Journal of Athletic Training最新文献

Context: Quadriceps strength is a key outcome for guiding rehabilitation and return to sport-specific activities after anterior cruciate ligament reconstruction (ACLR) surgery.

Objective: (1) Describe the quadriceps-strength-testing practices and barriers college athletic trainers (ATs) are using and experiencing when returning patients to sport-specific activities after ACLR. (2) Compare testing methods between college ATs working in the National Collegiate Athletic Association (NCAA) Division I setting and other college settings.

Design: Cross-sectional study.

Setting: Online survey.

Patients or other participants: Two hundred forty-three full-time collegiate ATs who had primarily overseen/directed an ACLR rehabilitation in the past 5 years (age = 34.8 ± 10.7 years, length of AT practice = 11.7 ± 9.3 years, NCAA Division I setting = 56%).

Main outcome measure(s): Our survey included 4 sections: demographics, general ACLR rehabilitation practices, quadriceps-strength-testing methods and criteria, and quadriceps-strength-testing barriers.

Results: Knee-muscle strength was the most common (98%) outcome collegiate ATs used when determining whether an ACLR patient is ready to progress to sport-specific activities. Manual muscle testing was the most used testing method (57%), followed by isokinetic dynamometry (IKD) (48%), repetition maximum testing (35%) and handheld dynamometry (22%). Most ATs (63%-64%) used greater than 90% side-to-side symmetry as their return to sport-specific activities criterion. Lack of equipment needed (83%), lack of financial means (28%), and lack of training/education (20%) were the barriers that most limited ATs use of IKD testing, the gold standard testing method. Compared with ATs in other settings, a greater proportion of ATs working in the NCAA Division I setting used IKD testing (65% vs 28%) and a smaller proportion used manual muscle testing (47% vs 70%).

Conclusions: Although almost all college ATs considered knee-muscle strength an important outcome to assess when returning patients to sport-specific activities after ACLR, quadriceps-strength-testing practices were highly variable among ATs and may be affected by access to necessary resources.

Context: During a baseball pitch, energy is transferred from the lower extremities through the lumbopelvic junction to the upper extremity. Reduced lumbopelvic stability has been associated with elbow injuries, but the mechanisms are unclear.

Objective: To characterize the predictive ability of lumbopelvic stability on elbow-varus torque during a baseball pitch.

Design: Cross-sectional study.

Setting: Facilities at National Collegiate Athletic Association Division I universities.

Patients or other participants: A total of 44 National Collegiate Athletic Association Division I baseball players (age = 19.6 ± 1.3 years, height = 190 ± 10 cm, mass = 90.1 ± 6.3 kg).

Main outcome measure(s): Pitchers completed a warm-up and then threw 10 fastballs from a mound to a catcher. During the pitches, elbow-varus torque was recorded using an inertial measurement unit, and ball velocity was recorded using a radar gun. Participants also completed a single-legged step-down (SLSD) task with and without a cognitive Stroop, and triplanar pelvic and trunk kinematics were recorded using inertial measurement units. Statistical analysis consisted of a cluster analysis, principal components analysis, and a multivariate logistic regression model.

Results: Cluster analysis identified 2 clusters: low torque-high velocity and high torque-low velocity. The principal components analysis identified 4 patterns of variability (principal components) during the SLSD: (1) sagittal plane, (2) transverse plane, (3) frontal-plane trail leg, and (4) frontal-plane lead leg. Logistic regression models indicated increased transverse-plane trunk (odds ratio = 2.9; 95% CI = 1.1, 8.0; P = .04) and increased pelvis motion (odds ratio = 2.5; 95% CI = 1.1, 6.0; P = .03) predicted higher odds of belonging to the high torque-low velocity cluster.

Conclusions: Lumbopelvic movement assessed during the SLSD can identify deficits that relate to high elbow torque-low ball velocity during the baseball pitch. Specifically, higher transverse-plane pelvis and trunk motion were independently associated with pitchers in the high torque-low velocity cluster. Our assessment of trunk and pelvis motion during an SLSD provides a method for coaches and clinicians to identify a potential risk factor related to increased elbow-varus torque and decreased ball velocity.

Context: Immediate athletic trainer (AT) availability for acute injuries is essential as worse long-term outcomes are associated with delays in receiving medical care. Several factors have been found to influence AT availability between secondary schools, but few studies have evaluated how medical coverage varies between athlete groups.

Objective: The purpose of this project was to identify factors that impact the time to AT evaluation following acute sport-related injury in a secondary school setting.

Design: Cross-sectional study.

Setting: Retrospective analysis of deidentified patient records via the Athletic Training Practice-Based Research Network.

Patients or other participants: High school athletes diagnosed with an acute sport-related injury during in-season play from 2010 to 2023.

Main outcome measure(s): Time to AT evaluation was measured as the number of days between injury onset, reported by the patient, and AT evaluation.

Results: This report consists of 17 354 patient cases representing 20 different sports. Overall, 46.9% (n = 8138) of patients who sustained an injury during in-season play were evaluated by an AT the same day (range, 0-14 days). Significant group differences were reported for sex (P < .001), setting (P < .001), and sport level (P < .01), with female athletes and in-game injuries associated with longer times to AT evaluation. Freshmen were evaluated sooner than junior varsity (P < .01) and varsity (P < .001) athletes. No difference was observed between junior varsity and varsity athletes (P = .34).

Conclusions: Almost half of patients received medical care within 24 hours following an acute injury during in-season play, highlighting how qualified health care is accessible for many student-athletes through ATs in the secondary school setting. Differences in time to AT evaluation may be attributable to sex discrepancies in immediate medical coverage between sports and injury reporting patterns among athletes.

Objective: Dehydration associated with exertion is a commonly encountered condition in the first aid setting, particularly at outdoor sporting events. Part I of this systematic review demonstrated that commercial sports drinks can be suggested for effective restoration of fluid balance in dehydrated people. In part II, we perform a systematic review to compare alternative liquids, such as cow's milk, beer, and coconut water, with water for effective oral rehydration after prolonged exercise.

Data sources: Cochrane Library, MEDLINE via the PubMed interface, and Embase databases were searched up until June 1, 2022.

Study selection: Controlled experimental and observational studies involving adults and children were included when dehydration was induced by physical exercise and oral rehydration fluids were administered and compared with regular water. No additional food intake accompanied the rehydration drinks or water. Articles in all languages were included if an English abstract was available.

Data extraction: Study design, study population, intervention, outcome measures, and study limitations were extracted from each included article.

Data synthesis: Of 3485 articles screened, 11 articles in which authors compared skim or low-fat cow's milk, coconut water, or beer (0%-5% alcohol) with water were included. Authors of 4 studies showed that drinking skim or low-fat milk, without additional food intake, led to improved volume/hydration status compared with drinking water. Authors of 3 trials showed no differences at multiple times for outcomes related to volume/hydration status after rehydration with fresh coconut water compared with water. Evidence to recommend beer (0%-5% alcohol) for rehydration is insufficient.

Conclusions: Consuming skim or low-fat cow's milk without additional food intake as compared with water appears to improve volume/hydration status in people with exercise-induced dehydration. However, evidence is of very low certainty and should be interpreted with caution.

Context: The Landing Error Scoring System (LESS) is a common assessment used to determine biomechanical landing errors. However, this assessment is completed as a single motor task, which does not require additional attentional resources. It is unclear if the LESS can be used to detect cognitive-motor interference (ie, dual-task cost) in biomechanical errors associated with lower extremity injury.

Objective: To determine if the LESS is a suitable clinical assessment of dual-task performance in uninjured women and to evaluate whether specific landing criteria are more affected by an additional cognitive load than others.

Design: Cross-sectional study.

Setting: University research laboratory.

Patients or other participants: A total of 20 uninjured, physically active female participants (age = 22.4 ± 2.5 years, height = 1.68 ± 0.07 m, mass = 67.0 ± 13.8 kg, Tegner Activity Scale = 5.9 ± 1.1).

Intervention(s): Participants performed the LESS under 3 different conditions: baseline landing with no cognitive distraction (Single), a visual-based dual task (Visual), and a number-based dual task (Number).

Main outcome measures(s): Mean sagittal-plane, frontal-plane, and total LESS scores were compared between conditions using a 1-way repeated-measures analysis of variance with Tukey post hoc correction. A Cohen d effect size with a 95% confidence interval was used to determine the magnitude of differences. The frequency of errors for each LESS item under the 3 conditions was compared using χ2 analysis.

Results: Participants exhibited greater sagittal-plane (P = .02, d = 0.91; 95% confidence interval, 0.26-1.56) and total (P = .008, d = 1.03; 95% confidence interval, 0.37-1.69) errors during the Visual condition than during the Single condition. The frequency of errors observed for each LESS item did not differ between conditions (all P > .05).

Conclusions: The LESS was able to detect a dual-task cost in landing errors during both the Visual conditions. We recommend developing clinically oriented solutions to incorporate similar dual-task paradigms in traditional injury risk-reduction programs.

Context: Authors of extensive research have exposed health care disparities regarding socioeconomic status (SES) and race and ethnicity demographics. Previous researchers have shown significant differences in access to athletic training services (athletic trainer [AT] access) in the secondary school setting based on SES, but with limited samples.

Objective: To investigate differences in AT access based on race and ethnicity and SES on a national scale.

Design: Cross-sectional study.

Setting: Database study using secondary analysis. Data were collected from the National Center for Education Statistics, Athletic Training Location and Services database, and US Census Bureau.

Patients or other participants: A total of 10 983 public schools.

Main outcome measure(s): Descriptive data were summarized by measures of central tendency. A 1-way analysis of variance determined differences between school characteristics (median household income, percentage of students eligible for free and reduced lunch, percentage of White students, and percentage of non-White students) based on AT access: full-time (FT-AT), part-time (PT-AT), and no AT (no-AT). A Bonferroni pairwise comparison was used for variables with significant main effects.

Results: Across all schools included in the study, 43.8% had no-AT (n = 4812), 23.5% had PT-AT access (n = 2581), and 32.7% had FT-AT access (n = 3590). Significant effects were found between AT access and median household income (P < .001), the percentage of students eligible for free and reduced lunch (P < .001), the percentage of White students (P < .001), and the percentage of non-White students (P < .001). Schools with FT-AT access had a higher SES than PT-AT and no-AT schools. Significant differences existed between AT access groups and the race and ethnicity of schools. Schools with FT-AT access had a significantly lower percentage of non-White students (31.3%) than schools with no-AT (46.0%; P < .001). No significant differences between FT-AT and PT-AT access based on race and ethnicity demographics presented (P ≥ .13).

Conclusions: Schools with higher SES had greater AT access, whereas schools with a higher percentage of non-White students were more likely to have no AT access, demonstrating the disparities in health care extends to athletic health care as well. To increase AT access, future initiatives should address the inequities where larger minority populations and counties of lower SES exist.

Context: As new athletic trainers (ATs) transition into their roles, some employers provide orientation and onboarding to assist with the transition to practice. Research in which authors outline the ideal onboarding process for new ATs transitioning to practice is lacking.

Objective: To examine the onboarding process for new ATs.

Design: Grounded theory.

Setting: College or university, secondary school, and hospital or clinic.

Patients or other participants: Seventeen newly credentialed, employed ATs who recently graduated from professional masters' programs (11 female, 6 male; 25.6 ± 2.2 years) and 12 employers (6 female, 6 male; years in role supervising new ATs: 8.5 ± 4.9) participated in this study.

Data collection and analysis: Participants were recruited via purposive sampling. Each participant was interviewed via phone using a semistructured interview guide. Employees were interviewed approximately 3, 6, 9, and 13-15 months after beginning employment. Employers were interviewed 1 time. Data saturation guided the number of participants. Data were analyzed through grounded theory, with data coded for common themes and subthemes. Trustworthiness was established via peer review, member checks, and multianalyst triangulation.

Results:

Conclusions: Onboarding is vital in transitioning to practice for newly credentialed ATs, as it provides support and helps new employees understand and adapt to their roles. Onboarding should go beyond initial orientation and include regular meetings with supervisors, other ATs, and site visits to provide feedback and ensure new ATs adapt to their roles. New ATs should seek support from supervisors and local ATs to help better understand their role.

Objective: Exercise-associated dehydration is a common problem, especially at sporting events. Although recommendations have been made to drink a certain volume per kilogram body mass lost after exercise, no clear guidance about the type of rehydration beverage is available. We conducted a systematic review to assess the effectiveness of carbohydrate-electrolyte (CE) solutions as a rehydration solution for exercise-associated dehydration.

Data sources: MEDLINE (via the PubMed interface), Embase, and the Cochrane Library databases were searched up until June 1, 2022.

Study selection: Controlled trials involving adults and children were included when dehydration was the result of physical exercise and when drinking carbohydrate-electrolyte solutions, of any percentage carbohydrate, was compared with drinking water. All languages were included if an English abstract was available.

Data extraction: Data on study design, study population, interventions, outcome measures, and study limitations were extracted from each included article. Certainty was assessed using Grading of Recommendations Assessment, Development and Evaluation.

Data synthesis: Of 3485 articles screened, 19 articles in which authors assessed CE solutions (0%-9% carbohydrate) compared with water were included. Although variability was present among the identified studies, drinking 0% to 3.9% and especially 4% to 9% CE solution may be effective for rehydration.

Conclusions: A potential beneficial effect of drinking CE drinks compared with water was observed for many of the reviewed outcomes. Commercial CE drinks (ideally 4%-9% CE drinks or alternatively 0%-3.9% CE drinks) could be suggested for rehydration in individuals with exercise-associated dehydration when whole foods are not available.

Context: Recent epidemiological data have indicated a potential connection between sport-related concussion (SRC) and elevated anterior cruciate ligament (ACL) injury risk. Limited research exists in which authors have quantified cognitive and motor outcome measures between SRC and ACL injury history.

Objective: To examine the individual and combined effects of a history of SRC and ACL injury and reconstruction (ACLR) on neurocognitive and neuromechanical function.

Design: Cross-sectional study.

Setting: Research laboratory.

Patients or other participants: Forty-seven recreationally active college individuals with either an injury history of SRC (n = 12), ACLR (n = 12), combination of SRC + ACLR (n = 11), or uninjured controls (n = 12).

Main outcome measure(s): Participants completed a neurological battery using the C3 Logix application and TRAZER system for neuromechanical reaction time (RT). C3 Logix subtests consisted of the Trail Making Test (TMT) A, B, and B - A; simple and choice RT; and processing speed. TRAZER subtests consisted of simple, Flanker-task, and Stroop-task RT. Participants were categorized into 3 group comparisons of either (i) SRC, ACLR, SRC + ACLR, and controls, (ii) any or no SRC overall, or (iii) any or no ACLR overall.

Results: No differences were demonstrated between SRC, ACLR, SRC + ACLR, and controls on TMT (P = .07-.14), neurocognitive (P = .14-.93), or neuromechanical (P = .64-.99) performance. Those with any SRC had slower TMT B - A times (P = .03), while those with any ACLR had slower TMT A (P = .02) times than those with no ACLR. No differences were noted for the TRAZER simple, Flanker, or Stroop RT for any or no SRC and ACLR groups.

Conclusions: College students with a combined effect of SRC and ACLR did not differ from other groups on neurocognition and neuromechanical RT. Individuals with a history of SRC or ACLR had a worse TMT, leading to inquiry about potential long-term neurological deficits, despite no differences in those with a combined history.