What are the current practices of sports physiotherapists in integrating psychological strategies during athletes' return-to-play rehabilitation? Mixed methods systematic review

Key points

1. 01Goal setting was the most commonly used psychological strategy across studies, with positive self-thought encouragement a close second
2. 02Most sports physiotherapists believed athletes are psychologically affected by injury and saw psychological strategies as important, yet many were unsure whether it falls within their scope
3. 03Physiotherapists tended to implement psychological strategies based on intuition or gut feeling rather than formal training
4. 04Postgraduate psychology content made up less than 5% of physiotherapy continuing professional development courses
5. 05Approximately 2 hours of online education on sports psychology improved physiotherapists' attitudes toward and frequency of implementing psychological techniques

How it was conducted

Design

Mixed-methods systematic review following PRISMA guidelines; registered on PROSPERO (CRD42016068 0)

Databases searched

Medline (Ovid), AMED, PsycINFO, PubMed, CINAHL, Cochrane Library, Scopus, and Google Scholar, from inception to August (year not fully legible)

Included studies

11 studies involving sports physiotherapists: six quantitative, three qualitative, two mixed-methods

Participants

Sports physiotherapists, predominantly from the United Kingdom and Australia, many working with professional or Olympic athletes

Primary outcome

Current psychological strategies used by sports physiotherapists; attitudes toward and barriers to implementing those strategies

Quality assessment

Guidelines for Critical Review Form (GCRF); quantitative studies scored 8-9/9, qualitative studies scored 22-24/24

What they found

• Goal setting was the most commonly prescribed psychological strategy across all included quantitative studies
• 99.7% of respondents in one survey believed all athletes are psychologically affected by injury
• Only 25% of sports physiotherapists in one study reported having access to a sports psychologist
• Access to sports psychologists across studies ranged from an unstated low to 69% depending on study sample
• Approximately 2 hours of online education improved physiotherapists' attitudes toward implementing psychological techniques and increased frequency of use
• Postgraduate psychology content represented less than 5% of offered physiotherapy continuing professional development courses; in those who had received postgraduate psychology training, the majority was obtained indirectly through other courses rather than a dedicated sports psychology course
• Qualitative studies scored 22/24 to 24/24 and quantitative studies scored at least 8/9 on the GCRF quality assessment

Limitations

• Most quantitative studies used the ATSPQ with closed-ended questions, so contextual detail on how strategies were implemented and their outcomes could not be captured
• Most included studies were conducted more than 10 years before the review, and physiotherapy curricula have since changed
• The review was conducted in the context of Australian and New Zealand competency frameworks; athletic trainers in some countries have overlapping roles with sports physiotherapists, limiting generalisability
• Only English-language articles were included, restricting global coverage

Why it matters

For patients

Injured athletes may benefit from knowing their physiotherapist can provide basic psychological support such as goal setting and positive reinforcement, but may need onward referral to a sports psychologist for more complex needs, and reducing the stigma around seeking that help is important.

For clinicians

Sports physiotherapists should seek targeted professional development in psychological strategies, as even a short online module can meaningfully increase confidence and uptake; clear referral pathways to sports psychologists are also needed in clinical settings.

For readers

There is a recognised gap between physiotherapists' desire to address the psychological side of injury rehabilitation and their actual training and confidence, pointing to a curriculum and continuing education reform agenda.