Journal of Athletic Training最新文献

Context: Driving requires continuous sensorimotor and cognitive coordination for extended time periods, and these are commonly impaired domains postconcussion. The postconcussion driving management practices and opinions of health care providers such as athletic trainers/therapists (ATs) are essential for effective patient recommendations but have yet to be examined outside of the United States.

Objective: To examine postconcussion driving management practices and opinion among Irish and Canadian ATs and to explore whether concussion assessments, highest earned degree, practice setting, or years of experience associate with postconcussion driving management practices.

Design: Cross-sectional study.

Setting: Online survey.

Patients or other participants: Fifty-three Irish and 166 Canadian ATs.

Main outcome measures: A previously validated survey capturing demographics, self-reported management practices, and opinions for refraining from (ie, stopping) and restricting (ie, limiting) driving.

Results: The majority (50.9%) of Irish and Canadian ATs (69.9%) endorsed that they always or sometimes recommended refraining from driving, respectively. Both cohorts commonly used verbal instructions (Irish ATs: 86.8%, Canadian ATs: 90.4%). Irish ATs (58.5%) favored sideline assessments, and Canadian ATs (56.6%) favored clinical examinations to determine driving readiness. Despite agreeing or strongly agreeing that patients with a concussion pose a danger on the road (Irish ATs: 72%, Canadian ATs: 46.6%), approximately 10% of Irish and Canadian ATs reported never recommending driving restrictions. Weak correlations were observed between years of experience and the number of restrictions recommended for Irish and Canadian ATs (Ρ range, -.15 to .05).

Conclusions: We observed that Irish and Canadian ATs overall have similar practices and opinions on postconcussion driving management. The lack of uniform recommendations and written instructions regarding safe return-to-driving management practices after concussion resulted in reliance on verbal advice. Our findings emphasize the need for clear and consistent guidelines related to driving after concussion.

Context: Despite the efficacy of injury prevention programs, anterior cruciate ligament (ACL) injury rates have remained steady, which may be due to limited knowledge of which groups/athletes are greatest at risk of sustaining an ACL injury.

Objective: The purpose of our study was to characterize ACL injury rate (IR) across sex, sport, and levels of play to identify high-risk groups per season.

Data sources: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searched electronic databases of PubMed and EBSCOhost.

Study selection: Inclusion criteria required that studies noted level of play, number of ACL injuries, and total number of athletes. We excluded studies if the injury was a secondary one, the total population was unclear or noted only cases of reconstruction.

Data extraction: We extracted data on sex, sport, level of play, number of ACL injuries, and total number of athletes.

Data synthesis: The electronic literature search yielded 9469 studies for initial review, and at the end of the search, a total of 89 studies were included in our meta-analysis. The highest-risk sports were female semipro handball (IR = 0.045/athlete-year), female professional basketball (IR = 0.027/athlete-year), and female professional alpine skiing (IR = 0.025/athlete-year). Across all the comparisons of sex, sports, and levels, there were large gaps in the data and variability in the injury rates.

Conclusions: There was variability in injury risk rates across sex, sport, and competition level with the highest risk of ACL injury in semiprofessional and professional sports. Whereas female athletes demonstrated greater risk of ACL injury than male athletes, it is unknown if this trend replicates in every sport or level. Improved understanding of the impact of sex and sport differences in ACL injury risk can help guide the best target areas for evidenced-based risk reduction strategies.

Context: Although most children and adolescents recover from concussion within several weeks, a substantial subset experience persisting symptoms that can interfere with daily functioning. Early identification of those at risk for persisting symptoms after concussion (PSaCs) is critical for guiding intervention.

Objective: To determine predictors of PSaCs in children and adolescents aged 8 to 18 years presenting to a community practice setting.

Setting: Community practice clinics.

Design: Prospective cohort study.

Patients or other participants: A total of 236 children and adolescents (97 females, 138 males, 1 who did not report sex; age = 14.3 ± 2.1 years) who sustained sport- or recreation-related concussions.

Interventions: Individuals reported to community practice clinics within 72 hours of sport- or recreation-related concussion. At this initial visit, parents or guardians provided information including demographics, their children's behavior after injury, injury characteristics, and reported symptoms. Approximately 1 month later (median = 36 days [interquartile range, 31-41 days] after injury), parents or guardians were contacted to provide information about PSaCs, indexed using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ).

Main outcome measures: Factors provided at the initial visit (demographics, parent- or guardian-reported behavior, injury characteristics, and reported symptoms) were examined as predictors of the presence of PSaCs (endorsement of ≥3 RPQ symptoms as being worse than preinjury) at 1 month using univariate logistic regressions. Factors that were significant predictors in the univariate models (P < .05) were entered into a multivariable model. Secondary analyses examined which factors were predictors of endorsing more (≥3) versus fewer (1-2) persisting symptoms on the RPQ.

Results: Female sex, parent or guardian reports of acting abnormally, parent reports of lethargy, and the initial total symptom score were predictors of PSaCs (P ≤ .03). Acting abnormally was the only significant predictor of endorsing more versus fewer persisting symptoms (P = .03).

Conclusions: Children and adolescents who are female, whose parents or guardians report them acting abnormally or being lethargic, and those with a higher initial total symptom score within 72 hours of injury may be at increased risk of experiencing PSaCs. Acting abnormally postinjury also may be a risk factor for endorsing more PSaCs. These findings provide information about potential indicators of children and adolescents who may benefit from early, targeted clinical intervention to reduce persisting symptom burden after sport- or recreation-related concussion.

Context: Adolescence is a critical period for bone development. Due to an elevated risk for low body mass index (BMI) and/or low energy availability, certain adolescent athletes are at increased risk of bone stress injury (BSI) and eating disorders (EDs). Despite this risk, the incidence of EDs in patients with BSI is unclear.

Objective: To compare the incidence of a premorbid drop in BMI percentile in a sample of adolescent athletes diagnosed with a BSI between 2005 and 2016. We also evaluated the relative risk of developing an ED for this sample, compared with a sex-matched, age-matched (±6 months), and time-matched (±2 years) sample of active adolescents with knee pain.

Design: Retrospective cohort study.

Setting: Data collected through the Rochester Epidemiology Project.

Patients or other participants: One hundred eighty-seven adolescent (aged 13-18) athletes with BSI and 187 active adolescents with knee pain.

Main outcome measures: Conditional logistic regression was used to assess whether premorbid weight loss was a risk factor for BSI. A stratified log-rank test was used to evaluate the association between ED diagnosis and case-control status up to 5 years postinjury.

Results: Patients with a BSI had 1.53 times the odds of premorbid BMI percentile drop compared with controls (95% CI = 0.83, 2.12; P = .17). A total of 14 patients with a BSI had ED diagnoses after injury compared with 8 controls (P = .13). Patients from weight-based or aesthetic sports had 1.93 times the odds of a BSI compared with controls (95% CI = 1.23, 3.02; P = .0040). The Kaplan-Meier estimates indicate that the case group had a greater risk of ED diagnosis.

Conclusions: Results suggest a trend toward a greater drop in BMI percentile and increased frequency of ED diagnoses in the BSI group compared with controls. The documented co-occurrence of weight loss, stress fractures, and EDs in adolescent athletes should inform guidelines for screening and treatment of adolescent athletes with BSIs.

Context: Sport-related inflammatory conditions cannot only impair sport performance but may also accelerate the onset of age-related morbidities. Authors of recent studies have highlighted a notable prevalence of these injuries among female collegiate athletes, yet limited research exists on the burden of sport-related inflammatory conditions in this population.

Objective: To describe the epidemiology of sport-related inflammatory conditions across women's National Collegiate Athletic Association (NCAA) sports.

Design: Descriptive epidemiology study.

Setting: Injury surveillance in collegiate women's sports.

Patients or other participants: Women competing in NCAA sports during 2009-2010 through 2018-2019.

Main outcome measures: We examined inflammatory condition frequencies and distributions across factors such as sport, body part, competition level (Divisions I, II, or III), and season segment (preseason, regular season, or postseason). We used a Bayesian framework to estimate inflammatory condition incidence rates (per 10 000 athlete exposures [AEs]) by sport, event type, competition level, and season segment.

Results: The NCAA Injury Surveillance Program recorded 3595 inflammatory conditions across all women's sports during the study period, and injuries were most frequently attributed to the lower leg (31.1%) and knee (26.7%). The most reported specific condition was medial tibial stress syndrome (shin splints; 14.4%), followed by patellar tendinitis (12.0%). Overall, 18.1% of all inflammatory conditions were reported as recurrent injuries. The posterior mean overall injury rate was 8.09 per 10 000 AEs (95% credible interval = 5.18, 12.57), and the highest overall rate was estimated in cross country (posterior mean = 16.20; 95% credible interval = 10.26, 25.25).

Conclusions: Our findings indicate that lower-leg inflammatory conditions, particularly among long-distance runners, warrant further attention in NCAA female athletes. In addition, our results highlight specific diagnoses that merit focused investigation, with medial tibial stress syndrome (shin splints) and patellar tendinitis emerging as the most reported conditions. Our results can help guide future research efforts aimed at better understanding the mechanisms underlying the development of inflammatory conditions in female athletes.

Objective: We examined the weight management practices of successful high school wrestlers to contribute meaningful data to the conversations that weight-certifying clinicians and athletic trainers have with athletes at the start of the wrestling season. Understanding how elite athletes navigate weight management can inform safer and more individualized guidance during preseason assessments. Specifically, we sought to determine the proportion of state-qualifying wrestlers who competed at or above their certified minimum weight class. We also quantified the magnitude of weight change from certification to state competition and analyzed seasonal trends in both body weight and body fat percentage over a 20-year period.

Design: Longitudinal retrospective review.

Setting: Four Minnesota high schools.

Patients or other participants: State-qualifying wrestlers from 2003 to 2023.

Independent variable: State-qualifying weight class.

Main outcome measures: Dependent variables are certification weight, measured body fat percent, and calculated minimum weight class.

Results: Only 48 wrestlers (52.7%; CI = 42.5%, 63.0%) competed at state in their minimum weight class, while the other 43 competed 1 to 2 weight classes above. Thirty-six wrestlers (39.6%) gained weight over the season.

Conclusions: Nearly half the successful wrestlers competed in weight classes above their minimum weight, while 5% lost 9% to 18% of their body mass over the wrestling season. This suggests factors other than maximizing individual athletic potential, such as team needs to fill a weight class, influence weight management decisions. Over the 20-year span of the study, trends toward lower measured body fat percentage and lower weight fluctuations suggest influences from sports specialization and year-round training and less emphasis on extreme leanness for competitive advantage. Athletes, in consultation with their coaches and clinicians, should select a competition weight class where they can adequately fuel, train, and recover. This may not be their minimum certified weight class.

Context: Current graded exertion tests (GXTs) for concussion management require specialized equipment and in-person supervision. The Montreal Virtual Exertion (MOVE) protocol is a telehealth-compatible GXT but has been tested only in pseudo-virtual conditions.

Objective: To determine the safety and feasibility of the MOVE protocol when administered remotely to children with concussion.

Design: Cohort study.

Setting: Virtual visit.

Patients or other participants: Asymptomatic (9 girls, 6 boys; age = 12.9 ± 2.7 years, time postconcussion = 40.8 ± 19.2 days) and symptomatic (9 girls, 6 boys; age = 12.9 ± 2.5 years, time postconcussion = 28.7 ± 23.0 days) children with concussion were recruited from the Montreal Children's Hospital Concussion Clinic between November 2023 and June 2024.

Main outcome measures: Participants completed the MOVE protocol and a follow-up visit 24 hours later over Zoom. The MOVE protocol consists of 7 plyometric exercises performed for 60 seconds with 60 seconds of rest between stages. Safety (adverse events) and feasibility measures (protocol, outcomes, intensity, and technology categories) were collected. Linear mixed models were used to evaluate exercise intensity outcomes with all other outcomes analyzed using chi-square tests.

Results: One participant in each group experienced a minor adverse event (symptom increase of ≥10 points on the Post-Concussion Symptom Inventory at the 24-hour visit); however, no major adverse events were reported. Mean heart rate (78.7 ± 33.6 beats/min; P < .001) and rate of perceived exertion (4.87 ± 1.50; P < .001) change scores increased throughout the MOVE protocol, but no main effect of group or interaction effect was observed. Feasibility outcomes were less likely to be captured during the rest period for asymptomatic children (outcomes not collected on time on 33 [31.4%] of 105 occasions) than symptomatic children (11 [11.7%] of 94 occasions; ${\text{χ}}_1^2$ = 10.1, P < .001). Otherwise, all outcomes met the a priori definition of feasibility.

Conclusions: The MOVE protocol can be safely and feasibly administered virtually. A no-equipment, virtual GXT can remove barriers to exercise testing and broaden access to best-practice concussion-management strategies.

Context: Low energy availability, disordered eating, and/or compulsive exercise behaviors may negatively affect health-related quality of life (HRQOL), and this has not been studied specifically in adolescent athletes.

Objective: Assess the correlations of HRQOL with energy availability, disordered eating, and compulsive exercise in adolescent athletes.

Design: Cross-sectional study.

Setting: A single sports medicine center and local athletic partnerships.

Patients or other participants: Thirteen- to 18-year-old male and female athletes who were actively engaged in at least 1 organized sports team at the time of study participation.

Main outcome measures: Participants completed the Pediatric Quality of Life Inventory (PedsQL), the Eating Disorder Examination Questionnaire, the Compulsive Exercise Test, and 7 days of exercise monitoring (via wrist-worn heart rate activity monitor) and dietary intake reporting to assess energy availability.

Results: Sixty-four participants (n = 39 female, mean age = 15.5 ± 1.5 years) completed the study. There were no significant associations between energy availability (β = -0.07; 95% CI = -0.32, 0.19; P = .56) or Compulsive Exercise Test scores (β = -0.28; 95% CI = -1.28, 0.72; P = .58) and PedsQL scores, but there was a significant association between Eating Disorder Examination Questionnaire scores (β = -4.78; 95% CI = -8.53, -0.76; P = .01) and PedsQL scores, after adjusting for participant sex. We observed a significant association between female sex and lower PedsQL scores (β = -6.43; 95% CI = -12.1, -0.76; P = .03).

Conclusions: Adolescent athletes who reported more significant disordered eating behaviors demonstrated worse HRQOL. Female athletes reported worse HRQOL overall compared with male athletes. This highlights the importance of screening and early intervention for disordered eating behaviors to prevent the potential negative impact on HRQOL, as well as the consideration of sex-specific differences regarding HRQOL in adolescent athletes.

Context: Assessments used after concussion provide strong diagnostic accuracy and aid in initial health care planning, but they can have limited utility after the acute time frame. Current concussion assessments have low ecological validity in assessing return-to-sport readiness. We developed a functional assessment protocol, the Functional Assessment of Neurocognition in Sport (FANS), to address these limitations.

Objective: To evaluate the psychometric properties of the FANS, including test-retest reliability, minimal detectable change, and divergent validity.

Design: Descriptive laboratory study.

Setting: Clinical laboratory.

Patients or other participants: A total of 17 healthy, physically active participants (10 [58.82%] women, 7 [41.18%] men; age = 21.94 ± 3.15 years, height = 170.49 ± 11.42 cm, mass = 72.99 ± 26.72 kg; 13 [76.5%] with no lifetime concussion history).

Main outcome measures: Participants completed the FANS at 2 time points approximately 14 days apart and conventional clinical assessments (symptom checklist, balance testing, and computerized neurocognitive testing) at the first time point. We used the FANS to examine 7 cognitive domains (verbal memory, visual memory, reaction time, processing speed, cognitive-motor flexibility, delayed verbal memory, and delayed visual memory) by incorporating neuropsychological test paradigms with whole-body cognitive-movement tasks. We used intraclass correlation coefficients with 95% CIs and Pearson r correlations to evaluate test-retest reliability and divergent validity.

Results: All FANS outcomes displayed acceptable test-retest reliability (intraclass correlation coefficient ≥ 0.63), with the lowest being the verbal memory interference subtest. Standard error of measurement and minimal detectable change values overall were small relative to their possible score ranges. Correlations between the FANS and conventional clinical assessments demonstrated select FANS reaction time and processing speed outcomes exceeded the divergent validity threshold with computerized neurocognitive testing reaction time (r range, -0.79 to 0.77).

Conclusions: The FANS overall displayed acceptable test-retest reliability comparable with traditional neurocognitive test platforms and acceptable divergent validity. The FANS reaction time and processing speed may overlap partially with computerized neurocognitive testing reaction time, and this warrants further examination in a clinical population. Although the FANS is reliable and valid for use, future research is needed to establish the utility of the FANS for return-to-sport readiness for concussion.