Journal of Athletic Training最新文献

Context: The monetary costs of sport-related injuries are significant, but complexity in public and private payers and disparate injury-reporting systems create challenges in accurately estimating their economic impact. Few researchers have characterized the cost of athletic training services for sport-related injuries.

Objective: To describe the treatment and cost characteristics of high school athletic training services provided to student-athletes for knee and ankle cases.

Design: Cross-sectional study.

Setting: Secondary schools.

Patients or other participants: High school student-athletes receiving athletic training services for knee and ankle cases.

Main outcome measures: Treatment and costs characteristics of athletic training services provided to high school student-athletes for knee and ankle cases, including comparison of total cost of care by gender, sport, and injury severity outcome.

Results: Between 2014 and 2019, 219 knee and 400 ankle cases and their associated treatments were documented by athletic trainers in the National Athletic Treatment, Injury and Outcomes Network Surveillance Program. Therapeutic exercises and ankle strapping were the most commonly documented services. The median estimated total cost of care was $124.20 (interquartile range, $75.44-$231.64) per knee case and $148.58 (interquartile range, $27.00-$287.10) per ankle case. Median total cost of care varied across injury severity.

Conclusions: This study provides insights into the cost characteristics of high school athletic training services. Although costs were generally lower than previously reported, the findings highlight the worth of athletic training services in managing knee and ankle cases and underscore the need for improved documentation and cost data collection to further demonstrate the economic value of athletic training services.

Context: Previous researchers have identified that athletic trainers (ATs) desire more guidance regarding documentation during professional education and on-the-job training.

Objective: Examine the professional socialization of ATs' documentation practices from multiple perspectives.

Design: Qualitative case series.

Setting: Zoom audio interviews.

Patients or other participants: Using purposeful and snowball sampling, we recruited participant triads including (1) a newly credentialed AT (certified ≤1 year), (2) their current supervisor, and (3) an educator from their professional program. Four triads, mostly from the college/university setting, participated in the study (9 women, 3 men, age = 35.08 ± 9.24 years), averaging 11.66 ± 9.44 years as an AT (educators = 17.05 ± 2.50, supervisors = 13.75 ± 8.06, ATs = 1.00 ± 0.00).

Data collection and analysis: We developed and validated 3 semistructured interview guides, then piloted them with 3 individuals. Three researchers inductively analyzed interviews using the consensual qualitative research approach through 4 rounds of coding and consensus meetings. We analyzed data collectively, followed by within- and between-cases analyses of each triad's data and confirmed saturation. Trustworthiness was obtained via multiple-analyst and source triangulation.

Results: Analysis revealed 4 domains representative of all cases, including (1) electronic medical records (EMRs), (2) lack of point-of-care documentation, (3) differences and accountability, and (4) learning. Although EMRs are central to completing high-quality documentation, ATs face challenges integrating EMRs into professional education. We found that point-of-care documentation is not a strongly implemented behavior, contributing to inefficient documentation practices. It is common for ATs to use different approaches to documentation, but employer accountability improves consistency within workplaces and learning environments. Lastly, we found that learning over time through classroom and clinical experience facilitates the transferability of quality on-the-job documentation.

Conclusions: Supervisors should establish workplace guidelines and onboarding to support new ATs' documentation practices. Educators can facilitate high-quality documentation by teaching effective documentation strategies, engaging students in EMR use, and consistently engaging students in clinical documentation during clinical education experiences.

Context: Athletic trainers (ATs) are health care professionals who provide care across multiple settings, including outpatient rehabilitation. Given the increase in health care utilization in the general population, ATs may provide necessary rehabilitation services to treat common musculoskeletal conditions.

Objective: Describe patient populations, conditions, health care utilization, and billing practices of ATs practicing in an outpatient orthopaedic setting from January 2010 to December 2024.

Design: Retrospective cohort study.

Setting: University-based health care system.

Patients and other participants: Patients in outpatient orthopaedic rehabilitation.

Main outcome measures: Episode of care (EOC) data were extracted from health insurance claims. Median and interquartile range (IQR) were reported for patient age, number of visits per EOC, current procedural terminology (CPT) codes billed, and charges per visit. Diagnoses associated with the EOC were by injury category, nature of injury, and body region categories using International Classification of Disease version 9/10 codes. Frequencies, proportions, and 95% CIs were reported for injury category, nature of injury, body region, and surgical cases.

Results: Athletic trainers were primary providers for 7789 EOCs. Median patient age was 37 years (IQR: 19, 51), with the majority of patients being female (4189; 54%, 95% CI = 53%, 55%). The knee and shoulder were the most common body regions treated (knee: 2993, 26%, 95% CI = 25%, 27%; shoulder: 1863, 16%, 95% CI = 15%, 17%). Seventeen percent of EOCs indicated the presence of a surgical procedure. Episodes of care comprised a median number of 3 visits (IQR: 2, 6) with 6 median CPT codes (IQR: 2, 6) billed, resulting in median EOC charges of $1291 (IQR: $782, $2099). Episodes of care that were isolated to the inclusion of AT-billable procedural codes resulted in $13.5 million in charges and $10.8 million in reimbursements over 15 years.

Conclusions: Athletic trainers provided primary rehabilitative care for common musculoskeletal conditions, particularly of the knee and shoulder. Similar billing practices as other allied health professionals were observed based on CPT codes billed and median charges per visit.

Clinical question: Several factors contribute to work-related recordable injuries within industries; this leads to increased workers' compensation expenditure. More companies are using the services of athletic trainers (ATs) to reduce recordable injuries and save on costs related to an injured employee. The clinical question is, "What is the cost savings of having an AT on-site, particularly as it relates to workplace injury reduction?"

Setting: A warehouse distribution center with approximately 300 full-time and 100 temporary workers from a variety of ethnic backgrounds and ages. One AT provided services 1 day a week, 4 hours per visit. Services included group stretching sessions, guided whole body exercises, manual stretching, light massage, ergonomic assessments, and job coaching.

Variables: Cost comparisons were used that identified the services the AT rendered with the Current Procedural Terminology (CPT) code of a similar service performed within clinical practice. This provided the direct cost, but an additional multiplier of 5 times the direct cost was used to identify the indirect cost. The calculations for the return on investment included the estimated cost savings (direct and indirect costs subtracted from the cost of services divided by the cost of service).

Strategy: Cost-savings metrics were tracked within an Excel spreadsheet. The cost-savings method used Current Procedural Terminology reimbursement codes found in the clinical setting.

Findings: Of the 19 employees discharged from the program, 10 had received AT care for reasons directly linked to experiencing discomfort while on the job; estimated cost-savings metrics totaled $164 765.88.

Outcome: The case example presented a 6 : 1 cost-savings ratio; for every $1 spent on the program, the company contracting AT services saved an estimated $6 in medical expenses. Improved clinical practice initiatives focus on using data collection and aggregation practices to justify services and create opportunities.

Lessons learned: By collecting clinical practice data and using cost-savings calculations, ATs can demonstrate their impact within the occupational setting. With the focus on prevention, education, and ergonomics, the profession has become more engaged with different stakeholders who value the services rendered by ATs.

Context: The Sports as a Laboratory Assessment Model (SLAM⁺) allows for point-of-care data collection to improve outcomes after concussion and assist with clinical research.

Objective: To cross-validate a prognostic formula to predict clinical recovery in collegiate athletes with concussion leveraging the SLAM⁺.

Design: Cross-sectional Study.

Patients or other participants: Collegiate athletes (n = 133 [42.9% female]) who were, on average, 20.4 ± 1.57 years of age.

Main outcome measures: Collegiate athletes with concussion were administered the Sport Concussion Assessment Tool-5 (SCAT-5) Symptom Evaluation and the Revised Head Injury Scale (HIS-r) within 48 hours of injury. The HIS-r was administered daily until a participant reported symptom free. The SCAT-5's total symptom severity score and the HIS-r's duration of drowsiness, neck pain, nervousness, and tingling were used to predict days until clinical recovery. Spearman rho (ϱ) was calculated between predicted and actual days until clinical recovery. Sensitivity, specificity, positive, and negative predictive values were calculated to determine the formula's ability to correctly classify participants who achieved clinical recovery within 7 (n = 57), 8-14 (n = 45), 15-21 (n = 17), and 22+ (n = 14) days.

Results: A weak and nonsignificant correlation (ϱ = 0.14, ϱ ² = 0.02, p = 0.10) was observed between actual (median = 8.0 [interquartile range = 8.0]) and predicted 17.9 (7.0) days until clinical recovery. Approximately 30.4% and 80.6% of collegiate athletes with concussion were correctly identified to recover within 14 or 15 days or longer, respectively. Sensitivity was highest (100%) for athletes with concussion who recovered within 7 days and lowest (4.2%) when recovery occurred after 22 days. Specificity was highest (88.1%) when athletes recovered beyond 22 days and lowest (58%) when recovery occurred within 7 days. The positive and negative (+/-) predictive values were 7 (3.5%/100%), 8-14 (34.3%/66.3%), 15-21 (15.0%/90.3%), and 22+ days (7.1%/80.7%).

Conclusions: Upon cross-validation, our prognostic formula had limited sensitivity and specificity when predicting clinical recovery after concussion. This formula may be used, with caution, when accompanied by a multidimensional assessment to inform clinical decision making after concussion.

Context: Many professional challenges are associated with being a member of the lesbian, gay, bisexual, transgender, queer, intersex, asexual, and others (LGBTQIA+) community in health care and athletics. Previous researchers have explored perceptions of LGBTQIA+ athletes, coaches, nursing, and physicians; however, research in which the challenges of LGBTQIA+ community members as athletic trainers (ATs) within the profession have been examined is limited.

Objective: The purpose of this study was to explore challenges of LGBTQIA+ ATs specifically related to the profession of athletic training.

Design: Phenomenological qualitative study.

Setting: Individual phone or virtual interviews.

Patients or other participants: Thirty ATs identifying as LGBTQIA+ (aged 32 ± 11 years).

Data collection and analysis: Participants were interviewed after a semistructured interview guide. Data were analyzed through phenomenological reduction. Trustworthiness was established via member checking, peer review, and multianalyst triangulation.

Results: Three themes emerged: (1) the job search, (2) acceptance in athletic training, and (3) neutrality from other ATs. When looking for jobs, cisgender and heterosexual ATs may not consider some factors, such as inclusive policies, spouse health care, or even if they were overlooked for a job due to sexual orientation or identity. Athletic trainers who identity as LGBTQIA+ seek acceptance, support, and a true sense of belonging in the profession, regardless of their personal identities. Potentially one of the largest challenges is neutrality from other ATs, in which ATs are not openly hostile or discriminatory, but they are also not doing anything to provide support to or advocate for LGBTQA+ ATs.

Conclusions: Participants identified challenges associated with being an AT and LGBTQIA+. As LGBTQIA+ ATs enter the job market, they should actively search for organizations that have inclusive, nondiscrimination policies. Organizations should ensure they display and follow inclusive policies. Education for all ATs on acceptance, working with LGBTQIA+ patients and colleagues, and creating safe spaces are needed.

A 13-year-old male competitive club soccer player with a history of bilateral Osgood-Schlatter disease over the past 6 months reported unusually high fatigue and right heel pain after a match. Over the next 4 days, fever developed and persisted despite antipyretics. Right heel pain, warmth, and redness increased until weight-bearing was not tolerated. Subsequent imaging and blood work eventually lead to a calcaneal osteomyelitis diagnosis. A bone biopsy procedure and a 6-week course of antibiotics were completed. The rehabilitation and conditioning plan, which was successful, was based on assessment findings and targeted a return to sport 12 weeks postsurgery. Interprofessional collaboration was key for the diagnosis and effective medical treatment. Rehabilitation and conditioning protocol development was challenging as (1) no postsurgical rehabilitation protocol for a patient with calcaneal osteomyelitis wishing to return to sport has been described and (2) the impact of postinjury rehabilitation on training load is poorly documented.

Context: Individuals who undergo anterior cruciate ligament reconstruction (ACLR) have altered sensorimotor brain activity that can persist for years. Directing an individual's focus of attention (FoA) using instructional cues during rehabilitation and motor control training can impact movement performance, but the direct effects on sensorimotor brain activity and network-level relationships in an ACLR population are less understood. This can have important implications for understanding the neural underpinnings of automatic control processes for direct application to motor learning.

Objective: Determine differences in brain activity and patterns of activity when ACLR knee movement is cued using an internal FoA (iFoA) compared with an external FoA (eFoA).

Design: Cross-sectional study.

Setting: Research laboratory.

Patients or other participants: We recruited 12 participants (7 female, 6.9 ± 1.0 weeks post-ACLR) after primary, unilateral ACLR. Participants performed repeated isometric quadriceps contractions under iFoA and eFoA conditions during functional magnetic resonance imaging scans.

Main outcome measures: Brain activity (blood oxygen level-dependent response) from anatomic regions of interest were extracted from move-rest contrasts in each FoA condition, and paired t tests determined differences in activity across conditions. Intranetwork and internetwork connectivity analyses were performed using Multivariate Exploratory Linear Optimized Decomposition into Independent Components Independent Component Analysis. Dual regression and fsl randomise were used to determine differences in network connectivity between iFoA and eFoA conditions.

Results: The eFoA condition elicited greater activity in the precuneus compared with the iFoA condition. The default mode network (DMN) demonstrated greater intranetwork connectivity in the eFoA condition compared with the iFoA condition in the precuneus and lateral occipital cortex.

Conclusions: Increased precuneus activity may be a favorable adaptation for motor performance, and greater within-DMN connectivity could indicate more optimal network organization to improve motor efficiency and support automation. This suggests that automatic control processes may be facilitated neurologically by an eFoA, reducing the attentional demand to perform basic knee movement after ACLR.

Context: Postconcussion driving assessment has been limited to driving simulators, which are not clinically feasible. There is a need to equip clinicians with tools that can assist in making recommendations on return to driving.

Objective: To determine the association between clinical measures and driving simulator performance in college students within a week of a concussion.

Design: Cross-sectional study.

Setting: Laboratory.

Patients or other participants: Forty-three college students with concussion and 46 controls.

Main outcome measures: Clinical outcomes included total symptom score, dual-task tandem gait completion time, dual-task cost (the percentage decline in performance under dual task versus single task), Complex Figure performance, Useful Field of View performance, and Vestibular/Ocular Motor Screening (VOMS) symptom provocation score. Driving simulator outcomes included the number of collisions, speed exceedances, stop signs missed, centerline crossings, and road-edge excursions. Within each of the drive segments, we collected standard deviation of speed (SDS) and lane position (SDLP). Separate models for each clinical assessment and driving outcome with negative binomial and linear regression models were used.

Results: Greater dual-task cost was associated with increased road-edge excursions (P = .018) and SDS (P = .009). Higher VOMS symptom provocation was associated with less SDS (all P < .050). A higher Complex Figure copy score was associated with decreased centerline crossings (P = .001), road-edge excursions (P < .001), SDS (P < .001), and SDLP (all P < .050). A slower Complex Figure copy completion time was associated with lower SDS (P = .010). A higher Complex Figure delayed score was associated with fewer road-edge excursions and lower SDLP (all P < .050). Longer Complex Figure delayed completion time was associated with greater SDS (P = .03).

Conclusions: Dual-task and Complex Figure tests might be useful when assessing postconcussion driving ability. Higher VOMS symptom provocation was associated with better driving performance, possibly indicating that individuals experiencing vestibular-oculomotor symptoms may adopt more cautious strategies.

Context: Individuals with acute lateral ankle sprain (ALAS) demonstrate balance deficits and altered neural excitability associated with acute injury symptoms. However, it is unknown whether corticospinal excitability is altered during standing after ALAS and which factors are associated with neural change.

Objective: To investigate corticospinal excitability during single-legged standing and its relationship with postural control and acute injury symptoms after ALAS.

Design: Case-control study.

Setting: Research laboratory.

Patients or other participants: A total of 14 individuals with ALAS (age = 19.8 ± 2.0 years, height = 171.9 ± 8.2 cm, mass = 69.7 ± 8.2 kg) and 14 uninjured matched controls (age = 20.7 ± 2.3 years, 174.2 ± 8.8 cm, mass = 69.5 ± 14.9 kg) participated.

Main outcome measures: We measured the normalized motor-evoked potential (MEP) in the fibularis longus using transcranial magnetic stimulation at 100%, 120%, and 140% of the active motor threshold (AMT) while participants maintained a single-legged stance. Postural control was assessed using a 10-second single-legged stance immediately before transcranial magnetic stimulation testing. Center-of-pressure (COP) variables were recorded and analyzed.

Results: Individuals with ALAS demonstrated a trend toward facilitated corticospinal excitability of the fibularis longus during single-legged balance, with 64% (n = 9) of patients with ALAS exceeding the 95% CI upper limit for MEP at 100% of the AMT of the control group. Of the 4 patients with grade II ankle sprains, 75% (n = 3) exceeded this boundary for MEP at 100% of the AMT of the control group, and 100% (n = 4) exceeded the boundaries for all COP measures. Furthermore, correlation analyses revealed that a higher normalized MEP was associated with greater total COP velocity (r _s = 0.543, P = .048).

Conclusions: After ALAS, corticospinal excitability in the fibularis longus may have been facilitated during a single-legged stance, and the level of excitability tended to be associated with an increased rate of postural sway. The severity of ALAS appeared to influence both outcomes. These findings suggested a potential compensatory supraspinal mechanism for impaired postural control after ALAS.