Considering how athletic identity assists adjustment to spinal cord injury: a qualitative study
Introduction
Worldwide, the annual incidence rate of spinal cord injury (SCI) is between 5 and 59 cases per million [1], [2]. In Europe, approximately 252 people per million inhabitants have an SCI [3], and approximately 40,000 people live with an SCI in the UK [4]. In Australia, it has been estimated that the mean patient healthcare costs (>6 years post SCI) range between $139,427 (moderate SCI) and $297,453 (quadriplegia) [5]. In the UK, the annual cost of care exceeds £500 million [4].
An individual's identity can be severely affected by loss resulting from a chronic illness [6], such as an SCI. One particular identity that can be affected following an SCI is an individual's athletic identity [7]. The athletic identity for those previously involved in sport can represent the apex of identities in the identity hierarchy. Cases have been reported where a strong athletic identity before the SCI made adaptation difficult [8] or ‘life not worth living’ [9]. However, there are also examples of individuals with a strong athletic identity who are able to embrace and accept their disability [10]. This is important because accepting the disability that accompanies the SCI is a significant barrier to overcome to achieve positive adjustment [11]. As such, exploring how individuals who have a strong athletic identity can adapt and adjust to their SCI may be valuable in detailing how to facilitate positive adjustment.
Social identity has been defined as ‘an individual's knowledge that he or she belongs to certain social groups together with some emotional and value significance to him or her of this group membership’ [12]. As such, people's classification of themselves into various social categories or groups (e.g. I am a disabled-bodied sportsperson, or I am a badminton player) initiates a process of self-stereotyping, whereby one embodies the meaning associated with that category [13]. With regard to sport and for the purposes of this article, athletic identity represents the degree to which an individual feels that they belong to the athletic group of choice, and the significance of this. Further, it is important to consider that our group memberships, and sensitivities to them, form the lens through which we interpret and respond to others’ behaviours, and how we evaluate and justify our own behaviours. Thus, changes in our social identities (memberships of new categories and/or changes in the meaning of existing group memberships) will be accompanied with changes in our behaviour. With this in mind, the meaning and value of group memberships for individuals who have suffered an SCI could be associated with, or determine, the potential for positive adjustment. Indeed, recent quantitative research has provided evidence that supports this hypothesis [14], although further in-depth research using a participant's own words is required to explore and clarify this relationship.
Past qualitative research has not been able to demonstrate how post-SCI identity is associated with and expressed alongside the adjustment process [7], [8]. Individuals with an SCI may not simply consider and use one distinct identity to represent themselves. One reason for this is that individuals with chronic illness often express the paradox of chronic illness [15], [16], [17]. The paradox suggests that individuals are simultaneously impelled to accept and defy the limitations of their disability. Further, the expression of which limitations individuals can accept or defy is likely to vary, change and evolve. One consistency in this experience may be the sport group with which individuals associate; that is, their athletic identity as a badminton player may help the process of acceptance and act as a factor that can support and facilitate adjustment. Further research needs to consider the association between athletic identity and individual's adjustment and hope following the onset of an SCI.
Section snippets
Design
A qualitative design was selected in order to obtain an in-depth description of athletic identity and the other psychosocial constructs under consideration. Semi-structured interviews were chosen as they allow flexibility and some spontaneity/adaption during the interaction. The final interview schedule consisted of eight categories around the topics of identity, adjustment and the paradox of chronic illness (see Appendix A, online supplementary material). Not all questions were asked. These
Results
Table 1 provides the demographic details of the eight participants. The mean age was 36.3 [standard deviation (SD) 8.1] years and the mean time since injury was 11.5 (SD 8.3) years. All individuals had taken part in sport before and after their injury (five males performed at national level, all others participated at local club level).
Following the thematic analysis, two themes emerged: (1) adjustment and paradox of chronic illness; and (2) the role and value of an athletic identity.
Discussion
These findings illustrate the importance of understanding the paradox of chronic illness and athletic identity for individuals with an SCI. Participants reported shock and disbelief at the magnitude of losses, and highlighted that their ongoing adjustment was influenced by losses from the past and worries about the future. Thus, the current losses, combined with uncertainty about the future, acted to diminish hope. However, hope was generated from being able to gain a sense of purpose, from
Conclusion
To conclude, adjustment for participants in the current study was a continuous process that involved realising and acknowledging the physical, psychological and social loss that had occurred. Participants were challenged by their present circumstances and the loss of important identities; they were also challenged by considering an uncertain future. However, the participant's athletic identity represented a consistency in their life, and provided access to a network of social support from their
Ethical approval
Ethical approval was gained following ethical review at the University of Birmingham (Protocol Reference Number: PEAJ 005).
Funding
No funding was obtained for this study.
Conflict of interest
At the time of the investigation, the primary author provided physiotherapy treatment to individuals at the club and had established therapeutic relationships with individuals.
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