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40 Collegiate athletes with ankle sprain history exhibit increased fear-avoidance beliefs
  1. MN Houston1,
  2. JM Hoch2,
  3. MC Hoch2
  1. 1Department of Interdisciplinary Health Sciences, A. T. Still University, Mesa, AZ, USA
  2. 2School of Athletic Training and Physical Therapy, Old Dominion University, Norfolk, VA, USA


Background Post-injury, collegiate athletes have reported elevated levels of fear. However, it is unclear how history of ankle sprain impacts injury-related fear.

Objective To determine if Fear-Avoidance Beliefs Questionnaire (FABQ) scores differ between collegiate athletes with a history of a single ankle sprain, those with recurrent sprains, and healthy controls.

Design Cross-sectional.

Setting Athletic facilities.

Participants From a large database of collegiate athletes 76 participants with a history of a single ankle sprain (38M, 38F; age = 19.5 ± 1.4 years; height = 175.0 ± 10.8 cm; body mass = 71.5 ± 12.7 kg), 44 with a history of recurrent sprains (≥2) (11M, 33F; age = 19.3 ± 1.0 years; height = 170.9 ± 8.7 cm; body mass = 68.3 ± 11.4 kg) and 29 controls with no injury history (16M, 13F; age = 19.5 ± 1.4 years; height = 173.2 ± 10.9 cm; body mass = 73.0 ± 14.8 kg) were included. Athletes with a current injury or history of surgery were excluded.

Interventions Participants completed a self-reported injury history questionnaire and the FABQ. A Kruskal-Wallis test was used to compare FABQ scores across groups. Mann-Whitney U tests were performed to determine where group differences occurred. Alpha was set at p ≤ 0.05 for all analyses. Z-values were used to estimate non-parametric effect sizes (ES) and interpreted as small (0.10–0.29), medium (0.30–0.49), and large (≥ 0.50).

Main outcome measurements The dependent variable was FABQ score. The FABQ is a 16-item injury-related fear scale. FABQ scores range from 0–66 with higher scores representing elevated fear.

Results Group differences were detected for FABQ score (p = 0.002). Athletes with recurrent ankle sprains (41.4 ± 23.4) reported elevated levels of fear compared to those with a single sprain (31.8 ± 21.8, p = 0.03, ES = 0.20) and healthy controls (20.3 ± 21.3, p < 0.01, ES = 0.39). Athletes with a single sprain reported increased fear compared to healthy controls  (p = 0.02, ES = 0.23).

Conclusions Collegiate athletes with any history of ankle sprain exhibited elevated levels of fear compared to healthy controls. These findings suggest that ankle sprains in general may elevate injury-related fear but those with a history of recurrent sprains appear to be more vulnerable. Accordingly, fear should be addressed during rehabilitation.

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