Injury rehabilitation overadherence: Preliminary scale validation and relationships with athletic identity and self-presentation concerns

Context: Evidence suggests that nonadherence to rehabilitation protocols may be associated with worse clinical and functional rehabilitation outcomes. Recently, it has been recognized that nonadherence may not only reflect a lack of rehabilitation engagement but that some athletes may "overadhere" to their injury-rehabilitation regimen or risk a premature return to sport. Presently, no measure of overadherence exists, and correlates of overadherence and risking a premature return to sport remain uncertain. Objective: To provide initial validation of a novel injuryrehabilitation overadherence measure (study 1) and to examine correlates of overadherence and risking a premature return to sport (study 2). Design: Cross-sectional study. Setting: High school athletes (study 1) and collegiate athletes (study 2). Patients or Other Participants: In study 1, 118 currently injured US adolescent athletes competing in a range of high school sports participated. In study 2, 105 currently injured collegiate athletes (National Collegiate Athletic Association Divisions I-III) volunteered. Main Outcome Measure(s): The Rehabilitation Overadherence Questionnaire was a novel instrument developed to assess injured athletes' tendency toward overadherence behaviors and beliefs. We used an adapted version of the Injury Psychological Readiness to Return to Sport Scale to assess the tendency to risk a premature return to sport. Results: In study 1, the construct validity of the overadherence measure was supported using principal axis factoring. Moreover, bivariate correlation and regression analyses indicated that self-presentation concerns and athletic identity were positive predictors of adolescent rehabilitation overadherence and a premature return to sport. Study 2 provided support for the 2-factor structure of the overadherence measure found in study 1 via confirmatory factor analysis. Further support for the relationship among self-presentation concerns, athletic identity, and rehabilitation overadherence was also noted. Conclusions: The Rehabilitation Overadherence Questionnaire is a valid and reliable measure of overadherence.