an impact on the actual recovery outcomes. In other words, the success of any injury rehabilitation programme is largely influenced by the ways in which athletes think, behave, and feel during the rehabilitation process.

THE ULTIMATE GOAL: GETTING BACK IN PLAY A successful rehabilitation is often characterised by therapists and athletes alike as getting back to the pre-injury level of performance. As an example, one of the therapists I interviewed as part of my thesis stated that for her, successful rehabilitation meant that the athletes “return to the level of which they had been playing previously. And, particularly if they are youngsters, not only that they return to that level but that they have the potential to go on… to achieve the potential they would have done before the injury”. Such is often reflected by the athletes in general, as their expectations of rehabilitation outcome are often linked with their ability to get back in play (12): “I just expect to be able to play… back at the level that I was before I think… just… just to go back to what, I think you just want to be back able to do what you did before the injury” (an injured female football player). Literature in general tends to agree with the above, as often rehabilitation is seen as a treatment or treatments designed to facilitate the process of recovery from injury, illness, or disease to as normal a condition as possible.

ADHERENCE AND TREATMENT COMPLIANCE: ENSURING REHABILITATION SUCCESS One of the ways in which successful rehabilitation can be achieved is to ensure that athletes comply and adhere well with the treatment and the rehabilitation programme. Much research, investigating health related behaviours, tends to suggest that in order to achieve the desired outcome, individual adherence to the treatment programme is necessary (13). A wealth of research exists to suggest that athletes who comply with their rehabilitation exercises and adhere to their rehabilitation programme also tend to cope better with their injuries (14). I recently completed a comprehensive UK national survey (15) on the role of psychology as part of rehabilitation physiotherapy. The findings suggested that 143 (39.61%) of the therapists surveyed believe that compliance with the rehabilitation/treatment programme is one of the most common characteristics among athletes who cope well with their injuries. Similarly, 126 (34.9%) therapists indicated that non-compliance with the rehabilitation/ treatment programme was often regarded as a characteristic of an athlete who does not cope with their injury. In other words, it appears that rehabilitation adherence, athletes’ coping skills, and successful rehabilitation are interlinked. To an extent, a successful rehabilitation is dependent on how an athlete is coping with his/her injury, and how the coping ability is having an effect on treatment compliance and rehabilitation adherence. This in turn is seen as influencing the rehabilitation outcomes.

Existing research has also identified a range of personal and situational factors which can be either facilitative or debilitative for rehabilitation adherence. For example, self-motivation has been regarded as having a major impact on the rehabilitation process and treatment compliance (16). According to Taylor and Taylor (7), having motivation during rehabilitation is essential, as it “enables an athlete to offer sustained effort in the face of compelling and competing obstacles, including pain, fatigue, boredom, frustration, setbacks, and the desire to do other less pleasant activities” (p.118). In short, if an athlete is not motivated to partake in the rehabilitation programme, even the most effective programmes will fail to be successful. Some of the

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situational factors influencing rehabilitation adherence include the rehabilitation environment (home, treatment sessions), rehabilitation scheduling, and the therapist- athlete relationship (13). Of the above, the relationship between the therapist and the athlete has been highlighted as important by both the athletes and the therapists (17, 18). In order to build a successful rehabilitation relationship, an athlete needs to have trust and confidence in the therapist. If the athlete does not like the therapist, or believe that he/ she knows better than the therapist, achieving treatment compliance is an unlikely outcome (19). For that reason, building a good, or should I say an excellent rapport with the injured athlete is crucial for compliance, and ultimately a core element for successful rehabilitation. I believe a quote from a therapist working with high level athletes encapsulates this well: “Certainly it (successful rehabilitation)

comes down to compliance, and I think the quality of the relationship that is built between the therapist and the athletes, is probably the most important thing; because it’s that relationship that will either get you compliance or not compliance.” To summarise, a key (or at least one of

the keys) to successful rehabilitation depends on the athlete’s rehabilitation adherence and treatment compliance. As therapists are often the primary medical professionals looking after the injured, they are in an ideal position to ensure that athletes comply with their treatment, and to facilitate rehabilitation adherence. The question now is, how?

PSYCHOLOGICAL INTERVENTIONS IN REHABILITATION: FOCUS ON GOAL SETTING

A bulk of research exists to indicate that a range of psychological intervention techniques have been found to be useful during sport injury rehabilitation. These include the use of goal setting, imagery, relaxation techniques, positive self-talk, and seeking social support. All of the above methods have been found to be useful, and are often associated with effective and rapid recovery from sport injury (6). I will focus on the use of goal setting as a means for improving rehabilitation adherence and treatment compliance for six main reasons: n Goal setting has been found to have a positive effect on increasing athletes motivation, rehabilitation adherence and compliance during injury rehabilitation (20) n Setting goals during rehabilitation can have a positive effect on the athlete’s physiological and psychological healing (7) n Therapists themselves feel that goal setting

sportEX medicine 2008;37(Jul):15-19