants to scan, directing them to the
Qualtrics survey. During the same period, the researcher sent recruitment emails to employees
(e.g. athletic directors, coaches, sport psychology consultants) within the athletic departments of
institutions that met the inclusion criteria to request the participation of student-athletes at those
institutions. The researcher informed these contacts of the study information including the
purpose, potential benefits, and time commitments, and included a link for the Qualtrics survey.
These methods persisted for over one month. The third method of recruitment began when the
researcher collected and emailed student-athletes, individually. The researcher again, through a
recruitment script, provided potential participants with the study information, potential benefits,
time commitments, and a link to the online Qualtrics survey. Data collection occurred for a total
of three months. Through these recruitment methods, 12,606 emails were sent to individual
student-athletes and 424 college students were present for in-person recruitment. Out of the
College Athlete Perspective 7
13,030 total potential participants contacted, 742 responses were received resulting in a response
rate of 5.7%. This percentage is a slight underestimate due to the limitations in calculating inperson and email response rates independently. Of the responses received, 321 respondents met
inclusion criteria for the present study. Each participant was contacted only once.
Measures
Demographics
Participants were asked to report age, gender, sport type, school conference, injury type,
rehabilitation length, current rehabilitation status (i.e. currently or not currently completing), and
previous injury experience.
Multidisciplinary Team Categorization
The titles of all professionals/individuals who may have participated as part of the
rehabilitation team, according to Clement and Arvinen-Barrow (2013), were listed in random
order for the athlete to choose from and categorize into either primary or secondary care teams.
The definitions of the terms primary care team and secondary care team were provided for
participants. Primary care team members were defined as “[professionals and/or individuals]
who work closely with the injured athlete from injury occurrence through the entire
rehabilitation process until their successful return to [sport]”. The secondary care team was
defined as “[professionals and/or individuals] who have varying degrees of interaction
throughout the [athlete’s] injury rehabilitation”. Athletes were instructed to first select
professionals/individuals from the randomized list and then asked to categorize only those
selections.
College Athlete Perspective 8
Modified Social Support Survey
Participants were then asked to complete a modified version of the Social Support
Survey (SSS; Corbillon et al., 2008). This modified SSS consisted of three items designed to
assess perceived satisfaction with social support using a 5-point Likert scale (1 = very
dissatisfied to 5 = very satisfied). The items asked, “In general, how satisfied were you with the
quality of support you received during your rehab?”
First, participants rated their perceived satisfaction with support from each individual or
professional they specified as part of their injury rehabilitation team from the multidisciplinary
team categorization instrument. Next, they rated their satisfaction with the overall quality of
support received during their rehabilitation. Finally, participants rated their satisfaction with
support from their reported primary rehabilitation team and their reported secondary
rehabilitation team.
Open-ended questions
Finally, participants were invited to answer four open-ended questions, including: (1)
“Describe why you rated the level of support provided by your primary rehabilitation team the
way you did. Feel free to comment on individuals in your primary rehabilitation team that were
more or less helpful/supportive in your recovery,” (2) “Describe why you rated the level of
support provided by your secondary rehabilitation team the way you did. Feel free to comment
on individuals in your secondary rehabilitation team that were more or less helpful/supportive in
your recovery,” (3) “Which services would you have liked to receive during your rehabilitation
that you did not get? For each service you missed, please describe how you believe the inclusion
of that service would have helped your injury rehabilitation,” and (4) for those who included a
CMPC or LMHP in their multidisciplinary team, “You indicated a sport psychology consultant
College Athlete Perspective 9
or licensed mental health professional as part of your injury rehabilitation team, please describe
your experience with this professional including what was helpful and/or unhelpful.”
Pilot Study
Before recruiting participants, the researcher conducted pilot testing of the survey
materials. Cognitive interviews were conducted with four current NCAA Division I studentathletes who met the study’s inclusion criteria and two former DI student-athletes who
retrospectively met inclusion criteria. Pilot study participants were directed to complete the
survey and encouraged to provide commentary on their thoughts. There were minor adjustments
made to the survey based on the responses from the six cognitive interviews.
Data analysis
The researcher conducted the quantitative data analysis for this study using SPSS to
address several research questions. Descriptive statistics were calculated for demographic
variables. Frequencies of interactions with various professionals or individuals were calculated
and visually represented in a diagram to compare with the published multidisciplinary sport
injury rehabilitation model (Clement & Arvinen-Barrow, 2013). This descriptive comparison
allowed for the identification of similarities and differences in the interactions reported by
collegiate athletes as compared to professionals during their rehabilitation process.
Dependent t-tests were conducted to assess perceptions of satisfaction with the social
support received from the various professionals and individuals identified, using mean scores.
This analysis facilitated comparisons of support satisfaction across different levels of the
rehabilitation team and among individual professionals.
Additionally, the researchers performed 2x2 mixed-ANOVAs to examine the impact of
sport type and rehabilitation length on social support perceptions. Initial analyses confirmed the
College Athlete Perspective 10
normality of the data and verified that all theoretical assumptions were met. Interaction graphs
illustrated the effects of the independent (i.e., sport type, rehabilitation length) variables on the
dependent variable (i.e., social support). The independent variable “sport type” (individual vs.
team sport athletes) was chosen to explore potential differences in social support, considering
team sport athletes may have access to larger support networks and are accustomed to working
within a team dynamic towards collective goals. The independent variable “rehabilitation length”
was chosen to explore if the amount of time spent in rehabilitation influenced perspectives of
social support, hypothesizing that extended rehabilitation lengths may increase interactions with
a broader range of rehabilitation team members.
Utilizing thematic analysis (Braun & Clarke, 2012), the researcher identified and
interpreted significant patterns of data within participants’ open-ended responses. Specifically,
thematic analysis permitted a nuanced understanding of collegiate athletes’ injury rehabilitation
experiences and their interactions with sport psychology and mental health professionals via
theme identification. Furthermore, the researcher integrated the identified themes with the
quantitative findings to enrich the explanation of the data.
Results
Demographics
Participants included 321 collegiate student-athletes representing 21 different NCAA
Division I sports and 16 different conferences; 104 participants did not provide demographic
information (e.g., sport, college conferences, gender, race). Given that approximately one-third
of the participants did not complete the demographic questionnaire, there may be additional
sports and conferences represented that were not fully documented in the analysis. The average
age of participants completing the web-based questionnaire was 20.3 years old (SD = 1.4). Of
College Athlete Perspective 11
these participants, 69% (n = 149) self-identified as female, 29.6% (n = 64) as male, 0.9% (n = 2)
preferred not to disclose their gender, and 0.5% (n = 1) identified as non-binary/third gender.
Most of the sample identified as White or Caucasian (81.5%, n = 176). For a detailed breakdown
of demographics, see Table 1.
Regarding rehabilitation status, 55.6% (n = 178) of participants were currently
completing injury rehabilitation protocols at the time of data collection, whereas 44.4% (n = 142)
reported previous completion of injury rehabilitation protocols. Using the Orchard Sport Injury
and Illness Classification System (OSIICS; Rae & Orchard, 2007), respondents most commonly
reported injuries to the lower limbs (e.g., knee, thigh, ankle; 54.7%; n = 173). In terms of injury
severity, 72.6% (n = 233) reported severe injuries requiring over 4 weeks of rehabilitation, with
the minority (27.4%; n = 88) reporting injuries requiring less than 4 weeks of rehabilitation. For
detailed percentages of other injury locations and severities, see Table 2.
Primary and Secondary Team Categorizations
Among the primary care team, the most frequently identified members included athletic
trainers (n = 264), athletic coaches (n = 106), strength and conditioning coaches (n = 92), and
physicians/orthopedic surgeons (n = 92). For the secondary rehabilitation team, the most
frequently identified members were athletic coaches (n = 112), strength and conditioning
coaches (n = 105), and teammates (n = 104). For the visual representation corresponding to this
data, consult Figure 1.
Athletic coaches (n = 106) were the second most frequently reported professionals on the
primary care team, but a higher percentage of participants (51.4%; n = 112) associated this
profession with the secondary rehabilitation team. Similarly, strength and conditioning coaches
College Athlete Perspective 12
were the third most identified members of the primary rehabilitation team (n = 92) but were more
frequently placed on the secondary care team (n = 105).
Mental health and mental performance professionals (i.e. psychiatrists, sport
psychologists, clinical/counseling psychologists, sport psychology consultants, licensed mental
health providers) were identified a total of 139 times as primary or secondary caregivers.
Specifically, 20% of participants (n = 82) reported that a sport psychologist was involved in their
injury rehabilitation process. Additionally, 8.8% of participants noted the involvement of
licensed mental health providers, 6.6% identified sport psychology consultants, 5.6% identified
clinical/counseling psychologists, and 2.5% identified psychiatrists as part of their rehabilitation
team. Mental health and performance professionals were most frequently categorized as part of
the secondary care team.
Perceptions of Social Support During Rehabilitation
Analysis of individuals involved in the injury recovery process revealed differences
regarding frequency of identification and perceived support levels (see Table 3). A total of 320
participants initially indicated involvement of at least one professional provided on the
randomized list.
The most frequently identified professionals were athletic trainers, who received an
average social support rating of 4.1 (SD = 1.2, n = 312). They were followed by athletic coaches
(M = 3.7, SD = 1.2, n = 240), strength and conditioning coaches (M = 4.3, SD = 0.96, n = 214),
and family/parents (M = 4.7, SD = 0.6, n = 173).
Specifically pointing out mental health and mental performance professionals, based on
rankings of ratings, licensed mental health providers received an average rating of 4.3 (SD =
1.10, n = 28), followed by clinical/counseling psychologists (M = 4.2, SD = 1.30, n = 18), sport
College Athlete Perspective 13
psychologists (M = 4.1, SD = 0.92, n = 64), sport psychology consultants (M = 4.1, SD = 1.10, n
= 21), and psychiatrists (M = 4.1, SD = 1.20, n = 8).
Effect of Sport Type and Rehabilitation Length on Social Support Perceptions
Sport Type Categorizations
A 2x2 mixed analysis of variance was conducted to investigate differences in ratings of
social support for rehabilitation care teams (primary vs. secondary) based on the classification of
sport type as either team or individual sport. The results indicated no significant main effect on
social support ratings for rehabilitation team levels, F(1, 204) = 0.49, p = .488. Additionally,
there was a non-significant effect for the interaction of sport type on social support ratings for
rehabilitation care teams, F(2, 204) = 1.16, p = .315. For a visual representation, see Figure 2.
Length of Rehabilitation
Researchers conducted a second set of mixed-ANOVAs to explore differences in social
support ratings for rehabilitation care teams based on rehabilitation length, which were grouped
into two categories to maximize group size and power for the analysis. The first category
included all athletes with less than or equal to 4 weeks of rehabilitation and the second group
included athletes who reported over 4 weeks of rehabilitation. These 2x2 analyses were
conducted separately in the sub-group of athletes currently completing rehabilitation and those
who previously completed rehabilitation. Refer to Table 4 for a visual representation of the data.
Currently Rehabilitating Group. Results showed that among participants currently
undergoing rehabilitation (n = 157), there was a significant main effect on social support
perceptions between primary and secondary rehabilitation teams, F(1, 155) = 8.99, p = .003, η2
= .06, indicating significantly higher ratings of social support for the primary care team (M = 4.3,
SD = 0.98) compared to the secondary care team (M = 3.8, SD = 1.1), with a medium effect size.
College Athlete Perspective 14
However, no significant effects were found for the interaction of rehabilitation length on
perceptions of social support overall, F(1, 155) = 1.33, p = .251. Although not statistically
significant, participants with rehabilitation lengths equal to or less than 4 weeks tended to rate
the level of social support for the secondary care team higher (M = 4.04) than those with over 4
weeks of rehabilitation (M = 3.77). Refer to Figure 3 for a visual representation.
Previous Completion of Rehabilitation Group. There was another significant main
effect on social support perceptions between primary and secondary rehabilitation teams, F(1,
130) = 8.90, p = .003, η2 = .06, with a medium effect size. The interaction effect between
rehabilitation length and level of social support ratings was not significant F(1, 130) = 0.82, p =
.368). Participants with over 4 weeks of rehabilitation (M = 4.06) rated the secondary team
higher than those with equal to or less than 4 weeks of rehabilitation time (M = 3.94). Refer to
Figure 4 for further insights.
Qualitative Analyses of Open-Ended Responses
Thematic analysis procedures set forth by Braun and Clarke (2012) were conducted to
investigate themes relevant to (a) participant distinctions between primary and secondary sources
of support during injury rehabilitation, (b) identification of missing professionals, and (c)
experiences working with either a SPC or LMHP. The researcher reviewed all participants' openended responses to become familiar with the data before coding the data to identify recurring
themes (identified below in italics).
Rehabilitation Team Members’ Categorizations
Two primary themes emerged as criteria for categorical differences in participant
decisions regarding the placement of individuals on either the primary or secondary
rehabilitation care teams: the amount of contact time and support functions. Participants
College Athlete Perspective 15
expressed that individuals were frequently placed on the secondary rehabilitation team due to a
lack of consistent involvement (i.e., contact time) compared to members of the primary
rehabilitation team. One participant remarked, “The secondary support team, even though their
support wasn’t as frequent, was always beneficial when working with them.” Secondly,
participants more commonly reported receiving and seeking psychological and emotional
support from the secondary team, whereas they predominantly looked to the primary team for
physical support more specific to injury rehabilitation protocols. “[The secondary team] were
more the emotional/mental side and they kept me motivated,” stated one participant. Conversely,
about the primary team, one participant noted, “I felt that I was supported physically, but not
mentally.”
Identification of Missing Professionals
The most frequently identified missing service was mental support. The desire for the
inclusion of mental support was mentioned a total of 33 times by participants, with several
individuals named as potential providers of this support, including sport psychologists, mental
health counselors, and psychiatrists. One participant stated, “If I had a sports psychologist, I feel
this would help me get through mental blocks, depression, and anxiety.” Other professionals that
participants wished to include during rehabilitation were sport massage therapists (n = 11), either
nutritionists or dieticians (n = 7), and chiropractors (n = 4).
Experiences Working with Either an SPC or LMHP
Of participants who identified working with either a sport psychology consultant or a
licensed mental health provider, which were the two professions added to the list by the
researcher, two main themes emerged regarding experiences with these professionals: a safe
space and support beyond sport. Concerning a safe space, many participants described relief
College Athlete Perspective 16
associated with the ability to express feelings and emotions about their injury to an individual not
directly involved in their sport. One participant expressed, “It was the only place where I felt safe
to break down because I was trying so hard to be strong.” Indicative of support beyond sport,
participants appeared to find comfort in talking with someone who discussed topics outside sport
and injury. One participant described their experience, reporting, “He talked to me like I was
more than just my athletics and checked in on other areas of my life.”
Despite these overarching themes, some participants indicated dissatisfaction with their
experience working with these professionals. For instance, one participant stated, “I never
received any coping techniques or ways to improve my mental state which was not very helpful.”
Discussion
According to data from over 300 collegiate student-athletes, these findings represent the
first sample of student-athletes concerning their perspectives on, and perceptions of,
multidisciplinary rehabilitation teams in the collegiate setting. In this sample, sport injury
rehabilitation in the collegiate setting closely resembled the multidisciplinary model of sport
injury rehabilitation (Clement & Arvinen-Barrow, 2013), with all professionals from the original
model accounted for by at least one participant in the present study.
Professionals Involved in Collegiate Injury Rehabilitation
The current sample demonstrated the comprehensiveness of the individuals and
professionals outlined in the multidisciplinary model (Clement & Arvinen-Barrow, 2013).
Despite the original model featuring ATCs and physicians/surgeons as the only primary team
members, according to ATC and SPC viewpoints (Arvinen-Barrow & Clement, 2015; 2017),
student-athlete participants identified 16 additional roles they considered integral to the primary
rehabilitation team. Notably, collegiate student-athletes more frequently reported athletic
College Athlete Perspective 17
coaches as part of the primary rehabilitation team in comparison to the secondary team, similar
to the experiences of former high school athletes (Clement & Arvinen-Barrow, 2021). This
difference in athlete perceptions highlights the significant role athletic coaches play in injury
rehabilitation and suggests that coaches may be well-positioned to promote interprofessional
approaches to injury rehabilitation (Podlog & Dionigi, 2010). Additionally, it indicated that
coaches’ roles may align closely with those of ATCs, acting as directors of injury rehabilitation
processes and coordinating the involvement of other professionals (Arvinen-Barrow & Clement,
2015; Kraemer et al., 2019).
Differing from previous literature, the current sample identified strength and conditioning
coaches more consistently on the primary rehabilitation team, at a frequency matching that of
physicians/orthopedic surgeons. This finding is not only inconsistent with the model (Clement
and Arvinen-Barrow, 2013) but also contradicts the perspective of ATCs and SPCs, who
considered strength and conditioning coaches as essential secondary team members (ArvinenBarrow & Clement, 2015; 2017). However, this finding can be explained by the significant roles
strength and conditioning coaches typically play in collegiate athletics, particularly in developing
athletes’ physical strengths (Stewart et al., 2017). Additionally, Eisner and colleagues (2014)
found that both DI and DII athletes regard strength and conditioning coaches as vital to their
development as athletes, with a significant positive correlation between the perceived importance
of strength and conditioning and increased time spent in the weight room. Contrastingly, strength
and conditioning coaches at the professional level have reported a limited role primarily toward
the end of the rehabilitation process, despite recognizing the potential benefits of a more
significant involvement (Armstrong et al., 2021). Barriers to earlier and increased involvement at
College Athlete Perspective 18
the professional level were related to relationships and communication among other members of
the rehabilitation team that may not be present at the collegiate level.
Like the sample of former high school student-athletes (Clement & Arvinen-Barrow,
2021), parents and family emerged as significant support providers for injured college athletes.
While parents and family were equally represented across primary and secondary rehabilitation
teams, spouses and partners were more frequently identified as primary rehabilitation team
members, a finding not previously documented in related literature. Additionally, sport
nutritionists were predominately assigned to the primary rehabilitation team, a finding also not
previously reported in the literature. This finding contradicts the original model Clement &
Arvinen-Barrow, 2013), and previous perspectives of ATCs (Arvinen-Barrow & Clement, 2015),
SPCs (Arvinen-Barrow & Clement, 2017), and former high school athletes (Clement & ArvinenBarrow, 2021), all who typically considered these professionals as secondary rehabilitation team
members. Importantly, the incorporation of a suitable and balanced nutrition plan into athletes’
rehabilitation processes can be essential for mitigating inflammation and promoting physical
healing (Papadopoulou, 2020), thus encouraging quicker recoveries (Smith-Ryan et al., 2020).
Similar to the finding with strength coaches appearing on the primary team, it is possible that
some Division I athletes have consistent access to nutrition professionals and consider these
services central to their recovery. Compared to athletes participating at the high school level,
college athletes likely have much higher access to both strength coaches and nutrition
professionals.
To explore potential interactions with mental performance and mental health
professionals, this study expanded the list of professionals within the multidisciplinary team to
include sport psychology consultants and licensed mental health providers. Approximately 15%
College Athlete Perspective 19
of participants in the current study indicated the involvement of either an SPC or LMHP in their
injury rehabilitation, with another 20% indicating sport psychologists, 5.6% indicating clinical or
counseling psychologists, and 2.5% indicating a psychiatrist. A possible explanation for these
seemingly high numbers could be attributed to the NCAA’s attempts to support student-athlete
mental health, such as the release of two documents to facilitate understanding and
recommended best practices (NCAA, 2014; 2016). Per the release of “Mental Health Best
Practices” in 2016, the NCAA required all institutions to have mental health services available
for student-athletes. Data from the current study could serve to indicate that the NCAA mandates
are having a positive impact on some athletes experiencing the emotional consequences of
injury.
Determinants of Rehabilitation Team Categorization and Social Support Perceptions
Thematic analysis revealed that participants primarily considered the consistency of
interactions when categorizing team members, aligning with the model (Arvinen-Barrow &
Clement, 2013). Participants also highlighted the type of support as a main determinant. Most
participants expected more direct support related to the physical aspects of their injury from
primary team members and rated their satisfaction with this support higher than secondary team
members. This finding corresponds with previous research indicating that athletes typically seek
the most support from athletic trainers during the rehabilitation phase, particularly for both
informational and emotional support (Bianco, 2001; Clement et al., 2015). Participants relied
more heavily on secondary team members for mental and emotional support, confirming distinct
types of support received from rehabilitation team members. These novel qualitative findings can
help researchers and practitioners more clearly understand athletes’ perceptions of support
during rehabilitation.
College Athlete Perspective 20
One explanation for higher support ratings of primary team members could be their
frequent contact with participants and more instrumental role in physical healing. Previous
researchers in the field of medicine found positive correlations between patient satisfaction
ratings and the amount of time spent with physicians (Chung et al., 1999; Like & Zyzanski,
1987). Despite overall moderate to high perceptions of support, individual sport athletes and
those undergoing rehabilitation lasting over four weeks reported lower mean ratings for social
support. Whereas it may be logical to assume that participants with more severe injuries could
perceive a decline in support throughout their lengthy rehabilitation, this finding contradicts
previous research. Taylor and May (1995) found significantly higher levels of satisfaction among
athletes experiencing more severe injuries requiring at least four weeks of rehabilitation.
Conversely, the overall highest support for the primary team was reported by participants who
had previously completed rehabilitation and had less severe injuries requiring less than four
weeks of recovery. A potential explanation for the influence on perceptions of past support could
be “rosy retrospective bias,” (Mitchell et al, 1997), where individuals tend to recall experiences
more positively after they are over compared to during the experience. Additionally, it is possible
that progress in rehabilitation is more tangible and measurable for the physical aspects of
recovery than for the psychological components.
Interestingly, the highest rating for the secondary rehabilitation team was reported by
participants who had previously completed rehabilitation and had been in protocols for over four
weeks. Injury severity is a contributing factor to how an athlete perceives and responds to a sport
injury (Wiese-Bjornstal et al., 1998) and more severe injuries can contribute to more severe
emotional responses (Gervis et al., 2020). Thus, athletes with more severe injuries facing longer
rehabilitation durations may rely more heavily on the secondary rehabilitation team than athletes
College Athlete Perspective 21
with less severe injuries. This assertion is supported by data from the current participants who
noted the most important functions of the secondary team as mental and emotional support. A
further explanation could be that those requiring longer rehabilitation periods may just have had
more time to have contact with secondary rehabilitation team members.
Professions Missing in Collegiate Rehabilitation
Even in Division I environments, participants highlighted the absence of certain
professionals and services in their injury rehabilitation. Missing services and professionals
included mental support from various providers, sport massage therapists, nutritionists or
dietitians, and chiropractors. Participants also expressed a desire for increased coach
understanding and communication during injury recovery. Athletes commonly seek support from
their coaches during injury rehabilitation (Yang et al., 2010), and the absence of this support can
negatively impact their emotional responses to injury, potentially impeding the rehabilitation
process (King et al., 2023).
The significance of communication, as highlighted in participants’ open-ended responses,
emphasizes its crucial role in effective interprofessional collaboration and athletes’ perceptions
of support (Hess & Meyer, 2021). Consistent with the multidisciplinary team concept, ATCs
typically serve as central communicators within the collegiate environment, coordinating
between various professionals (Karol, 2014). Whereas multidisciplinary collaboration offers
numerous benefits in injury rehabilitation, it also presents challenges, such as communication
breakdowns, where stakeholders, including athletes, may not receive timely and adequate
updates on injury and rehabilitation status. Although transdisciplinary team approaches represent
the ideal for interprofessional collaboration, a more realistic shift for the collegiate injury
rehabilitation environment would be towards interprofessional collaboration, first. This transition
College Athlete Perspective 22
would foster greater collaboration among individuals involved in the injury rehabilitation process
for treatment planning (Karol, 2014), aiming to alleviate communication stressors for injured
athletes.
The mention of communication is key to the importance of this study and for future
research to continue to explore. This study, along with previous research (e.g., Arvinen-Barrow
& Clement, 2015; 2017; Clement & Arvinen-Barrow, 2021, Hess & Meyer, 2021; Hankemeier
& Manspeaker, 2018) has provided support for the multidisciplinary model of injury
rehabilitation for multiple sport contexts. However, it remains crucial for further research to
investigate how multidisciplinary teams can operate more effectively, with communication a
pivotal factor in this regard, and how potential shifts could be made towards a more
interdisciplinary approach to injury rehabilitation within the collegiate environment. Subsequent
studies should explore athlete viewpoints across diverse competition levels (e.g. Division II,
Division III, NAIA, etc.,) as athletic departments’ financial resources can influence the care
provided and thus the injury experience. To better understand potential aspects of change that
could enhance the quality of injury rehabilitation care, future research should also consider a
qualitative approach.
Limitations
Whereas this study explored the first sample of collegiate student-athletes on their
experiences with a multidisciplinary model of sport injury rehabilitation, several limitations
persisted. One limitation is the low response rate of 5.7%, as only a small proportion of the
targeted sample participated in the study. Low response rates can potentially lead to issues with
generalizability, meaning the data may not be representative of all NCAA Division I athletes
who have experienced an injury at their collegiate institution. Despite the NCAA reporting a
College Athlete Perspective 23
response rate of 31% for NCAA Division I athletes in response to an emailed time demand
survey when distributed by athletic directors and coaches (NCAA, 2016), the present study
represents one of the largest datasets on Division I college athletes’ perceptions of social support
amongst interprofessional rehabilitation team collaboration relative to injury recovery. Another
limitation is the cross-sectional nature of this study as this data is only representative of studentathlete perceptions at a single time point, limiting the ability to establish causal relationships
between variables. Further research should look to assess changes over time from the onset of
injury through return-to-sport phases of injury recovery. There may also be recall bias present in
the study for those participants who had previously completed rehabilitation, which could affect
accurate depictions of recollections of their experience.
Conclusions
Injured collegiate student-athletes interact with many individuals throughout their
rehabilitation, with ATCs remaining in a crucial “director” role. College athletes were
moderately to highly satisfied with all stakeholders and overall rehabilitation teams.
Additionally, the study revealed some nuances within the collegiate environment compared to
previous research, which is crucial for understanding how improvements can be made to the
rehabilitation process for better care of injured athletes. In general, a significant number of
injured student-athletes interacted with either a mental performance or a mental health
professional, indicating their access to these resources throughout the rehabilitation process.
Moreover, there was a notable level of interest among those who were not currently working
with these professionals, suggesting a desire for these services. Future investigation needs to gain
a more comprehensive understanding of the workings of multidisciplinary approaches to injury
College Athlete Perspective 24
rehabilitation in the collegiate setting so that rehabilitation programs can be optimized to
promote physical and emotional recovery from injury.
College Athlete Perspective 25
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