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Need Satisfaction, Well-Being, and
Perceived Return-to-Sport Outcomes
Among Injured Athletes
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b
Leslie Podlog , Marc Lochbaum & Tara Stevens
a
Texas Tech University/Charles Sturt University,
b
Texas Tech University,
b
Version of record first published: 27 Apr 2010
To cite this article: Leslie Podlog, Marc Lochbaum & Tara Stevens (2010): Need Satisfaction, WellBeing, and Perceived Return-to-Sport Outcomes Among Injured Athletes, Journal of Applied Sport
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JOURNAL OF APPLIED SPORT PSYCHOLOGY, 22: 167–182, 2010
C Association for Applied Sport Psychology
Copyright ISSN: 1041-3200 print / 1533-1571 online
DOI: 10.1080/10413201003664665
Need Satisfaction, Well-Being, and Perceived Return-to-Sport
Outcomes Among Injured Athletes
LESLIE PODLOG
Downloaded by [Texas Technology University] at 12:51 07 September 2012
Texas Tech University/Charles Sturt University
MARC LOCHBAUM AND TARA STEVENS
Texas Tech University
The purpose of this investigation was to examine whether components of psychological wellbeing (i.e., positive affect, negative affect, self-esteem, and vitality) mediated the relationship
between self-determination theory (SDT) basic needs (competence, autonomy and relatedness) and perceived return-to-sport outcomes. Competitive athletes (n = 204) from Australia,
Canada, and the United States completed an injury need satisfaction scale, psychological wellbeing inventories, and a measure of perceived return-to-sport outcomes. Mediation analysis
(Baron & Kenny, 1986) revealed that positive affect partially mediated the relationship between competence and autonomy need satisfaction and a renewed perspective on sport, while
negative affect, self-esteem, and vitality fully mediated the relationship between relatedness
need satisfaction and return concerns. Interpretation of the findings suggests the importance of
components of well-being in mediating relatedness need satisfaction on “return concerns” in a
sport injury context. Prospective longitudinal designs using an SDT framework are discussed
to further research in this area.
Returning to sport following serious injury has been highlighted as a potentially arduous
transition period among competitive athletes. Difficulties such as re-injury anxiety (Kvist, Ek,
Sporrstedt, & Good, 2005), concerns about performing to pre-injury levels (Evans, Hardy, &
Fleming, 2000), and uncertainties about meeting the expectations of others may be common
(Podlog & Eklund, 2006). Athletes may also experience a loss of identity and a sense of
disconnectedness from teammates, training partners, and coaches during their recoveries and
return-to-sport transitions (Petitpas & Danish, 1995). An additional challenge regarding return
to sport from injury relates to pressures to return, emanating from coaches, teammates, and
family members (Andersen, 2001). For example, Canadian national team skiers indicated that
they returned to competition prematurely to avoid negative judgments from coaches and to meet
Received 26 November 2008; accepted 26 November 2008.
Funds for this research were provided by a Charles Sturt University Faculty of Education Seed Grant.
The author would like to thank Bernice Strauss, Hope Parker, Laurie Freebairn, Allan Best, and Mike
Jones for their assistance in recruiting participants. Appreciation is also extended to James Dimmock for
his valuable feedback on this manuscript.
Address correspondence to Leslie Podlog, Ph.D.,Texas Tech University, Health Exercise and Sport
Sciences, Box 43011, Lubbock TX, 79409-3011. E-mail: les.podlog@ttu.edu
167
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L. PODLOG ET AL
specific return deadlines (Bianco, 2001). These negative return-to-competition appraisals and
experiences may lead to a number of detrimental consequences once athletes begin competing:
heightened performance anxiety (Gould, Udry, Bridges, & Beck, 1997), diminished confidence
in the injured area (Andersen, 2001), and performance decrements (Bianco, 2001).
In a review of the return-to-sport from injury literature, Podlog and Eklund (2007a) used
self-determination theory (SDT; Ryan & Deci, 2000) to help understand and explain the
transitional issues associated with a return to sport following injury. The authors found that
competence, autonomy, and relatedness concerns were prevalent among returning athletes.
For example, investigations demonstrating that athletes experience apprehensions about performing to pre-injury standards and concerns about re-injury suggest that proficiency or
competence issues may be at the forefront of athletes’ minds as they re-enter the competitive
arena (Evans et al., 2000). Similarly, pressures to return to sport highlight the fact that autonomy issues may be relevant to athlete decisions about when and whether to return to sport
following injury (Bianco, 2001). Finally, relatedness issues may surface in terms of feelings of
alienation and isolation from teammates, coaches, and fellow competitors (Petitpas & Danish,
1995).
Ryan and Deci’s (2000, 2007) self-determination theory explicitly examines the importance
of satisfying individual psychological needs for competence, autonomy, and relatedness for
enhancing well-being, personal development, and self-determined behavior in a variety of
settings. Competence is characterized by a sense of proficiency or effectiveness in the activities in which one engages (Ryan & La Guardia, 2000). Autonomy is characterized by an
internal locus of causality and the perception that one is the originator or initiator of his/her
own actions (Ryan & La Guardia, 2000). Relatedness refers to a sense of connectedness or
social integration. SDT researchers have posited that satisfaction of the three basic needs
results in both a direct and indirect effect (via different behavioral regulations) on well-being
(Vallerand, 1997; Wilson & Rodgers, 2007). Moreover, Ryan and Deci (2000) specified that
for optimal human functioning and well-being to occur, all three needs require satisfaction in
a balanced manner (Sheldon, Elliot, Kim, & Kasser, 2001; Wilson & Rodgers, 2007). From
a SDT perspective, the processes of satisfaction of the needs for competence, autonomy, and
relatedness are complementary psychological processes, such that satisfaction of autonomy
needs can occur only under circumstances in which competence and relatedness needs have
been fulfilled (Wilson & Rodgers, 2007).
Empirical investigations support the notion that environments that satisfy the three basic
needs are more likely to result in enhanced social functioning, personal well-being, and greater
persistence and task involvement (Ryan & Deci, 2000). Conversely, research across numerous
social settings including education (e.g., Miserando, 1996), family (e.g., Grolnick, Deci, &
Ryan, 1997), health care (Williams, 2002), and work (Gagné & Deci, 2005) indicates that
diminished well-being such as apathy, alienation, and irresponsibility may result when the
environment thwarts need satisfaction. For example, in a study by Ilardi, Leone, Kasser,
and Ryan (1993), factory workers who experienced greater satisfaction of the needs for
competence, autonomy, and relatedness in the workplace reported more positive job attitudes,
higher self-esteem, and fewer symptoms of diminished well-being than their colleagues who
experienced less need satisfaction.
Although support for the beneficial effects of need fulfillment has been found across SDT
research as a whole, studies examining the need support contentions within a sport environment
are only beginning to surface (Ryan & Deci, 2007). In one investigation, Reinboth and Duda
(2006) found that changes in the satisfaction of the needs for autonomy and relatedness
emerged as significant positive predictors of athletes’ increased subjective vitality over the
course of a competitive season. Similarly, Gagné, Ryan, and Bargmann (2003) found that
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NEED SATISFACTION, WELL-BEING, AND RETURN AFTER INJURY
169
pre-practice to post-practice changes in gymnasts’ well-being varied according to the needs
experienced during practice. In particular, gymnasts who perceived that coaches were highly
involved in their training had more stable self-esteem than athletes who perceived their coach
as uninvolved. Finally, Kowal and Fortier (2000) found that satisfaction of all three needs
independently contributed to situational motivation and flow among Canadian masters-level
swimmers.
As indicated earlier, initial findings within the sport injury context have shown that athletes
returning to sport following injury rehabilitation also experience competence, autonomy, and
relatedness issues (Podlog & Eklund, 2006, 2007b). Qualitative interviews with Australian
coaches (Podlog & Eklund, 2007b) and high performance athletes (Podlog & Eklund, 2006)
revealed that stressors such as a fear of re-injury, concerns over regaining competitive fitness
and reaching pre-injury levels, “falling behind” competitors, and losing or regaining a spot on
the team were all related to athletes’ desires to maintain particular levels of athletic competence.
Athletes also indicated the importance of minimizing pressures to return to sport, and coaches
highlighted the potentially deleterious consequences of a premature return (Podlog & Eklund,
2006). These findings underscore the importance of ensuring athletes’ autonomy in decisions
regarding when they are ready to return to sport, once they have been given medical clearance
to do so. Finally, a sense of affiliation and feeling part of the team was important for returning
athletes, particularly those with a high athletic identity. Coaches suggested the importance
of keeping athletes involved in sport in meaningful ways such as weight-training sessions or
input at team training sessions, in part to avoid social isolation from teammates and/or training
partners.
The aforementioned investigations by Podlog and Eklund (2006, 2007b) indicate that the
three needs proposed within SDT may be relevant in understanding and explaining athletes’
return-to-sport outcomes following injury. In particular, these studies point to the idea that
satisfaction of athletes’ basic psychological needs may influence the likelihood that athletes
experience “positive” or “negative” return-to-sport outcomes such as a renewed sport perspective or return-to-sport concerns (Podlog & Eklund, 2005). A wealth of SDT research outside
the sport injury domain indicates that satisfaction of psychological needs yields positive health,
well-being, and performance outcomes (see Ryan & Deci, 2000 for a review). However, the
effects of need satisfaction on athletes’ well-being during rehabilitation and their post-injury
outcomes (i.e., a renewed sport perspective or return to sport concerns) has yet to be empirically examined. This lack of research is surprising given the abundance of research indicating
that injury rehabilitation can be a stressful process (Gould et al., 1997) and that satisfaction
of an individual’s psychological needs may be important in diminishing stress, promoting
well-being, and enhancing performance outcomes (Ryan & Deci, 2000, 2007). Examining
the effects of need satisfaction may provide coaches with important information regarding
the types of rehabilitation environments that promote successful return-to-sport outcomes
following injury.
Based on SDT theory and research (e.g., Ryan & Deci, 2007), as well as findings from the
psychology of sport injury literature (e.g., Gould et al., 1997; Kvist et al., 2005), the present
investigation sought to retrospectively examine the effect of psychological need satisfaction on
indicators of well-being during rehabilitation, and on two perceived return-to-sport outcomes:
a renewed perspective on sport and return concerns. Specifically, the purpose of this study was
to examine whether indicators of psychological well-being (i.e. positive affect, negative affect,
self-esteem, and vitality) mediated the relationship between need satisfaction and perceived
return-to-sport outcomes. In line with Vallerand’s (1997) proposal that psychological need
satisfaction has both a direct and indirect effect (via different behavioral regulations) on
well-being, the present investigation focused on the direct effect of need satisfaction on
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L. PODLOG ET AL
injured athlete well-being, as well as the mediating (indirect) effect of well-being in the need
satisfaction/return-to-sport outcome relationship.
We selected indices of well-being that past SDT (e.g., Gagné et al., 2003; Ryan & Frederick,
1997) and sport injury research (Leddy, Lambert, & Ogles, 1994) have suggested are affected
by the sport and/or injury experience. One is the athlete’s emotions, which we assessed
using the widely adopted measure of positive and negative affect developed by Watson,
Clark, and Tellegen (1988). A second aspect of well-being measured in past SDT research
is subjective vitality (Reinboth & Duda, 2006; Ryan & Frederick, 1997) or the experience
of feeling energetic and alive. Finally, a third aspect of well-being measured in the present
investigation was self-esteem. Injured athletes have been shown to have lower self-esteem
following serious injury compared to their non-injured counterparts (Leddy et al., 1994).
In addition, SDT research indicates that environmental supports for need satisfaction are
associated with enhanced self-esteem (Deci, Ryan, Gagné, Leone, Usunov, & Kornazheva,
2001).
Based on SDT contentions (Vallerand, 1997; Wilson & Rodgers, 2007), we hypothesized
direct relationships between need satisfaction and indicators of well-being (i.e., positive affect,
self-esteem, and vitality) such that positive associations between need satisfaction (competence, autonomy, and relatedness) and a renewed perspective on sport, would be mediated
by components of well-being. Similarly, for the hypothesized negative associations between
need satisfaction and return concerns, we predicted that these relations would be mediated by
diminished indices of well-being: negative affect, reduced vitality, and lower self-esteem.
METHOD
Participants
A total of 204 athletes male n = 138 and (female n = 66) competing at professional (n = 37),
international (n = 28), national (n = 13), or intercollegiate (n = 126) levels, participated in this
study. Participants ranged from 18 to 36 years of age (M = 21.75 years; SD = 2.9), had been
competing in their respective sport for an average of 9.5 years (SD = 4.6), and self-reported
an average of 20 hr per week in training. A total of 15 sports were represented in the sample
including amateur wrestling (n = 40), athletics (n = 32), American football (n = 27), Rugby
League (n = 18), Australian rules football (n = 15), soccer (n = 15), swimming (n = 14), ice
hockey (n = 12), gymnastics (n = 8), volleyball (n = 6), basketball (n = 5), baseball (n = 4),
tennis (n = 1), softball (n = 1), and triathlon (n = 1; n = 5 missing). On average, participants
had incurred their injury 2 years and 3 months prior to their study participation (range 4
months to 12.5 years). In line with previous research examining psychological phenomena
associated with sport injury, this study used a time loss criterion of a minimum of 2 months for
determining injury severity (Bianco, 2001). The average length of time that participants were
unable to train and/or compete as a consequence of their injury was 4 months. Moreover, 56%
of the sample required some type of surgical intervention for their injury. In short, the majority
of the sample had experienced an injury requiring a prolonged sport absence and rehabilitation
regimen. Athletes from Australia, Canada, and the United States were recruited to obtain a
sample of sports across several Western industrialized nations. Athletes were recruited with the
assistance of coaches, athletic trainers, and strength and conditioning experts from a number
of venues, including several National Rugby League and Australian Football League clubs,
two post-secondary institutions in Western Canada (Canadian Interuniversity Sport), and a
tertiary institution in the United States, the National Collegiate Athletic Association (NCAA),
Division 1.
NEED SATISFACTION, WELL-BEING, AND RETURN AFTER INJURY
171
Instruments
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Participants completed an injury information questionnaire, an adapted version of the
Need Satisfaction Scale (Gagné et al., 2003), and three measures of well-being including
the Positive and Negative Affect Scale (PANAS; Watson et al., 1988), the Self-Esteem Scale
(SES; Rosenberg, 1965), and the Subjective Vitality Scale (SVS; Ryan & Frederick, 1997).
Perceived return-to-sport outcomes were assessed using the Return to Sport after Serious
Injury Questionnaire (RSSIQ; Podlog & Eklund, 2005).
Need Satisfaction Scale
Participants completed an adapted version of the Need Satisfaction Scale. Gagné et al.
(2003) employed this 12-item scale to assess the extent to which gymnasts felt their needs for
autonomy (7 items, e.g., “My coaches helped me choose my own direction during practice”;
α = .87), competence (2 items, e.g., “I was good at gymnastics”; r = .39), and relatedness (3
items, “I felt like I was part of the team”; α = .89) were satisfied during their practice, using
a 1 (completely disagree) to 5 (strongly agree) Likert-type scale.
To ascertain athlete perceptions of need satisfaction over the course of their injury rehabilitation (as opposed to perceptions of need satisfaction during the course of a training session)
two modifications were made to the Need Satisfaction Scale employed by Gagné et al. (2003).
The first modification was to the questionnaire stem statement. The stem “Today. . .” from
the original scale was changed to “During my rehabilitation I felt like. . .” Athletes responded
to a 5-point Likert-type scale with anchors of 1 (completely disagree) to 5 (strongly agree).
Second, word substitutions and slight amendments to each of the 12 items were made to ensure
relevance for the current investigation. Items from the original scale that made reference to
teammates or support from fellow gymnasts were amended to focus on support from coaches
and/or physiotherapists given previous research highlighting the important role of physiotherapists and coaches in facilitating athlete injury rehabilitation (Podlog & Eklund, 2007b). These
changes are available upon request from the first author.
Given the aforementioned changes, and the fact that the need satisfaction scale was used
for the first time in an injury context, an exploratory factor analysis (EFA) was conducted.
Principal component factor analysis with direct oblimin rotation revealed three interpretable
factors with an eigenvalue greater than one. On factor one, however, four autonomy items
cross-loaded with relatedness items (i.e., exhibited a loading of .35 or higher on two or more
factors; Tabachnick & Fidell, 2001); hence, the four autonomy items were eliminated and a
second EFA was conducted. These results, presented in Table 1, revealed three distinct and
interpretable factors with an eigenvalue greater than one. These factors were consistent with
the three SDT needs and accounted altogether for 73.9% of the total variance. On factor
one, the three relatedness items accounted for 34.9% of the variance. On factor 2, the three
autonomy items accounted for 24.2% of the variance, and finally, on the third factor, the two
competence items accounted for 14.8% of the variance. As shown in Table 1, scales indicated
acceptable levels of internal consistency as measured by Cronbach’s alpha coefficient.
Positive and Negative Affect Scale (PANAS)
This scale contained 10 items measuring positive affect (e.g., excited, enthusiastic, determined; α = .84) and 10 items measuring negative affect (e.g., distressed, upset, irritable; α =
.84: Watson et al., 1988). Responses to the statement stem “Overall during my injury recovery
I felt. . .” were recorded on a 1 (strongly disagree) to 5 (strongly agree) Likert-type scale.
Subscale items were averaged to form positive affect (PA) and negative affect (NA) scores.
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L. PODLOG ET AL
Table 1
Pattern Matrix and Alpha Coefficients of the Final Solution of the 3-factor Direct Oblimin
Rotation of the Needs Satisfaction Scale
Factor
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Response Item
During my rehabilitation I felt like
Relatedness (3 items)
. . .my coaches understood and appreciated the challenges I
faced during my injury recovery.
. . .my coaches made an effort to make me feel part of the
team.
. . .my coaches encouraged and supported me during my
injury recovery.
Autonomy (3 items)
. . .my physiotherapist provided me with choices and
options during rehabilitation sessions.
. . .my physiotherapist helped me choose my own direction
during rehabilitation sessions.
. . .my physiotherapist encouraged me to ask questions or
try new exercises.
Competence (2 items)
. . .I was good at performing my rehabilitation exercises.
. . .I could do well at new rehabilitation exercises.
Alpha coefficient
Item-total correlation range
1
2
3
.91
−.06
.02
.90
.05
−.05
.89
.02
.01
−.11
.91
−.06
.02
.82
.02
.09
.62
.05
−.04
.02
.88
.11–.72
−.04
.05
.70
.01–.23
.91
.86
.72
.13–.56
Note. Figures in boldface indicate a pattern-matrix loading greater than .45.
Support has been found for the reliability and construct validity of the scale among the general
adult population (Crawford & Henry, 2004).
Self-Esteem Scale
This 10-item scale was used to assess injured athletes’ feelings about themselves during
injury recovery (e.g., “On the whole I was satisfied with myself;” “I had a number of good
qualities;” “I took a positive attitude toward myself;” α = .86 [Rosenberg, 1965]). Responses
to the statement stem “Overall during my injury recovery I felt that . . .” were recorded on
a 1 (strongly disagree) to 5 (strongly agree) Likert-type scale. Item scores were averaged to
form an overall self-esteem score. The scale has established reliability and construct validity
(Rosenberg, 1965).
Subjective Vitality Scale
Six items from this 7-item scale (e.g., “I felt alive and vital;” “I had energy and spirit;” “I
looked forward to each new day;” α = .87) were used to assess athletes’ subjective feelings
of vitality. Responses to the statement stem “Overall during my injury recovery . . .” were
recorded on a 1 (strongly disagree) to 5 (strongly agree) Likert-type scale. Item scores were
averaged to form an overall vitality score. The scale has established reliability and construct
validity (Ryan & Frederick, 1997).
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NEED SATISFACTION, WELL-BEING, AND RETURN AFTER INJURY
173
Return to Sport After Serious Injury Questionnaire (RSSIQ)
Podlog and Eklund (2005) developed the RSSIQ to assess injured athletes’ perceived
outcomes of returning to sport. Using principal-axis factor analytic procedures, 21 items
derived from an examination of the psychosocial sport injury literature were reduced to two
interpretable factors (Podlog & Eklund, 2005). The factors emerging from these analyses were
interpreted as representing return concerns after a return to sport (10 items) (e.g., “My fear of
reinjury has interfered with performances;” “My anxiety about competing has been greater;”
“My confidence has been lower;” “My ability to focus during competition has been worse”).
These factors also represented a renewed perspective on sport (5 items) (e.g., “My appreciation
of sport has been greater;” “My motivation for sport success has been greater;” My mental
toughness has been better.”) (See Podlog & Eklund, 2005 for a more detailed discussion of the
psychometric properties of the RSSIQ). In the present investigation, the 5 items representing a
renewed perspective on sport (RSSIQ-RP) were averaged to form an overall RP score as were
the 10 items representing return concerns following a return to sport (RSSIQ-RC). Internal
consistency scores in the present investigation were α = .87 for return concerns and α = .79
for a renewed perspective on sport. The stem statement, “Within my first season since returning
to sport from injury. . .” prefaced each item from the RSSIQ. Responses were assessed using
a 1 (strongly disagree) to 5 (strongly agree) Likert-type scale.
Procedures
After approval of the study from the institutional human-research ethics committee, inventory items were pilot-tested with 60 undergraduate human-movement students and 15
university faculty members, all of whom had incurred a previous sport-related injury but
were injury-free at the time of their study involvement. After pilot testing, amendments to the
questionnaire statement stems and the adapted need satisfaction scale were made to increase
the clarity of stem and item content. For example, the term “Overall” was added to the statement stems for the well-being inventories (i.e., positive/negative affect, self-esteem, vitality) to
make it apparent that our interest was in capturing athletes’ well-being levels over the general
duration of their rehabilitation, as opposed to daily fluctuations in well-being.
After completion of pilot testing, participants in the current investigation were given an
information sheet outlining the study purposes and details of their involvement. Participants
were also given a verbal account of the study purposes and were provided with a standardized
set of instructions regarding questionnaire completion. Questionnaires were administered by
the first author at training facilities, team meetings, practice sessions, and competition venues.
Analyses
Data analysis involved descriptive and bivariate correlational examination of the study
variables. In these analyses, an item average score for each RSSIQ subscale (i.e. return concerns
and renewed perspective on sport) was created. The RSSIQ subscales were then correlated
with the need-satisfaction subscales (competence, autonomy, and relatedness), well-being
scores (PA, NA, self-esteem, vitality), and demographic variables of interest (i.e., age, years
competing, number of hours training per week, time since injury occurrence, and number of
months unable to train). These correlations provided an indication of the strength and direction
of the relationships between psychological need satisfaction, well-being, perceived return-tosport outcomes, and the demographic variables. In addition, to examine the potential influence
of dichotomous demographic variables on our main variables of interest, multivariate analyses
of variance (MANOVAs) were conducted. Next, mediation analyses (Baron & Kenny, 1986)
were conducted to explore linkages between need satisfaction, psychological well-being, and
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L. PODLOG ET AL
perceived return-to-sport outcomes. Finally, the Sobel method was used to determine the
significance of the mediated effect (http://www.people.ku.edu/∼preacher/sobel/sobel.htm).
RESULTS
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Descriptive Statistics and Bivariate Correlations
Descriptive statistics and correlations for all study variables are presented in Table 2.
Small but significant (p < .01) positive correlations appeared between competence need
satisfaction and positive affect (r = .25), self-esteem (r = .20), and vitality (r = .22). Moreover,
autonomy was positively associated with positive affect (r = .28, p < .01) and vitality (r =
.19, p <.05), while relatedness was positively associated with self-esteem (r = .21, p < .01)
and vitality (r = .20, p < .01) and negatively associated with negative affect (r = −.17, p <
.05). Although not all of the correlations between need satisfaction and well-being indicators
appeared significant, those that were fell in the expected direction postulated within SDT,
indicating that need satisfaction was positively associated with well-being indicators and
negatively associated with diminished well-being (Ryan & Deci, 2000).
Also noteworthy in Table 2 is the positive correlation between competence and RSSIQ-RP
(r = .19, p < .01) and the negative correlation between relatedness and RSSIQ-RC (r = −.15,
p < .05). Although relatively small, these correlations are congruent with SDT assertions
indicating the benefits of need satisfaction for enhancing positive return-to-sport outcomes
(i.e., a renewed sport perspective; e.g., Edmunds, Ntoumanis, & Duda, 2006; Wilson, Rodgers,
& Fraser, 2002). One other correlation finding of interest relates to the consistent pattern of
small-to-moderate negative associations between positive affect (r = −.22), self-esteem (r =
−.33), and vitality (r = −.25) and RSSIQ-RC (p < .01), while a moderate positive association
was observed between negative affect and RSSIQ-RC (r = .36, p < .01). Moreover, a small
but significant positive correlation between positive affect and RSSIQ-RP (r = .14, p < .05)
was observed. In line with SDT contentions, these findings suggest that indices of enhanced
well-being during injury rehabilitation may be associated with a diminished likelihood of
negative perceived return-to-sport outcomes and a greater chance of positive return-to-sport
outcomes.
Demographic Analyses
To determine the potential effects of the demographic variables in relation to our mediation
analyses variables, two sets of analyses were conducted. First, for the dichotomous variables
sex, type of sport, and competition level, separate MANOVAs were conducted. The MANOVA
for sport type (coded as individual or team sport) was not significant, Wilks’ λ = .94, F(9,
183) = 1.20, p >.05, nor was the MANOVA for competition level, Wilks’ λ = .83, F(27,
523.41) = 1.25, p >.05. The MANOVA for sex, however, was significant, Wilks’ λ = .86,
F(9, 183) = 3.33, p <.01. Follow-up univariate F-tests revealed significant (p < .05) sex
differences for relatedness (F[1, 191] = 6.01), negative affect (F[1, 191] = 3.96), self-esteem
(F[1, 191] = 5.21), and return concerns (F[1, 191] = 14.32). Examination of mean scores
indicated that males reported less relatedness, negative affect, and return concerns and greater
self-esteem than females. The second set of analyses involved correlational examination of
the five continuous variables including age, years competing, number of hrs training per week,
time since injury occurrence, and number of months unable to train. We included these five
variables in the correlation table (see Table 2). Only three significant correlations among
demographic, well-being, and dependent variables resulted. Age was significantly correlated
175
M
SD
Range
1
Note. ∗ p < .05. ∗∗ p < .01.
Psychological Need Subscales
1 Competence
3.69
.83 1.0–5.0
—
2 Autonomy
3.50
.67 1.7–5.0
.30∗∗
3 Relatedness
3.76 1.00 1.0–5.0
.20∗∗
Well-being Scales
4 Positive Affect
3.33
.66 1.8–5.0
.25∗∗
5 Negative Affect
3.20
.77 1.2–5.0
−.10
6 Self Esteem
3.39
.68 1.3–5.0
.20∗∗
7 Vitality
3.10
.78 1.0–5.0
.22∗∗
Return to Sport After Serious
Injury Questionnaire factors
8 Return Concerns
3.08
.79 1.0–5.0
−.04
9 Renewed Perspective
3.71
.79 1.4–5.0
.19∗∗
Demographic variable
10 Age
21.75 2.89 19.0–36.0
.11
11 Years competing
9.52 4.59 1.0–21.0
.03
12 Number of hrs training 19.94 10.54 6.0–117.0
.07
per week
13 Time since injury
26.89 22.56 1.0–122.0 −.03
occurrence (months)
14 Number of months
3.90 1.71 1.0–5.0
.21∗∗
unable to train
Study variables
—
3
4
5
−.15∗
.06
−.09
−.03
.03
.02
−.13
−.01
.14
−.02
−.06
.05
−.03
−.09
.08
−.08
—
.50∗∗
6
—
7
−.02
.06
.04
−.01
.10
.11
.02
.04
−.13
.13
−.07
.11
.36∗∗ −.33∗∗ −.25∗∗
.14∗
.01
.12
.18∗∗
.02
.01
−.07
.12
−.00
−.22∗∗
.14∗
.28∗∗
.08
—
.05
−.17∗ −.18∗
—
.14
.21∗∗
.55∗∗ −.52∗∗
.19∗
.20∗∗
.73∗∗ −.30∗∗
—
.13
2
—
9
.12
.05
−.01 −.05
−.11 −.18∗∗
−.08 −.12
−.01 −.01
—
.00
8
11
.13
.17∗
.03
.07 −.02
—
12
.25∗∗
—
.24∗∗ —
.05
−04
10
—
14
.11 —
—
13
Table 2
Correlations Among and Descriptive Statistics of Psychological Need Satisfaction, Well-Being Indicators and Return Outcomes
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176
L. PODLOG ET AL
with positive affect (r = .18, p < .01) and renewed perspective (r = −.18, p < .01). Number
of months unable to train as a result of the injury was significantly correlated with competence
(r = .21, p < .001). Hence, in the mediation analyses when a dependent variable was affected
by a demographic variable, the demographic variable was entered first into the regression
equation to control for its effect.
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Mediation Analyses
Using Baron and Kenny’s (1986) guidelines for testing our mediation hypotheses, two
mediation analyses were conducted. The first mediation analysis was related to the outcome
variable, a renewed perspective, and the second analysis to return concerns. Baron and Kenny
(1986) outlined three requirements for documenting mediation. First, the mediator variable
should be regressed on the predictor variable to show that the predictor variable is significantly
related to the mediator variable (i.e., Step 1). Second, the dependent variable should be
regressed on the predictor variable to show that the predictor variable is significantly related
to dependent variable (i.e., Step 2). Third, the dependent variable should be regressed on both
the predictor variable and on the mediator variable to show that the mediator is significantly
related to the dependent variable (i.e., Step 3). According to Baron and Kenny (1986) if these
conditions are all satisfied in the predicted direction, then the effect of the predictor variable
on the dependent variable must be less in the third step than in the second. Perfect mediation
holds if the predictor variable has no effect when the mediator is controlled. Furthermore, in
the present study, to determine the significance of change in the beta coefficient, the Sobel test
of mediation was conducted, with the percent of mediation explained provided by Shrout and
Bolger’s (2002) formula: a∗ b/c. The results of the mediation analyses for a renewed perspective
and for return concerns are presented separately below.
Tested Mediation Pathways for a Renewed Perspective
The first step in testing the mediation pathways for a renewed perspective involved regressing the four mediating variables (positive affect, negative affect, self-esteem, and vitality) on
the three need satisfaction predictor variables in 12 separate regression analyses. As indicated
in Table 3, nearly all regressions of the four well-being mediators to the predictors were significant. In the second step (in separate analyses), the renewed perspective outcome variable
was regressed on the three predictor variables. The direct effects of a renewed perspective on
the competence and autonomy predictor variables were significant but not for relatedness.
Where the results of the first two mediation steps highlighted the potential for mediation,
Step 3 was conducted. Specifically, a renewed perspective on sport was regressed on competence and positive affect, competence and self-esteem, and competence and vitality in three
separate analyses because the potential for mediation was evident (i.e., Step 3). The Sobel test
results indicated that none of these mediation pathways was significant (see Table 3). Nonetheless, positive affect partially mediated the relationship between competence and a renewed
perspective on sport. Partial mediation was present with the direct effect of .19 decreased to
.16 with the addition of the mediator. In addition, the mediator to the outcome variable beta,
.15, was still significant in the final mediation path as required by Baron and Kenny (1986).
Furthermore, a renewed perspective on sport was also regressed on autonomy and positive
affect, negative affect, self-esteem, and vitality in four separate analyses because mediation
potential was in evidence (i.e., Step 3). The mediation path for autonomy and a renewed perspective was not significant for positive affect, negative affect, self-esteem, and vitality based
on the Sobel test (exact Sobel test statistics are found in Table 3). Positive affect, however,
partially mediated the relationship between autonomy and a renewed sport perspective with
177
.23∗∗
−.09
.20∗∗
.22∗∗
.16∗
−.14∗
.28∗∗
.21∗∗
.08
−.20∗∗
.26∗∗
.20∗∗
.23∗∗
−.09
.20∗∗
.22∗∗
.16∗
−.14∗
.28∗∗
.21∗∗
.08
−.20∗∗
.26∗∗
.20∗∗
.18∗
.14∗
.03
.14∗
.18∗
.14∗
.03
.14∗
.18∗
.14∗
.03
.14∗
−.21∗∗
.33∗∗
−.29∗∗
−.25∗∗
−.21∗∗
.33∗∗
−.29∗∗
−.25∗∗
−.21∗∗
.33∗∗
−.29∗∗
−.25∗∗
Predictor to
mediator
−.20∗∗
−.12
−.03
.06
.14∗
.19∗∗
Direct effect of
predictor to outcome
—
—
.30∗∗
−.26∗∗
−.22∗∗
—
—
—
—
—
—
—
—
—
—
—
—
.17∗
.16∗
.00
.14
.15∗
—
−.04
.13
Mediator to
outcome
Note. ∗ p < .05. ∗∗ p < .01. 1Age was included in the regression analyses. 2Sex was included in the regression analyses.
Renewed perspective1
Competence and
Positive affect
Negative affect
Self-esteem
Vitality
Autonomy and
Positive affect
Negative affect
Self-esteem
Vitality
Relatedness and
Positive affect
Negative affect
Self-esteem
Vitality
Return concerns2
Competence and
Positive affect
Negative affect
Self-esteem
Vitality
Autonomy and
Positive affect
Negative affect
Self-esteem
Vitality
Relatedness and
Positive affect
Negative affect
Self-esteem
Vitality
Outcome
variable
Preliminary Path Results
Standardized B
—
—
−.14∗
−.14∗
−.16∗∗
—
—
—
—
—
—
—
—
—
—
—
—
.11
.16∗
.14∗
.11
.16∗
—
.19∗
.17∗
Residual direct effect
of predictor to outcome
Final Path Results
—
—
−2.41∗
−2.63∗∗
−2.21∗
—
—
—
—
—
—
—
—
—
—
—
—
1.72
−1.48
.02
1.60
1.76
—
−.04
1.55
Sobel mediation
test statistic
Table 3
Standardized Beta Weights for Paths Tested Where a Renewed Perspectives and Return Concerns are the Outcome Variables, Needs
Satisfaction Variables are the Predictor Variables and Well- Being Indicators are the Mediating Variables
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178
L. PODLOG ET AL
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the direct effect of .14 decreased to .11 with the addition of the mediator. The mediator to the
outcome variable beta of .17 was still significant in the final pathway as required by Baron and
Kenny (1986) (see Table 3).
Tested Mediation Pathways for Return Concerns
Using similar procedures as outlined above, a second mediation analysis with return concerns as the outcome variable was conducted. Given the same set of mediators and predictors
were examined with return concerns as with a renewed perspective, the initial step had identical
results (see Table 3). Once again, in the second step, the return concerns outcome variable was
regressed on the three predictor variables in separate analyses. The direct effect of the outcome
variable to the predictor variables was significant only for return concerns to relatedness (see
Table 3).
Based on the results of the first two mediation steps, the return concerns outcome variable
was regressed on relatedness and negative affect, relatedness and self-esteem, and relatedness
and vitality in three separate analyses because the potential for mediation was evident. As
required by Baron and Kenny (1986), the direct effect of relatedness on return concerns
increased as required for negative values from −.20 to −.14, −.14, and −.16, respectively,
for the separate regressions with negative affect, self-esteem, and vitality. In addition, all of
the mediation path beta coefficients between negative affect (.30), self-esteem (−.26), and
vitality (−.22) and return concerns were significant. Based on the Sobel test of mediation
for each final regression pathway, negative affect, self-esteem, and vitality fully mediated
the relatedness-to-return concerns relationship (see Table 3). For these significant paths of
mediation, our variables explained 29.3, 31.9, and 22.5% of mediation respectively, based on
the formula provided by Shrout and Bolger (2002).
DISCUSSION
The purpose of this study was to examine whether components of psychological well-being
mediated the relationship between need satisfaction and perceived return-to-sport outcomes.
The findings indicated some support for the hypothesis that well-being indicators (positive
affect, self-esteem, and vitality) would mediate the relationship between need satisfaction
and a renewed perspective on sport. The results demonstrated that positive affect partially
mediated the relationship between competence and autonomy need satisfaction and a renewed
perspective on sport. These results are consistent with previous SDT research (Gagné et al.,
2003; Reinboth & Duda, 2006), indicating the benefits of competence and autonomy need
satisfaction in enhancing athlete perceptions of psychological well-being. The present study
furthered these findings by demonstrating positive associations between competence and autonomy need satisfaction and athlete’s emotional well-being during injury rehabilitation, as
well as for enhanced return-to-sport outcomes (i.e., a renewed perspective on sport). Interpretation of these findings suggests the importance of ensuring competence and autonomy need
satisfaction in promoting rehabilitation and return to sport success. From a practical standpoint, the satisfaction of competence needs may be met through the provision of progressive
physical tests (e.g., functional rehabilitation tests, sport-specific performance tests) and the use
of psychological interventions (e.g., relaxation, guided imagery, stress inoculation) that have
been demonstrated to enhance athlete efficacy regarding a return from injury (Cox, 2002). Additionally, providing athletes with a meaningful rationale, while acknowledging their feelings
regarding the requested behavior and providing alternative exercises, may serve to reinforce
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NEED SATISFACTION, WELL-BEING, AND RETURN AFTER INJURY
179
feelings of autonomy in the recovery process. The greater the extent to which athletes feel
they are recovering to meet personal aims and objectives (i.e., are volitional in their desire
to return), the more likely the athletes may be to exhibit positive emotions throughout the
recovery period. Further meditational research examining relationships between autonomy
need satisfaction, positive affect, and rehabilitation compliance is needed to develop a further
understanding of how coaches and rehabilitation specialists can create optimal rehabilitation
environments that maximize the success of athletes’ return to sport from injury.
It was also hypothesized that negative associations between need satisfaction and return
concerns (i.e., a negative return to sport outcome) would be mediated by diminished wellbeing: negative affect, reduced vitality, and lower self-esteem. Findings indicated a great deal
of support for this hypothesis with negative affect, self-esteem, and vitality fully mediating the
negative relationship between relatedness, need satisfaction, and return concerns. This finding
is consistent with theoretical contentions regarding the buffering effect of social support in
mitigating perceived environmental stressors such as a return to sport following severe injury
(Cohen & McKay, 1984). From an SDT standpoint, the beneficial effects of relatedness may
be explained by the fact that affiliation needs as essential supports (i.e., emotional, tangible,
and informational support), are expected to have a functional effect on performance and wellbeing (Ryan & Deci, 2007). Given the potentially stressful nature of a return to sport following
injury (Andersen, 2001; Kvist et al., 2005), environmental supports (i.e., emotional, tangible,
and informational support) that foster relatedness need fulfillment may give athletes a secure
relational base which in turn diminishes their level of return concerns (e.g., performance
anxiety, diminished confidence). Indeed, coaches have indicated that ensuring athletes feel
connected to their teammates and their sport through the provision of emotional, tangible, and
informational support may be crucial in offsetting some of the potential stressors associated
with the return to full competitive activity (Podlog & Eklund, 2007b).
Several findings were in contrast to our hypotheses regarding the mediating effects of wellbeing indicators on need satisfaction and return-to-sport outcomes. No support was found for
the mediating effects of well-being indicators on relatedness and a renewed sport perspective.
One explanation may be that perceptions of connectedness or social support act more as a buffer
against negative events than as a key antecedent of positive return to sport outcomes (Cohen &
McKay, 1984). Although a number of investigations have examined the importance of social
support in facilitating injury recovery (e.g., Bianco, 2001; Udry, 1997), little consensus exists
regarding the mechanisms behind the social support benefits. Therefore, additional research
examining the link between relatedness need satisfaction, well-being, and positive return to
sport outcomes is needed.
With regard to the lack of a hypothesized direct or indirect effect between autonomy,
well-being indicators, and diminished return to sport concerns, it may be that autonomy need
satisfaction is more imperative in fostering positive return to sport outcomes than in the
prediction of maladaptive outcomes. Indeed, injured athletes may be content to relinquish a
certain amount of autonomy regarding their injury rehabilitation and “leave themselves in the
hands of the experts.” That is, once athletes autonomously or volitionally make the decision
to make a recovery from injury, they may be less inclined to make decisions (i.e., exert
decisional autonomy) about their treatment protocol given a potential lack of expertise on injury
rehabilitation. By relinquishing a certain degree of decisional autonomy over the recovery
process, athletes may feel reduced return-to-sport concerns. Further research examining this
contention is required.
A number of other findings from this investigation appear novel and warrant discussion. First, the small-to-moderate correlations between competence, autonomy, and
relatedness support SDT contentions that the psychological needs are complementary
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180
L. PODLOG ET AL
psychological processes. Some theorists have argued against the universal and innate nature of self-determination’s psychological needs (see Wilson & Rodgers, 2007). The small
positive correlations between competence and autonomy, and competence and relatedness
contradict this criticism and lend further support to the notion of compatibility among basic
psychological needs (Wilson et al., 2002). Further research is needed to explore the SDT
contention that satisfaction of each psychological need is imperative for individual growth,
integrity, and well-being in the sport injury context. Studies examining the unique contribution of each psychological need to athlete well-being and post-injury performance can assist
towards this end. Moreover, additional information on the potentially deleterious effects of
individual needs being thwarted is warranted in the prediction of maladaptive return-to-sport
outcomes.
A number of directions for future research arise from the present investigation. First, because some participants were recalling a return to sport of up to 12.5 years previous, event
outcomes may have positively biased athlete perceptions of their recovery experiences. That
is, retrospective recall biases may have influenced athletes’ perceptions of their return, especially given that all athletes were “successful” insofar as they returned to sport following
injury. Given retrospective recall biases, future research could examine the links among need
satisfaction, well-being, and perceived return outcomes using prospective designs. Research
assessing these variables in a study of injured athletes randomly assigned to an intervention
(i.e., physical rehabilitation and psychological need satisfaction) and control group (physical
rehabilitation only) is warranted. Second, the RSSIQ measure (Podlog & Eklund, 2005) employed in the present investigation measured perceived outcomes in returning to sport following
a serious injury. These outcomes may vary from actual return-to-sport outcomes. For example,
athletes may perceive that reinjury concerns are interfering with the tenacity and assertiveness
of their play, yet still be performing well according to various indicators of return-to-sport
outcomes (e.g., the achievement of personal bests, goal/assist statistics, coach evaluations).
Future research could examine relationships between need satisfaction, well-being, and objective indicators of return-to-sport outcomes. Finally, psychometrically sound instruments
addressing need satisfaction in a sport injury rehabilitation environment are needed to advance SDT-based research in this area. Because the need satisfaction subscale for competence
included only two items, the stability of this measure may have been compromised (Henson,
2001; Tabachnick & Fidell, 2001). Need satisfaction scales that address the full breadth and
types of competence, autonomy, and relatedness-needs require development and empirical
testing.
In summary, the purpose of this study was to examine relationships between psychological need satisfaction during injury rehabilitation, well-being indicators, and perceived
return-to-sport outcomes. Results of this investigation provided some support for the contention that SDT needs would have direct and indirect effects on return-to-sport outcomes
(e.g., competitive anxiety levels, post-injury performance, confidence levels) via psychological well-being indicators. In particular, positive affect partially mediated the effects between
competence and autonomy and a renewed perspective on sport (i.e., a positive return to
sport outcome). Strong support for the effects of well-being indices (i.e., negative affect,
self-esteem, and vitality) in fully mediating the negative relationship between relatedness
satisfaction and return concerns following injury were also found. These findings support
SDT theoretical links between need satisfaction, well-being and enhanced psychological outcomes (Ryan & Deci, 2007). As a result, further investigations examining the potential effects of autonomy, competence, and relatedness-need-fulfillment on post-injury outcomes are
recommended.
NEED SATISFACTION, WELL-BEING, AND RETURN AFTER INJURY
181
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