Psychological readiness to return to sport in elite female football players in Kosovo: a PRIA-RS cross-sectional study

BACKGROUND: Injury is an inevitable component of competitive football and has a significant influence on the psychological and physical well-being of the athletes. Psychological readiness to return to sport following injury is a multidimensional construct encompassing emotional, cognitive and contextual factors that influence an athlete's transition back to training and competition. OBJECTIVE: This study aims to evaluate the level and multidimensional structure of psychological readiness to return to sport in elite female football players using the Psychological Readiness of Injured Athletes to Return to Sport (PRIA-RS) questionnaire. METHODS: A cross-sectional questionnaire-based study was conducted, which included 84 elite and semi-professional female football players who were undergoing the final stages of rehabilitation or preparing to return to full training post a sports-related injury. The psychological readiness of these athletes was assessed using the PRIA-RS instrument. Descriptive statistics and exploratory factor analysis (EFA) were performed to identify the underlying psychological dimensions associated with the return-to-sport readiness. RESULTS: Most athletes reported positive perceptions of rehabilitation progress, mood, functional recovery, and overall readiness to return to training. Approximately 64.3% of the respondents rated rehabilitation progression as "very good," while 70.2% reported having a very positive attitude at the end of rehabilitation. However, a substantial proportion reported anxiety (29.8%) and uncertainty risk towards a reinjury (23.8%) related to returning to sport. Exploratory factor analysis identified four components explaining 61.2% of total variance, representing emotional confidence, fear and anxiety, perceived functional safety, and external pressure. CONCLUSION: Elite female football players generally report a high level of psychological readiness to return to sport following an injury, although anxiety and fear of reinjury remain prevalent in a meaningful portion of the athletes. Inclusion of psychological tools such as PRIA-RS into return-to-sport decision-making alongside physical rehabilitation provides the necessary psychological support to the athletes before them to return to full training and competition. The findings support the importance of evaluating psychological readiness as a multidimensional construct alongside physical recovery when making return to sport decisions.