Journal of Athletic Training最新文献

Clinical Problem: Implementation and sustainability of a clinical electronic medical record (EMR) allowing for multiple billable encounters in an athletic medicine practice.Environment: Division-I collegiate athletics clinic.Variables: For ATs to complete billable documentation clinicians must: use an electronic health record (EHR), understand and appropriately use Current Procedural Terminology (CPT) and International Classification of Diseases version 10 (ICD-10) codes, understand patient encounter types, Relative Value Units (RVUs), and the role of a service provider related to incident-to capability.Strategy: Proposed and implemented the use of a clinic based EMR which communicated within the entire medical system with all providers. Proposed and implemented structural changes within the athletic medicine clinic to support athletic trainer billing in a traditional clinical atmosphere. Implementation resulted in the ability to bill incident-to but posed a challenge in compliance of adopting a new documentation strategy.Strategy: Proposed and implemented the use of a clinic based EMR which communicated within the entire medical system with all providers. Proposed and implemented structural changes within the athletic medicine clinic to support athletic trainer billing in a traditional clinical atmosphere. Implementation resulted in the ability to bill incident-to but posed a challenge in compliance of adopting a new documentation strategy.Strategy: Proposed and implemented the use of a clinic based EMR which communicated within the entire medical system with all providers. Proposed and implemented structural changes within the athletic medicine clinic to support athletic trainer billing in a traditional clinical atmosphere. Implementation resulted in the ability to bill incident-to but posed a challenge in compliance of adopting a new documentation strategy.Findings: ATs were able to be reimbursed by some insurance companies. The use of the clinical EMR resulted in athletic trainers billing 13 CPT codes and insurance reimbursement as high as $38,000 per fiscal year in the 5 years since implementation.Outcome: Documentation in a clinical-based record has standardized communication between members of the athletic medicine team, generated revenue, and is used as a tool to measure productivity and demonstrate the fiscal value of the athletic trainer.Lessons Learned: ATs must buy-in to and understand the need to shift from an "athletic trainer specific EMR" to a clinical based EMR. Although the quantity of documentation does not change, the quality and structure of the notes must meet CMS guidelines. This significant change requires policy updates and demands that ATs in this system re-structure documentation practices. Creating a culture of growth is critical, allowing others to see that while this method is different, ATs can complete this level of documentation. (298 words).

Context:There is a 2-4x increased risk for musculoskeletal injury after concussion. A potential reason for the increased risk is aberrant biomechanics. The majority of prior research has focused on single-task biomechanics, but dual-task biomechanics may better represent athletic competition. Objective:To compare (1) jump landing and cutting biomechanics, (2) dual-task cost cognitive outcomes, and (3) perceived task difficulty/demands under single- and dual- task conditions (no-counting, serial 3s, serial 7s) between individuals with and without a concussion history. Design:Cross-sectional. Setting:Biomechanics laboratory. Participants:Twenty-three individuals with (age:20.2±1.9years, BMI:22.9±2.7kg/m2, 60.9% female, 44.7 months [95% confidence interval=23.6, 65.7] post-concussion) and 23 individuals without (age: 20.7±1.7years, BMI: 22.4±2.3kg/m2, 60.9% female) a concussion history participated. Main Outcome Measures:Jump landing and cutting trunk lower extremity kinematics and kinetics under single- and dual-task conditions. Cognitive accuracy and response rate during dual-tasking. NASA Task Load Index questionnaire. Results:During the jump landing, all participants exhibited a significantly faster reaction time during no counting versus serial 3s (p<0.001, Hedge's g=1.187) and serial 7s (p<0.001, Hedge's g=1.526). During the cutting, all participants exhibited a significantly faster reaction time during no counting versus serial 3s (p<0.001, Hedge's g=0.910) and serial 7s (p<0.001, Hedge's g=1.261), and serial 3s versus serial 7s (p=0.002, Hedge's g=0.319). All participants reported lower task demands during jump landing and cutting for no counting versus serial 3s (p<0.001) and serial 7s (p<0.001), and serial 3s versus serial 7s (p<0.001). Conclusion:Concussion history did not affect any of our outcomes, possibly because lingering biomechanical deficits may have resolved in our sample. Task demands did increase with increasing cognitive load, which may be beneficial for progressively manipulating the dual-task cognitive component during rehabilitation.

Context: Screening programs to identify negative ulnar nerve adaptations in throwing athletes can help minimize injury risk and individualize treatment programs prior to the onset of symptoms. However, it is currently unclear how the ulnar nerve structurally adapts chronically in professional baseball pitchers. Objective: To compare ulnar nerve ultrasound structural characteristics between the throwing (dominant) and non-throwing control (non-dominant) elbows in professional pitchers, with a secondary purpose of comparing ultrasound structural characteristics between subluxating and non-subluxating ulnar nerves. Design: Cross-sectional study. Setting: The beginning of the 2022 Minor League Baseball spring training of a single professional baseball organization. Participants: All asymptomatic professional baseball pitchers from a single organization. Main Outcome Measures: Bilateral elbow ultrasound examinations by a musculoskeletal radiologist for subsequent image quantification of ulnar nerve properties (echogenicity, area, circularity), as well as to identify ulnar nerve subluxation. Results: Overall, 67 male professional baseball pitchers were enrolled. No significant bilateral differences in ulnar nerve cross-sectional area (dominant: 0.2 cm2 vs. non-dominant: 0.2 cm2, p=0.4), echogenicity (137 pixel intensity vs. 128 pixel intensity, p=0.07), or circularity (0.67 vs. 0.69, p=0.4) were observed. Ulnar nerve echogenicity was significantly lower in subluxating dominant ulnar nerves compared to non-subluxating dominant ulnar nerves (127 pixel intensity vs. 143 pixel intensity, p=0.006), while no significant differences in ulnar nerve area (0.2 mm2 vs. 0.2 mm2, p=0.1) or circularity (0.68 vs. 0.66, p=0.4) were observed between groups. Conclusions: The ulnar nerve of the throwing elbow had similar cross-sectional area, echogenicity, and circularity compared to the non-dominant ulnar nerve. Nerve echogenicity was significantly decreased in subluxating ulnar nerves, however further research is necessary to determine why this difference exists and the potential direction of causality.

Objectives: To compare strength parameters and pain ratings across three different positions forisometric hip abduction and adduction strength testing. Design: Cross-sectional study. Setting: Two elite European football academies. Participants: Male football players (n=188, mean age 15.5 ± 1.6) from the U14-U19 teams. Methods: Isometric hip abduction and adduction were tested in 3 different positions on the ForceFrame: bent-leg with knees on pads, straight-leg with ankles on pads, and straight-leg with knees on pads. The order was randomised. The outcome measures were maximum isometric hip adduction and abduction strength (Fmax), limb symmetry index (LSI), hip adduction-to-abduction strength ratio and hip/groin pain numeric rating scale (NRS). Results: Correlation was moderate to high for Fmax in hip adduction (r = 0.64 to 0.73) and abduction (r = 0.78 to 0.84), but low for LSI and strength ratios (r = 0.06 to 0.48). Pain was reported by 19% and 13% of players during adduction and abduction respectively, with the majority (11% and 10%) only reporting pain in one of the three positions. Conclusions: The findings suggest that maximal strength values from the three test positions can be compared (i.e. using a conversion factor). The interchangeability of test positions is otherwise limited, due to inconsistent pain ratings and low correlation for LSI and strength ratios.

Context: Baseball is a popular sport in the United States, with widespread play among secondary school student-athletes. Baseball-related injuries may vary based on community-level socioeconomic status of schools. Objective: To describe the injuries sustained by secondary school baseball players from schools categorized by community-level socioeconomic status. Design: Cross-sectional study design. Setting: Data (2014/15-2018/19 academic years) were obtained from the National Athletic Treatment, Injury, and Outcomes Network (NATION-SP) Participants: Secondary school baseball athletes. Main Outcome Measures: Frequencies and percentages of injuries, injury rates, and competition/practice injury rate ratios (IRR) were reported by the community-level socioeconomic status (ie, affluent, average wealth, disadvantaged) where each school is located. Results: NATION-SP captured 320 baseball injuries across 140,619 total athlete exposures (AEs), for an overall injury rate of 2.4/1,000 AEs. Of those, 52% occurred among athletes in 24 schools situated in affluent communities, 15.6% occurred in 12 schools from average wealth communities, and 32.5% occurred in 12 schools located in disadvantaged communities. The largest injury rate was schools located in disadvantaged communities (3.3/1000 AE), followed by affluent (2.3/1000 AE) and average wealth (1.4/1000 AE) communities. On average, schools from affluent and disadvantaged communities had higher injury rates during competition than during practice (affluent: IRR=1.5, 95% CI=1.11, 2.05; disadvantaged: IRR=1.6, 95% CI=1.12, 2.41). Frequencies of many injury characteristics were consistent in schools across community-level socioeconomic status with contact, sprain/strain, and non-timeloss ranking highest in terms of injury mechanism, diagnosis, and time loss, respectively. Shoulder/clavicle was most frequent body part injured in schools in average and disadvantaged wealth communities, and ankle was most frequent in schools in affluent communities. Conclusions: Baseball athletes playing in schools located in disadvantaged wealth communities had the largest overall injury rate, followed by schools in affluent, and average wealth communities. Across most injury characteristics, a consistent trend emerged regardless of community-level disadvantage, with the highest baseball injury rates resulting from contact mechanisms, diagnosed as sprains or strains, and classified as non-time- loss injuries. While many injury patterns are consistent across socioeconomic communities, examining injuries through the lens of community-levels of disadvantage provides insight into subtle differences that could information targeted prevention strategies or resource needs.

Context Lean sports, endurance running, have been at the forefront of disordered eating and body image research, particularly in female populations. Yet, little is known about how athletic men and women differ in body checking behaviors, a known risk factor for body dissatisfaction and disordered eating, across sport type and athletic status. Objective The purpose of this study was to examine gender differences on measures of eating behavior and body checking between full-time collegiate student-athletes and nonathletes. Design Cross-sectional study. Setting NCAA DI collegiate athletics. Participants Two-hundred fifty-nine full-time college students (n = 174 student-athletes, 85 nonathletes) Main Outcome Measures Primary outcomes included self-reported disordered eating behavior and body checking behavior through the EAT-26 and the Body Checking Questionnaire (BCQ) and the Male BCQ (MBCQ). We explored differences based on sport type, team, individual, or nonathlete, and gender identity. Results There was a statistically significant multivariate main effect of gender F(10, 464) = 9.219, p<0.001, 𝜂 2 = 0.166, and a significant multivariate interaction of gender and sport type F(15, 699) = 2.806, p=0.001, 𝜂 2 = 0.057. Follow-up comparisons for team sport athletes showed that women scored significantly higher (p<0.001) on the MBCQ compared to men. Women team sport athletes also scored significantly higher on the MBCQ than women nonathletes (p < 0.001). Conversely, nonathlete men scored significantly higher on the MBCQ than men team and individual sport athletes (p = 0.003 and p = 0.048, respectively). Conclusions Findings suggest that body checking behaviors traditionally studied as masculine occur more frequently in women than men. This effect seems to be driven by women team sport athletes, who reported engaging in more body checking behaviors on the MBCQ than nonathletes. Therefore, assessments based on traditional views of maleness and femaleness may overlook significant risk factors for eating disorders (ED) in college athletes.

Scientific inquiry aims to minimize bias and ensure accurate conclusions. A critical yet often overlooked issue in sports medicine and exercise science research is the family-wise error rate (FWER) and experimental-wise error rate (EWER), which increase with multiple statisticalinferences, inflating the risk of Type I errors. While FWER corrections are standard in post-hoc ANOVA tests, they are inconsistently applied in broader research contexts. Using an example from our research team of over 67 million regression models, we illustrate how failing to correct for FWER can create spurious findings. Approximately 3 million (4.4%) models werestatistically significant (p<0.05), aligning with the expected false-positive rate. This underscores the necessity of solutions such as preregistration, false discovery rate control, and Bayesian approaches. Without proper corrections, erroneous conclusions may mislead clinical decision- making and potentially harm patients, highlighting the importance of rigorous statistical methods in evidence-based sports medicine.

Context: Shoulder and elbow problems are common among athletes in overhead sports, making 7 it essential to understand the characteristics of active athletes with arm trouble to improve and prevent upper extremity disorders. The Kerlan-Jobe Orthopaedic Clinic (KJOC) Score is widely used to evaluate upper extremity functionality in this population. Objective: (1) To compare the KJOC score between athletes with and without arm trouble in various overhead sports; and (2) to clarify the relationship between subjective competitive levels and functional characteristics using correlation analysis of the KJOC score questions. Design: Cross-sectional study Setting: College athletes from baseball, basketball, swimming, tennis, and track and field 15 throwing teams completed the KJOC score questionnaire. Participants were categorized into two groups based on their responses regarding current functional status: (1) playing without arm trouble (asymptomatic group) and (2) playing with arm trouble (symptomatic group). Participants: 401 college athletes from overhead sports. Main Outcome Measure(s): The Mann-Whitney U test was used to compare the overall KJOC scores and the scores of individual questions between symptomatic and asymptomatic groups. Spearman's rank correlation analysis determined the relationships between Q10 (subjective competitive level) and Q1-9 (upper extremity functionality). Results: The symptomatic group had significantly lower KJOC scores than the asymptomatic group across all sports (P < 0.001). Several individual question scores also differed significantly between groups, although the specific questions varied by sport. Correlation analysis revealed the association between Q10 and other functional scores with sport-specific variations. Conclusions: These findings demonstrate that impaired upper extremity function and its relationship to competition levels in athletes with arm trouble vary across different sports disciplines.

Context: Shoulder injuries comprise the largest proportion of swimming injuries, and a large percentage of swimmers participate with pain. Therefore, it is assumed that shoulder pain decreases performance, but researchers have not compared collegiate swimmers' performance with and without pain.

Objectives: (1) To determine if individual swimmers' shoulder pain and function are associated with a change in normalized swimming performance over a season, (2) to determine if differences in normalized swimming performance exist among 3 collegiate teams, and (3) to qualitatively describe and compare each team's training regimes.

Design: Cross-sectional study.

Setting: Swimmers completed preseason (T1) and postseason (T2) surveys including pain ratings and shoulder function using the Kerlan-Jobe Orthopaedic Clinic (KJOC) shoulder and elbow questionnaire. Swimming times were obtained from published meet results. Coaches reported training programs through interviews and tracking logs.

Patients or other participants: Fifty-two National Collegiate Athletic Association Division III swimmers from 3 teams.

Main outcome measure(s): Stepwise linear regression was used to determine if pain and function related to performance. Team demographics and normalized swimming performance (reduction in time per lap from season beginning to end) were compared with analyses of variance with post hoc tests.

Results: Initial KJOC scores, but not pain, related to individual swimming performance. Differences in team performance were found (P = .006), with Team 3 having the greatest reduction in time (1.01 s/lap), a lower percentage of females, a more experienced coach, and a periodization schedule with large increases and decreases in yardage. A main effect (P = .043) was found for baseline demographics, with Team 3's swimmers being taller and having longer competitive experience.

Conclusions: The initial KJOC score predicting swimming performance improvement demonstrates the need for athletic trainers to prioritize enhancement of preseason function. Endurance training-induced hypoalgesia and motivation may explain the lack of effect of shoulder pain on performance. Further research is needed to elucidate optimal periodization and dry-land training.

Context: Chronic ankle instability (CAI) patients exhibit altered movement patterns during jump landing/cutting movements. Persistent pain is one of the residual symptoms that may affect movements. Calculating joint energetics affected by chronic pain offers a novel method to understand how chronic pain influences energetics of lower extremity joints in CAI patients.

Objective: To identify the effects of chronic pain on lower extremity energy dissipation and generation during jump landing and cutting in patients with CAI.

Design: Cross-sectional study.

Setting: Laboratory.

Patients or other participants: Fifteen CAI patients with higher pain (6 men and 9 women; age = 22.1 ± 2.1 years, height = 1.74 ± 0.09 m, mass = 71.3 ± 10.6 kg, pain = 66.9 ± 9.4), 15 patients with CAI and lower pain (6 men and 9 women; age = 22.3 ± 2.1 years, height = 1.74 ± 0.08 m, mass = 70.1 ± 10.7 kg, pain = 89.3 ± 2.6), and 15 healthy control individuals (6 men and 9 women; age = 21.3 ± 1.7 years, height = 1.73 ± 0.08 m, mass = 70 ± 10.3 kg, pain = 100 ± 0).

Main outcome measure(s): Ground reaction force data were collected during 5 trials of maximal jump landing/cutting tasks. Joint power was defined as the product of angular velocity and joint moment. Energy dissipation and generation by the ankle, knee, and hip joints were calculated by integrating regions of the joint power curve.

Results: CAI patients with higher pain displayed less ankle energy dissipation (P = .013 and P = .018) and generation in the ankle (P = .002 and P = .028) than CAI patients with lower pain and healthy control individuals during the jump landing/cutting phase. CAI patients with higher pain showed more hip energy generation than CAI patients with lower pain (P = .038) and healthy control individuals (P = .013) during the cutting phase.

Conclusions: CAI patients with higher pain changed both energy dissipation and generation in the lower extremities, reducing the burden of the ankle joint during jump landing/cutting and having a hip-dominant compensatory strategy during the cutting phase. Our results suggest that chronic pain could be one of the factors that affect motor strategies in the CAI population.