The psychological impact of physical injury on recovery in Royal Marines’ recruit training

Abstract

Many Royal Marine recruits are plagued by physical injuries during the arduous 32 week training course at Commando Training Centre. Not all recruits recover from their injuries; some choose to leave the rehabilitation unit prematurely. Furthermore, some recruits experience unnecessarily lengthened recovery times that are unexplained by physical factors. As such, it seemed plausible that psychological theory might explain variance in rehabilitation outcome and recovery time. A number of empirically well-tested and validated psychological theories were reviewed and protection motivation theory was selected as the over-arching theoretical framework to guide this programme of research. The model was extended to include the constructs fear-avoidance, athletic identity (modified to measure marine identity) and organisational commitment. Measures of the intensity and impact of pain were also incorporated into the extended model. These constructs were identified as being potentially important in the prediction of behaviour, as well as being complementary to the model as a whole.
The primary purpose of this research programme was to establish the effectiveness of the extended model of protection motivation theory. This was achieved through a large-scale, prospective study. The secondary purpose was to develop and test measures of implicit attitude in order to combat some of the difficulties associated with traditional methods of attitude measurement such as social desirability response bias. This was achieved through three method development studies, a cross-sectional study, and a prospective study. Analysis of the longitudinal data revealed that each of the components of the extended model of protection motivation theory predicted outcome of rehabilitation. Self-efficacy and perceived severity of the injury explained 16.1% of the variance in outcome of rehabilitation. Furthermore, 10.4% of the variance in extended recovery time was explained by a combination of age and perceived severity. The implicit measure of organisational commitment explained 69% of successful training outcome in the cross-sectional study, which is remarkable in implicit attitudinal research.
Despite the vast literature linking attitudes and rehabilitation adherence behaviours, until now, the psychological effects of injury on rehabilitation outcome and recovery time have rarely been investigated, and have never been examined in the context of Royal Marines’ training. In addition, implicit measures have never been applied in a specific health psychology context, nor have they ever been developed in such a bespoke way. Thus it is concluded that this thesis has made a theoretical as well as applied contribution to the study of psychology, injury and rehabilitation.

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ORCID for Lucy Yardley: orcid.org/0000-0002-3853-883X

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