Emotional Responses of Athletes to Injury Questionnaire

1. If you could be anything you wanted to be in life, what would that be?
2. List in order of preference the sports & activities in which you participate.
3. What are your reasons for participating in sport?
   Rank 10 = high & 0 = low:
• Stress management ____
• Fun____
• Pursuit of excellence____
• Socialization____
• Personal improvement____
• Self-discipline____
• Weight management____
• Outlet of aggression____
• Competition____
• Other____
• Fitness____
4. Would you describe yourself as an athlete?
   1(absolutely not)...2..........3...........4............5(absolutely yes)
5. What specific goals do you have in sport?
6. Have they changed since the injury? Yes ____ No ____ If yes, how?
7. What is the nature of your injury?
8. In what sport were you injured?
   How did it happen?
9. When during the season did the injury occur?
   Circle one: before..........mid............end
10. Are you encouraged in sport by significant others?
    Yes _____ No _____
11. Do you interpret this support as:
    Pressure _____ Reluctant support ____ Just right _____
12. Who exerts most of the pressure?
    Self ____ Father ____ Mother ____ Coach ____ Other ____
13. How many hours per week were you in practice or competition before the injury?
    0–2 3–5 6–10 11–15 16–20 21–25 26–30 31 & over
14. Were you under any recent stress (life changes) before the injury? Yes _____ No _____
    If yes, could you please describe?
15. Do you have a strong family support system or close friends who know about your injury? Yes _____ No _____
    If yes, who are they?
16. How have you been feeling emotionally since the injury?
17. How would you rank these emotions in significance as to how you are feeling because of the injury?
    Rank: 12 = high, 0 = low
• Helpless _____
• Frustrated _____
• Optimistic _____
• Tense _____
• Shocked _____
• In pain _____
• Bored _____
• Discouraged _____
• Relieved _____
• Depressed _____
• Frightened _____
• Angry _____
18. If 0% is no recovery, what percentage of recovery have you made to your preinjury status?
    0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
19. When is your estimated date of return to sport?
20. Do you have fears about returning to sport?
    Yes ____ No ____
    If yes, what are they?
21. Are you a motivated person for exercise?
    1 2 3 4 5 6 7 8 9 10 (not at all) (extremely)
22. What is your current rehabilitation program?
    Which exercises ______ Times/day _____ Times/week ______
23. Are you able to work out on exercise equipment or modalities?
    Yes ____ No ____
    If yes, please describe

Criteria:

Source: Smith AM & Milliner EK (1994).