Journal of Athletic Training最新文献

Context: The demographic landscape of the United States is changing daily and the demand for representation in todays workforce is both a moral and practical imperative for creating workplaces diverse in thought, expression, and people.

Objective: The purpose of this study was to investigate workplace culture and the direct and indirect influence of supervisors on inclusion of minoritized communities, including those who have experienced marginalization for race, ethnicity, religion, national origin, age, marital status, ability, sexual orientation, sex, gender, gender identity and expression, socioeconomic status, spirituality, political affiliation, literacy, or the intersectionality of multiple identities.

Design: Consensual qualitative research study.

Setting: Semi-structured interview.

Patients or other participants: Eighteen participants were recruited through direct contact via their public domain email addresses that are located on college/university websites.

Data collection and analysis: Demographic data was collected through a web-based recruitment survey which was also used to schedule a semi-structured interview. We used the multi-phased CQR tradition to identify domains and categories representative of the data.

Results: Three domains emerged. The environment domain spoke to the culture each supervisor created through relationship building and intention; intention was further characterized as active or passive behaviors whereby almost all pa rticipants described both. Only one-third of participants referenced DEIA policies and procedures within their organization. The resources domain represented the existence and awareness of organizational DEIA resources, or lack thereof. The perceptions domain characterized the beliefs of the supervisors relative to DEIA.

Conclusion: Structural efforts must include the creation and implementation of policies and procedures for employee inclusion, not just patient inclusion. The awareness and use of organizational resources is an important component to support supervisor efforts and should be leveraged from within the unit.

Context: The importance of analyzing head impact exposure among football players is well established, yet few studies have explored the differences across position groups in high school athletes. Better understanding of these differences may provide optimized intervention strategies for coaches and healthcare providers.

Objective: To quantify the difference of head impacts per exposure (Imp/E) and impact burden high school football player position groups.

Design: Prospective observational.

Setting: High school athletic fields during Fall sports seasons.

Patients and participants: 200 football players from three high school varsity teams including 69 offensive/defensive linemen, 51 linebackers/running backs/tight ends and 80 cornerbacks/safeties/wide receivers (16.1±0.9yrs, 177.9±7.8cm, 86.4±22.7) categorized as linemen, backers, and skills players respectively.

Main outcome measures: Imp/E across positions, teams, session type, and seasons. Cumulative head impact burden per location (front, top, right, left, back) across position groups.

Results: Significant differences in Imp/E were found between position groups (P<0.001), where the backers group, (3.77[95% CI: 3.146, 4.395]) experienced higher total Imp/E compared to linemen (1.47[ 95% CI: 0.983, 1.96]) and skill players (1.56[95% CI: 1.11, 2.01]). Total accumulated burden of head impacts was significant (F(2,194) = 4.938, P<0.008), with backers (4622.85g's [95% CI: 3077.43, 6168.27]) significantly (P=0.011) higher than linemen (2657.70g's [95% CI: 2045.61, 3269.19 ]) and skill players (2875.7g's [95% CI: 2216.38, 3535.01]) (P=0.022). Front location impact burden (F(2, 194) = 7.784, P<0.001) revealed backers (1606.24g's [95% CI: 977.89, 2234.58]) also significantly (P=0.008) higher than both linemen (768.24g's [95% CI: 433.84, 1102.64]) and skill players (567.75g's [95% CI: 360.71, 774.78]) (P<0.001).

Conclusion: Linebackers, tight ends, and running backs experienced more Imp/E and higher cumulative burden than other positions, which highlights the potential influence of specific positional requirements during football participation. Coaches and healthcare providers should be aware that a position's role during play may directly relate to changes in head impact risk.

Objective: Our aim was to perform a systematic review of Return-to-Learn literature with the intent of determining what items are necessary to form a comprehensive Return-to-Learn policy.

Data sources: We searched CINAHL, Embase, PubMed, Scopus, Google Scholar, and WorldWideScience.org using 25 search terms including return to learn, adolescents, concussion management, concussion AND children, concussion AND department of education, concussion AND secondary schools, concussion AND middle school, concussion AND primary school, concussion AND policy AND procedures, concussion AND 504 plans.

Study selection: Eligible studies were (i) published between 2009 and 2022; (ii) originally published in English in a peer-reviewed journal; (iii) have a full text available; (iv) discuss the K-12 population; (v) contain one of the following terms in the body of the document: Return to Learn, RTL, Return to School, Return to Classroom, or Return to Academics; (vi) identify RTL as a primary aim of the document.

Data extraction: The Qualitative Assessment and Review Instrument and JBI Meta-Analysis of Statistics Assessment and Review Instrument tools were used to extract data from eligible studies. Extraction occurred independently by two researchers.

Data synthesis: Review yielded 32,766 articles, with 58 meeting inclusion criteria. Two qualitative themes and five subthemes aggregated with six quantitative narratives to produce five converged findings: 1) members and point person, 2) overcoming barriers to communication, 3) increasing concussion knowledge and training in the school system, 4) recommendations in the classroom, and 5) tackling the invisible injury.

Conclusions: Less than one-third of included articles reported data from younger (K-8) cohorts, therefore, the converged findings represent significant facets of high school Return-to-Learn that stakeholders should embed into novel and revised state concussion legislation. Subsequent efforts should seek to appraise current state Return-to-Learn laws for existing use of evidence-based practice and begin accumulating data specific to younger students and school professionals that monitor and teach these individuals such that commensurate policy recommendations can then be made.

Context: Postoperative muscle weakness contributes to the development of aberrant gait biomechanics that persist following traditional anterior cruciate ligament reconstruction (ACLR). However, it is unknown if quadriceps weakness impedes the ability of ACLR patients to modify gait biomechanics using a real-time gait biofeedback (RTGBF) intervention.

Objective: The purpose was to determine if quadriceps strength associates with the ability to modify vertical ground reaction force (vGRF) during a RTGBF intervention.

Design: Cross-Sectional Study.

Setting: Research Laboratory.

Participants: 35 individuals with unliateral ACLR (Time since ACLR= 32 ± 16 months; 22 Females, 13 Males).

Main outcome measures: Peak vGRF was evaluated during a baseline walking trial, and three 250-step randomized RTGBF walking trials which cued an increased average peak vGRF of the baseline walking trial by 5%, 10%, or 15%. The ability to modify gait was reported as changes in pvGRF (ΔpvGRF; BW) and root mean square error (RMSE) of the peak vGRF relative to the feedback target (pvGRF RMSE; BW). We also calculated quadriceps strength.

Results: There were no significant associations between strength (Mean: 2.56 ± 0.75 Nm/kg, Range: 0.84-4.6 Nm/kg) and ΔpvGRF (5% ΔpvGRF: 0.04 ± 0.03 BW, 10% ΔpvGRF: 0.10 ± 0.03 BW, 15% ΔpvGRF: 0.15 ± 0.04 BW) nor strength and RMSE (5% RMSE: 0.04 ± 0.02 BW, 10% RMSE: 0.05 ± 0.02 BW, 15% RMSE: 0.08 ± 0.04 BW) for any of the 3 RTGBF trials (R2: 0.003-0.025; P: 0.37-0.77).

Conclusions: The magnitude of quadriceps strength did not influence the ability to modify gait using RTGBF. These data suggest that it may be unnecessary to wait for quadriceps full strength recovery to capitalize on the benefits of RTGBF following ACLR.

Context: Authors of few studies have used randomized controlled trials (RCTs) to quantify clinical intervention safety of rehabilitation after sport-related concussion across sport levels.

Objective: Describe symptom exacerbation and adverse events (AEs) associated with two concussion rehabilitation interventions.

Design: Cluster RCT (NCT02988596).

Setting: Sports medicine clinic and field settings.

Patients or other participants: The RCT enrolled 251 concussed athletes (median age = 20 years; female, n = 48) across 28 sites from New Zealand professional rugby (n = 31), Canadian professional football (n = 52), US/Canadian colleges (n = 128) and US high schools (n = 40).

Interventions: Two medically supervised interventions: (1) enhanced graded exertion (EGE): international return-to-sport strategy and sport-specific activities only (EGE only, n = 119); and (2) multidimensional rehabilitation (MDR) followed by EGE: early symptom-directed exercises once symptoms were stable, followed by EGE after symptoms resolved (MDR + EGE, n = 132).

Main outcome measure(s): Primary outcomes were intrasession total symptom severity score exacerbation and significant intersession (increase 10+ severity points) sustained total symptom severity exacerbation, each measured with the Postconcussion Symptom Scale (132 total severity points on scale). Reported AEs were also described. Activity-based rehabilitation sessions (n = 1437) were the primary analysis unit. Frequencies, proportions, medians, and interquartile ranges were calculated for outcomes by treatment group.

Results: The 251 postinjury participants completed 1437 (MDR + EGE = 819, EGE only = 618) activity-based intervention sessions. A total of 110 and 105 participants contributed data (those missing had no documented session data) to at least 1 activity-based session in the MDR + EGE and EGE-only arms, respectively. Intrasession symptom exacerbations were equivalently low in MDR + EGE and EGE-only arms (MDR + EGE: 16.7%, 95% CI = 14.1%, 19.1%; EGE only: 15.7%, 95% CI = 12.8%, 18.6%). In total, 9/819 MDR + EGE sessions (0.9%) and 1/618 EGE-only sessions (0.2%) resulted in a presession to postsession symptom exacerbation beyond a 10+ severity point increase; 8/9 resolved to <10 points by the next session. Two study-related AEs (1 in each arm) were reported.

Conclusions: Participants in MDR + EGE and EGE-only activities reported equivalently low rates of symptom exacerbation.

Context: Borrowers burdened by high student debt generally experience financial constraints that can affect them both personally and professionally. To date, no published data exist that profile the education-related debt accrued by entry-level certified athletic trainers (ATs).

Objective: To assess the scope and scale of student debt associated with the completion of an entry-level athletic training degree.

Design: Cross-sectional study.

Setting: Online web-based survey.

Patients or other participants: Participants were recruited with assistance from the National Athletic Trainers' Association, who disseminated the survey to 18 689 certified ATs who were members in good standing and who had earned their certification between 2004 and 2022. A total of 2271 individuals accessed the survey.

Main outcome measure(s): The overall amount of student debt incurred to complete an entry-level degree in athletic training and the initial monthly repayment amount were collected from survey respondents. Education-related debt-to-income ratio (DTIR) and monthly payment DTIR, which are measures of financial health or stability, were also calculated from the acquired survey data.

Results: Among ATs who took out student loans, the average amount owed by entry-level ATs for the period spanning 2004-2022 was $61 717, with an average initial monthly loan payment amount reported to be $453. The mean education-related DTIR calculated from respondents was 169%, which exceeded the benchmark value of 100% recommended within the finance industry. Also, the average monthly payment DTIR calculated from study participants was 0.144, which approached the recommended acceptable upper limit of 0.15.

Conclusions: Education-related DTIR and monthly payment DTIR values reported by respondents suggest the potential for entry-level ATs to experience financial challenges related to their student debt.

Context: Musculoskeletal injuries (MSK-I) are a well-documented problem in military populations and a leading contributor to disability across military services. However, only a portion of Service members who sustain an MSK-I report it to medical providers. Although several studies have identified barriers to seeking medical care in military populations, less is known about what motivates Service members to seek care for MSK-I.

Objective: To describe determinants of medical care-seeking behavior for MSK-I and/or musculoskeletal pain (MSK-P) in recently enlisted US Marines during military training.

Design: Qualitative study.

Setting: School of Infantry-West (SOI-W), Marine Corps Base Camp Pendleton, California.

Patients or other participants: A total of 1097 US Marines entering Infantry Training Battalion or Marine Combat Training at SOI-W.

Data collection and analysis: Participants completed written surveys at entry to (baseline) and graduation from SOI-W. Closed-ended question responses were used to calculate MSK-I/MSK-P and care-seeking frequencies. Open-ended responses describing determinants of care-seeking behavior were analyzed using inductive thematic analysis.

Results: Ten percent of participants self-reported sustaining MSK-I during basic training, whereas 14% self-reported sustaining an MSK-I in SOI-W training. A greater proportion reported seeking medical care for their MSK-I/MSK-P during basic training than during SOI-W training. The thematic analysis resulted in 3 main themes that describe drivers and barriers for seeking medical care: (1) self-perceived need for medical care, (2) prioritizing military training, and (3) training-specific influences.

Conclusion: Understanding determinants of care-seeking behavior is valuable when designing intervention strategies to promote early MSK-I treatment. Our findings add to previous research to elucidate reasons underlying the decisions about care-seeking for MSK-I/MSK-P. Interventions, including educational strategies and direct approaches like embedding medical providers within units, to minimize barriers to seeking medical care in the military may reduce the burden of MSK-I/MSK-P on Service members throughout their military careers.

Context: Research that has examined the association between specialization and injury in basketball has been limited to cross-sectional or retrospective studies.

Objective: To determine whether specialization is a risk factor for injury among high school basketball athletes.

Design: Prospective cohort study.

Setting: Basketball players from 12 high schools participating in the National Athletic Treatment, Injury, and Outcomes Network Surveillance Program (NATION-SP) were recruited before the 2022-2023 interscholastic basketball season.

Patients or other participants: One-hundred thirty athletes (mean age ± SD = 15.6 ± 1.3; girls' basketball: n = 68 [52.3%]).

Main outcome measure(s): Before the start of the school basketball season, participants completed a questionnaire that had questions regarding participation in various specialized sport behaviors. During the basketball season, the school's athletic trainer reported all athlete-exposures and injuries (regardless of time loss) for participating athletes into NATION-SP. Injury incidence and incidence rate ratios (IRRs) with 95% CIs were calculated for the specialized sport behaviors previously described.

Results: No difference in injury risk between highly specialized and low specialized athletes was found (IRR [95% CI] = 1.9 [0.9, 3.7]). Players who participated in basketball year round were twice as likely to sustain an injury than those who did not play year round (IRR [95% CI] = 2.1 [1.1, 3.6]). Similarly, players who reported participating in basketball skills camps were at increased risk of injury compared with athletes who did not participate in basketball skill camps (IRR [95% CI] = 2.5 [1.2, 5.7]).

Conclusions: Injury risk related to sport specialization in basketball may be specific to certain behaviors such as year-round play and participation in skills camps. Validated measures of comprehensive sport activity are needed to better measure specialization in youth sports to better determine injury risk related to sport specialization and develop injury prevention programs for basketball athletes.

Context: When deciding to return to sport, in the literature, evaluations based on physical abilities have usually been used. However, in the current literature, we have been urged to use more than physical performance evaluations. Classical dual-task testing methods do not simulate in-game loads and cannot sufficiently measure football players' dual-task capacity.

Objective: To create a dual-task test that would simulate football players' in-game situations and measure their capacity.

Design: Cross-sectional study.

Setting: Football pitch.

Patients or other participants: Twenty-two football players (age = 17.37 ± 0.52 years) who played in a professional club (U19, elite league) were recruited for our study.

Intervention(s): A novel dual-task test with questions containing scenarios from a football game to cognitively load players while they are performing a modified t test.

Main outcome measure(s): After the warmup period, participants attended 4 tests in random order: juggling (foot), speed dribbling, long passing, and novel dual-task tests.

Results: No significant relationship was found between physical performance parameters and dual-task parameters (all P > .05). A significant increase was found in the completion time of the modified t test when performed under the dual-task condition (Z = -7.568, P < .001). The increase in completion time was 2.14 ± 1.29 seconds. This duration difference was calculated as 22.79% ± 14.58%, as dual-task cost.

Conclusions: Our test provides a new method to measure athletes' dual-task capacity, which is not related to physical performance and cannot be measured with current tests. This test also showed players with lower dual-task ability could not keep up their performance under dual-task conditions, such as passing a ball to a teammate when being pressed by an opponent. Players with good dual-task ability could maintain their performance (were affected only up to 10%); players with poor dual-task ability could not maintain their performance and were affected by up to 50% (with a mean of 22.79%).

Context: There are significant disparities in access to health care, but there are limited data about the impact of race and socioeconomic status on postoperative outcomes following anterior cruciate ligament reconstruction (ACLR) surgery.

Objective: To identify associations between the Area Deprivation Index (ADI), strength measures, and patient-reported outcomes following ACLR and examine differences in outcomes between race, sex, and socioeconomic status.

Design: Case-control study in a single hospital setting.

Setting: Database secondary analysis.

Patients or other participants: Data were collected from 340 patients who underwent primary, isolated, unilateral ACLR.

Main outcome measure(s): Strength measures and patient-reported outcomes were obtained at patients' postoperative assessments at approximately 6 months postsurgery. Area Deprivation Index values were calculated on each patient's census tract, as determined through medical records review. Correlations were conducted to determine the relationship between the ADI and Knee Injury and Osteoarthritis Outcome Score measures, International Knee Documentation Committee, and limb symmetry on strength measurements. The racial composition of the sample was heavily skewed and was excluded from statistical analyses.

Results: The ADI was weakly correlated with International Knee Documentation Committee (ρ = 0.11, P = .04) outcomes, with more disadvantaged patients reporting better quality of life and knee function. The ADI was not correlated with other outcomes of interest. The median ADI value of the sample was 32 (range, 1-86 [interquartile range, 19-47]).

Conclusions: Our study revealed a weak correlation between higher levels of socioeconomic disadvantage as measured by the ADI and improved subjective assessment of knee function and quality of life as measured by International Knee Documentation Committee. These findings are contrary to what other studies on this subject have found and highlight the importance of further research into the impact of socioeconomic status and other social determinants of health on post-ACLR outcomes.