Imagery and self-efficacy in the injury context

Objectives: To develop and test the factorial validity of an adapted version of the Athletic Injury Imagery Questionnaire (AIIQ-2: Sordoni, Hall, & Forwell, 2002). To explore the effect of an imagery intervention on self-efficacy in the sport injury context. Design: Study 1, cross-sectional; Study 2, multiple-base line. Method: In Study 1 the AIIQ-2 was adapted to include a pain management subscale. This adapted imagery questionnaire (AIIQ-3) was then administered to 291 injured athletes (M age 1⁄4 28.64 years, SD 1⁄4 14.30). In Study 2 using a multiple-baseline single subject design, the effects of an imagery intervention on self-efficacy prior to physiotherapy treatment of five athletes with a Type B malleolar fracture (M age 1⁄4 49.50 years, SD 1⁄4 16.56) was examined. A follow-up post-experimental interview explored participants' perceptions of the intervention. Results: Study 1, confirmatory factor analysis revealed evidence for the factorial validity of the AIIQ-3. Study 2, results from the multiple-base line design demonstrated that for two out of the five participants there were observable and statistically meaningful increases in task efficacy, with the same result in three out of five participants for coping efficacy. The post-interview results revealed that all intervention participants perceived the intervention to be beneficial and effective beyond the general information provided. Conclusions: The results are discussed in terms of overcoming an inherent weakness in previous injuryrelated imagery research and the applied implications for the time-course of rehabilitation. © 2016 Elsevier Ltd. All rights reserved. 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 * Corresponding author. E-mail addresses: [email protected] (N. Wesch), [email protected] (N. Callow), [email protected] (C. Hall), [email protected] (J.P. Pope).