Beyond the tendon:psychological factors during rehabilitation of lower limb tendon injuries

In recent years the amount of literature on patients’ psychological responses to injury during rehabilitation and the influence on return to sports has increased− in particular regarding anterior cruciate ligament injuries. However, there is a lack of studies on this topic regarding other sports injuries, specifically regarding the contribution of psychological factors to pain, dysfunction and rehabilitation outcome in lower limb tendon injuries, and there is a clear gap in the literature regarding the role of psychological factors in the recovery from Achilles tendon rupture.The general aim of this thesis is to increase the knowledge of the role of psychological factors during rehabilitation of Achilles tendinopathy, patellar tendinopathy and Achilles tendon rupture, and to assess the validity, reliability and responsiveness of patient-reported outcome measures that assess psychological readiness and confidence to Return to sports participation.The ACL-Return to Sport after Injury (ACL-RSI) scale and the Injury-Psychological Readiness to Return to Sport (I-PRRS) scale were translated from English to Dutch and showed sufficient validity and reliability to assess psychological readiness to resume sports among Dutch-speaking patients after ACL reconstruction. Both questionnaires are able to detect clinically important changes over time at group level. In patients with lower limb tendinopathy, the majority of the investigated psychological factors were associated with tendinopathy severity, tendon function, participation and satisfaction. Physiotherapists and other practitioners should aim to recognize patients with lack of psychological readiness to return to sports and also patients with kinesiophobia or catastrophizing thoughts when experiencing pain. In patients with Achilles tendon rupture, level of motivation, psychological readiness for return to sport, and fear of movement may affect rehabilitation outcome