Journal of Athletic Training最新文献

Context: Track & field and cross country athletes experience high rates of lower extremity injuries. The Running Readiness Scale (RRS) may help determine which athletes have a higher likelihood of lower extremity injury.

Objective: To determine if RRS performance at the start of the season was related to likelihood of experiencing a lower extremity injury during the subsequent track & field or cross country season.

Design: Prospective cohort study.

Setting: University.

Patients or other participants: 113 NCAA Division III track & field athletes in running, jumping and vaulting events and cross country runners (50 female, 63 male, mean±SD age 19.9±1.3 years).

Main outcome measure(s): Athletes were assessed on RRS tasks: double-leg hops, plank, step ups, single-leg squats, and wall sit at the start of their season and then were observed by team athletic trainers during the season for occurrence of lower extremity injuries that resulted in missing one or more practices or meets. Adjusted Odds Ratios (AOR) and 95% confidence intervals (CIs) were used to assess the likelihood of lower extremity injury.

Results: Thirty-seven athletes (32.7%) experienced a lower extremity injury. Athletes scoring ≤3 on the RRS were almost five times more likely to experience lower extremity injury (AOR=4.8; 95%CI: 2.1-11.3) than athletes scoring ≥ 4. Athletes failing double-leg hops or wall sit tasks were more likely to experience lower extremity injury (p<0.05).

Conclusions: Track & field and cross country athletes with RRS scores of ≤3 had a higher likelihood of lower extremity injury than those with scores of ≥4.

Context: Tendon abnormalities on imaging are commonly observed in individuals with Achilles tendinopathy. Those abnormalities can also be present in asymptomatic individuals, which is an important risk factor for developing tendon symptoms. Ballet dancers are particularly vulnerable due to the high loads placed on their Achilles tendons. Understanding the relationship between clinical measures and tendon abnormality is essential for this population.

Objective: To investigate the predictive value of clinical measures for identifying Achilles tendon abnormality in asymptomatic ballet dancers using a non-linear statistical analysis.

Design: Cross-sectional study.

Setting: Dance company facility and research laboratory.

Patients: Thirty-five asymptomatic professional and amateur ballet dancers enrolled (23 female/12 male).

Main outcome measures: Presence of Achilles tendon abnormality were investigated using grey-scale ultrasound. Tendons were classified as having abnormality if presenting fusiform shape and/or hypoechoic areas. Clinical measures assessed were foot pronation, ankle dorsiflexion angle, hip, knee, and ankle isometric torque, and standing calf endurance. CART analysis was used to explore nonlinear interactions among clinical measures and their role in identifying tendon abnormality.

Results: 68 tendons were included in analysis. Structural change was common in asymptomatic dancers, with 80% presenting tendon abnormality. Hip isometric torque, ankle dorsiflexion range of motion, and calf endurance were measures related to tendon abnormality. Interactions between hip torque and ankle dorsiflexion range of motion were statistically associated with presence of tendon abnormality. Increased hip abductor torque was linked to a 59% reduction in the probability of tendon abnormality. 26 The CART model reached proper accuracy (total classification percentage of 83.8%).

Conclusions: Hip torque was an important clinical measure related to tendon structure. Assessment of dancers should include the whole lower limb as combination of hip torque and ankle dorsiflexion range of motion accurately identified presence of tendon abnormality.

Context: Social determinants of health are known to affect overall access to youth sports, however, it is not fully understood how multiple social determinants of health may impact access to school-based athletic training services.

Objective: To determine the relationship between Social Vulnerability Index (SVI) scores on access to high school-based athletic trainers in California.

Design: Retrospective, cross-sectional study.

Setting: Online survey.

Patients or other participants: California Interscholastic Federation (CIF) high school respondents of the 2022-23 Participation Census.

Main outcome measures: Association between Social Vulnerability Index scores and access to school-based athletic trainer services.

Methods: This study uses data from CIF high school respondents of the 2022-23 Participation Census. School addresses were used to extract SVI scores from the U.S. Census Bureau. Separate multivariable logistic regressions and generalized linear mixed effects models assessed the relationships between access to school-based athletic training services and SVI scores at the census and county levels.

Results: There were 1,598 respondent schools (65% public, 24% private, and 11% charter). 49% of schools reported having an athletic trainer, of which 41% were certified. Adjusted analyses revealed that increased vulnerability in household characteristics was associated with lower odds of access to athletic trainers and certified athletic trainers at both county (OR: 0.89 (95% CI: 0.80, 0.99); p = .04) and census tract levels (OR: 0.93 (95% CI: 0.89, 0.97); p = .002). Increased vulnerability in socioeconomic status was associated with lower odds of having an certified athletic trainer at the census tract level (OR: 0.94 (95% CI: 0.89, 0.98); p = .006), but not the county level (p = .16).

Conclusions: Increased vulnerability in household characteristics is associated with decreased odds of access to high school-based athletic training services.

A female NCAA Division I track athlete experienced non-localized shin pain midway through her first season, which was diagnosed as medial tibial stress syndrome. Treatments included strengthening and range of motion exercises, reduced training volume, and pain control modalities, but symptoms worsened. It was revealed she had been suffering from severe sleep deprivation (<3 hours/night) contributing to bilateral tibial and fibular stress reactions. Months of trial and error eventually resulted in the implementation of sleep interventions which improved her total body bone mineral density and bilateral stress reactions. Two years after successful sleep interventions this athlete has remained injury-free and continues to set personal bests in her events. Our standard injury screening protocols did not include questioning sleep quality and quantity early in the process and this case highlights the need for these measures to be considered initially and throughout the treatment and recovery phases of sports-related injuries.

Context: Student-run health clinics (SRHC) are commonly utilized to provide clinical experiences to students in healthcare education programs as well as healthcare services to a target community. Recent reports on athletic training SRHCs (AT-SRHCs) with a client population of university students, employees and/or community members have reported positive patient outcomes and high patient satisfaction, however there is limited data about the treated conditions, services and value provided by AT-SRHC.

Objective: To track utilization of athletic training services at a free AT-SRHC.

Design: Retrospective chart review from September 2022-May 2024.

Setting: University-based AT-SRHC.

Patients: 97 patients (52 males, 44 females, 1 not documented; age 32.6±13.7 years, range: 18-65 years old; 50 employees, 47 students).

Main outcome measures: Data were extracted from an electronic medical record and scheduling software. Variables extracted included patient demographics, appointment numbers, mechanism of injury, injured body part, days since injury, injury diagnosis, injury severity, and common procedural terminology (CPT) codes. Data were analyzed descriptively.

Results: Sixty-four percent (226/352) of available appointment sessions were reserved. The 3 most commonly injured body areas were the knee (n=26, 23.9%), shoulder (n=23, 21.1%), and thigh (n=13, 11.9%). The 3 most common diagnoses were sprains/strains (n=51, 46.8%), overuse conditions (e.g. epicondylitis, impingement, tendonitis; n=18, 16.5%), and nonspecific joint pain (n=22, 20.2%). The 3 most common CPT codes were for therapeutic exercise (n=136), athletic training evaluation (n=98), and manual therapy (n=78). Estimates for the total value of services range from $6,901 to $13,498 ($39.89-78.03 per session).

Conclusions: Services at an AT-SRHC were utilized by a small portion of the campus population during its first 2 years of operation. Data provides preliminary insight into AT-SRHC service utilization and value. Additional organizations may benefit from developing an AT-SRHC to provide access to affordable care and student clinical experiences.

Context: Nontraumatic shoulder pain (NSP) is common in volleyball, affecting performance and well-being. It is more prevalent in female players. Previous studies lack comprehensive assessments of shoulder pain that consider multiple factors, including range of motion, muscle strength, joint position sense, dynamic stability, and volleyball-specific mechanics.

Objective: To investigate NSP prevalence in female high school volleyball players, considering shoulder joint functional parameters and volleyball-specific factors.

Design: Cross-sectional study.

Setting: High school gymnasiums.

Participants: Fifty-nine female high school volleyball players (15-17 years).

Main outcome measures: Demographic data, environmental factors (years of experience, spiking technique, serve type), shoulder joint function (passive glenohumeral joint's range of motion, muscle strength, joint position sense, dynamic stability), and NSP prevalence during spiking and serving. Logistic regression analysis was conducted to identify significant factors associated with NSP.

Results: NSP prevalence was 54.2%, with 68.8% not informing coaches. Significant associations were found between NSP and factors such as Upper Quarter Y-Balance Test-Medial (p=0.008; odds: 0.892; 95% CI, 0.82-0.97) and joint position sense of internal rotation (p=0.031; odds: 1.411; 95% CI, 1.03-1.93).

Conclusions: Shoulder pain leads to impaired proprioception and dynamic stability. Effective communication between players and coaches is crucial for managing and preventing pain. Targeted training programs to enhance proprioception and dynamic stability may reduce shoulder pain and injuries. Educating players on the importance of reporting pain and encouraging early intervention is essential.

Context: Athletic trainers (ATs) are in a unique position to mitigate the negative impact of social determinants of health (SDH) in their patients. In the secondary school setting, understanding common SDH may inform strategies that reduce these impacts. However, little is known about the types of SDH that ATs observe in patients in this setting.

Objective: To investigate SDH observed by ATs at the point-of-care in the secondary school setting.

Design: Descriptive, observational card study.

Setting: Secondary schools.

Participants: Twenty-seven ATs (mean [SD] age = 29.9 (5.6) years, 23 [85.2%] female).

Main outcome measure: Athletic trainers recorded SDH on a standardized observation card during patient interactions. Cards provided instructions for completion and had a 4-column table with a list of 19 predetermined SDH, a checkbox for observed SDH, a checkbox for perceived negative impact of observed SDH on patient health, and an open box to write in actions taken to address the observed SDH.

Results: Overall, 676 cards with 748 observed SDH were collected from 27 secondary schools. Of those, 46.9% (351/748) were perceived to have a negative impact on patient health. The top 3 observed SDH were academic stressors (14.2%, 106/748), access to social media (12.6%, 94/748), and lack of health literacy (11.4%, 85/748). The ATs reported acting on 37.7% of negatively perceived SDH 24 through counseling and education (48.6%, 137/282), additional resources (20.6%, 58/282), referral to others (17.4%, 49/282), and communication with others (13.5%, 38/282).

Conclusions: Our results indicated ATs in the secondary school setting were observing and acting to mitigate the negative impact of SDH. However, these ATs should be prepared to provide resources for patients negatively impacted by academic stressors, social media, and lack of health literacy. Resources, referrals, and additional education for patients may support a healthier community and positively impact athlete health and well-being.

Context: A patient-centered care (PCC) environment allows athletic trainers (ATs) to develop trusting relationships with patients, enabling them to make the most informed care decisions. To provide PCC, the AT should assess health literacy and deliver quality patient education.

Objective: To explore the lived experiences of ATs from different job settings to identify how they deliver PCC specific to health literacy and patient education.

Design: Qualitative.

Setting: Virtual interviews.

Patient or other participants: 27 ATs (age=34±10 y; women=15, men=12) from the physician practice (n=10), college (n=9), and secondary school (n=8) settings.

Main outcome measures: We interviewed the participants using a semi-structured interview protocol. Three researchers coded the transcripts following the consensual qualitative research process for each job setting. Trustworthiness was achieved through multi-analyst triangulation, member checking, and internal auditing.

Results: Four domains emerged from all interviews: 1) work environment, 2) essential traits and skills, 3) health literacy assessment strategies, and 4) patient education materials and delivery. In the work environment, ATs described the patient load, interprofessional relationships, and patient characteristics across settings. For essential traits and skills, ATs from the settings varied widely, and different strategies were needed based on differing patient needs. For health literacy assessment strategies, ATs did not formally assess health literacy and relied on perceptions and assumptions. Effective digital information and health informatics strategies were described for patient education materials and delivery.

Conclusions: ATs from physician practice, college, and secondary school settings describe using various strategies to create a patient-centered environment. Participants shared their behaviors in assessing health literacy and delivering patient education from various job settings.

Context: Parents are key decisionmakers for 1 the health and wellness of their children. Despite the benefits of engaging in physical activity, parental concerns about concussion may create hesitancy towards sport participation. The magnitude of concussion-related anxiety perceptions and factors that influence these beliefs in parents of youth athletes are largely unknown.

Objective: To determine the prevalence of concussion-related anxiety perceptions in parents of youth athletes and establish the associations among concussion-related anxiety and demographic variables (i.e., parent sex, parent concussion history, child concussion history, parent concussion education).

Design: Cross-sectional paper survey.

Setting: Youth sports.

Patients or other participants: 452 parents (60% female; mean age = 40.4±13.0 years) of youth athletes (8-14 years old) who participated in soccer, ice hockey, lacrosse, and football (i.e., higher concussion risk sports) in Pennsylvania and Michigan.

Main outcomes measures: Survey items were adapted from the Perceptions of Concussion Inventory for Athletes (PCI-A) to pertain to perceptions about their child. Parents also completed a demographic survey regarding concussion-related topics.

Results: Overall, 73.2% of parents found the possibility of their child sustaining a concussion to be upsetting, 61.5% were fearful of their child sustaining a concussion, and 45.1% reported that the thought of their child having a concussion makes them feel anxious. Only 4.6% of parents suggested that concussions do not worry them. The lack of a personal concussion history and being female were associated with greater concussion-related anxiety in parents.

Conclusions: This study provides evidence that parents of youth athletes have anxiety about their child sustaining a concussion, while also contributing to the understanding of what factors are related to such anxiety (i.e., female parent; no parent history of concussion). Negative parental concussion beliefs may contribute to the reduction in contact sport participation and should be directly addressed in concussion education specific to youth sport participation.

Context: Non-combat musculoskeletal conditions are endemic among service members and disproportionately affect females. Pregnancy and childbirth contribute to lower physical fitness assessment scores and higher body mass index, both risk factors for musculoskeletal conditions, for up to one-year post-pregnancy. However, there is a paucity of information regarding the impact of pregnancy on musculoskeletal conditions.

Objective: To explore the association between the post-pregnancy period and incident musculoskeletal conditions (MSK).

Design: Retrospective, longitudinal cohort study.

Setting: Medical and administrative data from the Medical Assessment and Readiness System.

Other participants: Female military service members with and without a pregnancy.

Main outcome measure(s): Months since pregnancy end, health history, and demographic and military service data were abstracted for each subject. Subsequent MSKs were identified with relevant ICD-10 codes. A multivariable logistic regression model assessed the association between the time since pregnancy end and MSK incidence.

Results: A total of 298,607 female service members were identified, of which 19,980 had a pregnancy. A larger percentage of post-pregnancy service members (65.8%) had a MSK diagnosis as compared to the non-pregnant cohort (60.3%). Adjusting for covariates, the model suggests a temporal influence on post-pregnancy MSK incidence, such that service members 3- to 4-months and 5- to 6-months post-pregnancy were more likely to be diagnosed with a MSK as compared to the non-pregnant cohort. However, service members <2 months post-pregnancy were less likely to be diagnosed with an MSK, and the odds of an MSK beyond 6-months decreased out to 24-months post-pregnancy.

Conclusions: Pregnancy may increase a service member's odds of sustaining an MSK 3- to 6- months post-pregnancy. Understanding the relationships between pregnancy and MSK risks may lead to changes in postpartum return-to-duty/activity policies, better enabling service members to care for themselves and their families.