COVID-19 Pandemic Impact on Confidence to Return to Sport: Perspectives From National Collegiate Athletic Association (NCAA) Athletes

Background: One of the unforeseen impacts of the COVID-19 pandemic has been a decrease in athletes' confidence to return to their sport after mandates were lifted. Both physical and psychological effects have been implicated. This study aimed to measure the severity of these changes among a group of National Collegiate Athletic Association (NCAA) athletes. Methods: A novel Readiness to Return to Sport Survey, based on the validated ACL-RSI survey, was distributed to Division 1 collegiate athletes. The survey evaluated the psychological readiness of each player to return to sport in the context of the COVID-19 pandemic, utilizing a 1-10 scale (1 = least confident and 10 = most confident). Numerical responses to each survey were summed to create a primary outcome score-an athlete's Return to Sport Readiness Score. Higher scores indicate higher levels of readiness to return to sport in the nearest coming season. Results: Responses came from 68 athletes representing a variety of sports. Of those with an injury, 14 (82.35%) attributed their injury to changes in their training schedule due to COVID-19 restrictions, and the remaining three (17.65%) did not. Among all athletes, the mean return to sport readiness (RTS) score was 44 (SD 24.76). Those playing a winter sport had the lowest mean RTS score, 35 +/- 23, and those playing a fall season sport had the highest mean score, 48 +/- 25.97. Overall, competitive athletes on leave from the sport due to collegiate and Division 1 COVID-19 guidelines had lower reported mean RTS scores as compared to athletes outlined in many other anterior cruciate ligament return to sport after injury survey (ACL-RSI) studies. Conclusions: Overall, the athletes surveyed in our study reported much lower levels of readiness to return to sport in the context of COVID-19 than athletes surveyed in other studies, exhibiting COVID-19's unique impact on their confidence to return to their scheduled sport season. These differences may highlight the COVID-19 pandemic as a more severe detriment to returning to sport readiness among division-one athletes than recovering from injury alone. Given such an impact, more research is needed to elucidate the percentage of these athletes that returned to or abstained from their sport, as well as any motivating, facilitating, or detrimental factors in their choice.