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Abstract:
The current study was conducted to determine the relationship among knowledge, attitude and reporting behavior of elite athletes, those who were injured of an ACL injury in their sporting career. A sample of n=332 (male=270 (81.30%); female=62 (18.70%)) was selected and participated in the cross-sectional survey. A self-made structured questionnaire was developed and used for the collection of the required information. The collected data was properly tabulated and analyzed with the help of appropriate statistical tests. The analyzed data revealed a moderate correlation of knowledge and attitude with reporting behaviours of elite athletes. Pertaining to attitude towards ACL injury, athletes reported statistically significantly more unsafe attitudes regarding the management of ACL injury during a practice session and competition. The analyzed data revealed that athletes prefer to use play with an ACL in jury a behavior embedded in competitive sports culture. These findings suggest an intentional education program that could the attitude of athletes towards ACL injury
Key Words:
Anterior Cruciate Ligament, Knowledge, Reporting Behavior, Elite Athletes
Introduction
Pakistan is a developing country with having a tiny budget that leaves less space for human, financial, and material resources pertaining to sports and athletes' sports injuries (Ali et al., 2017). By utilization of rarely available resources, we want to get maximum benefit regarding health-promoting activities for the youth of the nation, by bringing improvement in the sports and injuries department which supports the activities to produce an active, healthier, and stronger nation in long run. Ensure the availability of necessary information in the concerned field can be very much advantageous in the inseparable departments of sports and injuries at any level of competition.
In many developed countries of the world like the United States of America (USA) have estimated approximately 200,000 Anterior Cruciate Ligament (ACL) injuries. Currently, however, only Norway, Denmark, and Sweden are those countries having web-based registries, which accurately record nationwide ACL reconstruction, presumably reflecting the occurrence of ACL injuries (Granan et al, 2009). In another study, it is found that 350,000 ACL reconstructions are performed annually in the USA (Wojtys et al., 2010). Another study shows that around 150,000 Anterior Cruciate Ligament (ACL) injuries occurred annually in the sports-related population in the United States of America (Mihata et al., 2006). Universally, sports injuries are considered one of the factors effecting athlete performance in the shape of physical, mental as well as sociological, and economic loss. The majority of sports injuries are associated/ concerned with major sports events such as football, rugby, netball, etc (Finch et al, 1998).
In Pakistan, it is reported that sports are significantly affected by injuries particularly ACL injury. A study of 67 badminton players about 53.73% of players got an injury in the right knee while 46.26 % have on the left. Damage to Anterior Cruciate Ligament (ACL) nearly 38.81% of the players were injured during the hot weather while 61.19% during the cold-weather climate. The majority of the players 92% was reported that the injured intrinsically while only 8% of players injured extrinsically with collision. Among injured players, only 42% utilized the X-ray procedure in the diagnosis of the accurate pace of injury. About 76.9% got the physiotherapy while only 23.1% did not as rehabilitation (Shah, Ansari, & Jhatial 2018).
Sports are considered as physically-oriented activities in which injuries are common happening. Different injuries like muscle cramp, muscle soreness, muscle spasm, strain and sprain of ligaments like Anterior Cruciate Ligament Injury occurs in sports participation (Hewett et al, 2005). Sports injuries may be defined as an injury which directly or indirectly results in sports participation. Adversely it affects the physiological and psychological performance of an athlete, to avoid the severity/ seriousness of the injury, it is considered important to provide treatment or to rehabilitate the injured athlete (Van Mechelen et al., 1992). Furthermore, injuries that occur during competitive sport or training, virtually injury can happen to any part of the body and therefore athlete needs a planned approach to properly analyze and efficiently supervise sports injuries (Borg-Stein., 2009; Anderson., 2003). The human body consists of bones and muscles, any injury in the human body occurs when any change in the anatomical or physiological state of the human body caused some tissues or organs damage, which may be external or self-influence, that change leads to disruption of the work function of that tissue (Al Hashemi, 2019).
It has been reported that ACL is the most recurrent injury of the knee ligament which counts for approximately 50% of all injuries of the ligament that happen in all sports (Kendall, 2010). There are numerous injuries in sports and work but one of the most feared is an anterior cruciate ligament tear (ACL), which has finished or derailed the careers of various high-status professional athletes. A rupture in ACL is very painful and can enfeeble a person for quite a few months and maybe for life, although recuperation for some is possible (Brees et al., 2010).
ACL injury typically occurs during sports, such as jumping, pivoting and sudden lateral change occur. Many sports considered to have high rates of ACL injury are football, basketball, lacrosse, soccer, and skiing (Acevedo, Rivera-Vega, Miranda, & Micheo, 2014). This non-contact injury happens more frequently in women athletes (Allen et al., 2016). It is suggesting that the proper knowledge of the use of safety gear, changes to the playing environment and, causative factors for the occurrence of injuries can have a positive effect on the prevention and control of sports injuries (Silvers-Granelli et al., 2015; Deitch et al., 2006).
Yet information alone is not equivalent to behaviour. However, a better understanding is significant in reporting ACL injury, specifically among those individuals who actually have an ACL. In many activities attitude is an important factor (Bagram & Khan, 2012; Raudsepp, Viira, & Hannus, 2012). Basically attitude has two basic components. One is an individual’s belief that a particular behavior leads to a certain outcome. Secondly, a person’s evaluation of the outcome of that behavior (Register-Mihalik et al., 2013). Therefore, those individuals who have a positive attitude towards ACL may be more likely to take decision while reporting ACL injuries. Furthermore, if they also feel that their colleagues or coaches may challenge their injury reporting or that they may lose significant play time, they can still choose not to report the injury. It shows a negative attitude towards reporting the incident which is a conduct of concern. Such principles not only provide the basis for growing awareness and knowledge but also for addressing attitudes.
Athletes are the real assets of the nation they present a proper image of the nation at the national as well on the international level, hence it is necessary to give them facilities regarding sports-injuries because these injuries become long-lasting with longer recovery periods where some injuries have serious consequences that may lead to the end of the career. Keeping in mind, this research study will facilitate the serious effects of sport injuries. The study focuses on the knowledge, attitude, and reporting behavior of the athlete in Punjab (Pakistan) who are taking part in sports competition at different level toward sports injuries especially ACL injury.
Materials and Methods
The methods and materials portion of the research thesis not only focus on the steps to be taken to examine a research problem but also explains the justification for applying a specific technique used to identify, select, process, and analyze collected information applied to comprehend and understand the problem (Åkerlind, 2012).
As the study is focused on assessing and
describing the knowledge and decision-making behavior of athletes. The researcher was therefore used a cross-sectional survey research design to ensure evidence that could meet the study's set objectives and research questions. The results of the study in quantitative research can be illustrated in tables, graphs and pie charts (Watson, 2015). Consequently, the researcher was adopted a quantitative research design for illustrations of the data in the shape of numeric, graphs, and tables.
Population in research refers to the sum of all objects, subjects or members that adhere to the requirements (Rossi, Wright, & Anderson, 2013). In this study, the population was comprised of athletes of all sports and residential areas, who had Anterior Cruciate Ligament (ACL) injuries of Punjab, Pakistan.
The method of selecting a portion of the whole population, which represents the characteristics of the entire population, is called sampling (Etikan, Musa, & Alkassim, 2016). It is difficult to collect the required data from a whole population within the stipulated time and available financial resources. The researcher therefore was picked a group of athletes, who experienced ACL injuries in the vicinity of Punjab, a province of Pakistan. Snowball sampling is a non-probability sampling in which current subjects of study recruit potential subjects from among their acquaintances. Snowball sampling was used where potential participants was hard to find (Anieting& Mosugu, 2017).
Data in research is any information gathered, observed, generated, or created to validate the original findings of the research (Zohrabi, 2013). The researcher in the present study was collected data through a questionnaire for accordingly obtaining the proposed objectives.
The literature suggests that the two most commonly used survey questionnaires such as closed-ended questionnaire and open-ended questionnaire. Closed-ended questions are usually preferred in survey research, as the frequency of each answer is easy to count (Müller, Sedley, & Ferrall-Nunge, 2014). The closed-ended questionnaire was designed and used to capture the athletes ' awareness and perceptions towards ACL injuries. The closed-ended questionnaire was comprised of the following parts.
i. Part 1. Questions regarding the demographic profile of the participants.
ii. Part 2. Questions pertaining to attitude and knowledge regarding ACL injuries.
iii. Part 3. Questions about reporting behavior pertaining to ACL injuries.
iv. Part 4. Questions related to influence of athletes’ attitude and knowledge on their intention to report ACL injuries.
The extent to which a research instrument measures exactly what it intends to measure is known as validity (Burton & Mazerolle, 2011).
The questionnaire was subjectively checked with the help of content and face validity for clarification and relevancy of the questions. The questionnaire was given to field experts to check for the relevance, unambiguity and clarity of the questions. The supervisor and supervisory committee member was further critically evaluate the questionnaire, and their recommended suggestions was incorporated accordingly.
Reliability refers to the degree to which, under similar circumstances, separate administration of the same instrument produces the same performance (Heale & Twycross, 2015). To ensure the reliability of the data collection instrument, the responses was processed through Cronbach’s Alpha reliability method.
The Statistical Package for Social Sciences (SPSS), version 24, was used in this research to explain and demonstrate, condense, collect, and analyze data. Statistical tests like, multiple co-relations and multiple linear regressions were used.
Result and Discussion
Correlation Analysis
Correlation refers to, any empirical relationship between two different variables or different data sets, having a relationship or dependence on each other. Correlation is any quantitative connection in the broadest sense, but it usually refers to the degree to which a pair of variables is related linearly with each other (Cohen et al., 2013).
Table 1. Multiple Correlations
| width="17%"> Knowledge width="16%">Attitude width="16%">Behavior | > Knowledge width="31%" valign="top">Pearson Correlation width="17%">1 width="16%">.428** width="16%">.405** | > Sig. (2-tailed) width="17%">width="16%"> .000 width="16%">.000 | > N width="17%">332 width="16%">332 width="16%">332 | > Attitude width="31%" valign="top">Pearson Correlation width="17%">.428** width="16%">1 width="16%">.507** | > Sig. (2-tailed) width="17%">.000 width="16%">width="16%"> .000 | > N width="17%">332 width="16%">332 width="16%">332 | > Behavior width="31%" valign="top">Pearson Correlation width="17%">.405** width="16%">.507** width="16%">1 | > Sig. (2-tailed) width="17%">.000 width="16%">.000 width="16%">
| > N width="17%">332 width="16%">332 width="16%">332 | |
| Model width="90">R width="96">R Square width="126">Adjusted R Square width="141">Std. Error of the Estimate | > 1 width="90">.548a width="96">.300 width="126">.296 width="141">.19587 | ||||
| Model width="18%">Sum of Squares width="12%">Df width="17%">Mean Square width="12%">F width="12%">Sig. | > 1 width="16%" valign="top">Regression width="18%">5.413 width="12%">2 width="17%">2.706 width="12%">70.542 width="12%">.000b | > Residual width="18%">12.623 width="12%">329 width="17%">.038 width="12%">width="12%">
| > Total width="18%">18.036 width="12%">331 width="17%">width="12%"> width="12%">
| ||
| Model width="37%" colspan="2">Unstandardized Coefficients width="24%">Standardized Coefficients width="8%" rowspan="2">t width="9%" rowspan="2">? | > ? width="21%">Std. Error width="24%">Beta | > 1 width="11%" valign="top">(Constant) width="16%">1.796 width="21%">.203 width="24%">width="8%"> 8.834 width="9%">.000 | > Knowledge width="16%">.233 width="21%">.052 width="24%">.230 width="8%">4.512 width="9%">.000 | > Attitude width="16%">.352 width="21%">.044 width="24%">.408 width="8%">7.999 width="9%">.000 | |