Journal of Athletic Training最新文献

Context: Hip pain is a concern in young adults, with previous hip injury recognized as a key contributing factor. However, little is known about how prior non-hip lower extremity injuries impact current hip pain.

Objectives: To determine (1) whether past foot/ankle and knee youth sports injuries are associated with current hip pain in young adults and (2) the role of foot/ankle, knee, and hip pain in contributing to poor patient-reported lower extremity function in young adults.

Design: Cross-sectional study.

Setting: Electronic survey.

Patients or other participants: Four hundred twenty-four young adults with previous youth sports participation.

Main outcome measures: Individuals self-reported prior youth sports foot/ankle, knee, and hip injury histories, current pain in these regions, and current function using the Lower Extremity Functional Scale. Ordinal logistic regression models assessed the association of prior foot/ankle and/or knee injuries with current hip pain. Secondary analyses evaluated the effect of (1) foot/ankle and hip injury history on current knee pain and (2) knee and hip injury history on current foot/ankle pain. Finally, we explored the relationship between current lower extremity region pain and function.

Results: A history of both foot/ankle and knee injuries (odds ratio [OR] = 4.91; 95% confidence interval [CI] = 2.80, 8.60) or foot/ankle injury alone (OR = 2.72, 95% CI = 1.68, 4.41) was associated with increased odds of current hip pain; a knee injury history alone was not (OR = 1.17, 95% CI = 0.64, 2.15). Hip and foot/ankle injury histories were both associated with increased current knee pain. Greater current foot/ankle pain, but not knee or hip pain, was linked to worse current lower extremity function.

Conclusions: Prior lower extremity injuries, particularly involving the foot/ankle, increased the likelihood of current hip pain. Multi-region lower extremity injury histories appear to have a compounding effect on hip pain intensity.

A 17-year-old female athlete sustained a Morel-Lavallée lesion while participating in soccer. Following diagnostic ultrasound and aspiration performed by a sports medicine physician, the patient slowly returned back to soccer and flag football with compression and protection over the site of the lesion. The patient was able to return to full athletic participation with no residual symptoms and no complications. The prompt identification, referral, and treatment of the Morel-Lavallée lesion is encouraged by the existing literature to prevent complications such as necrosis, tissue damage, and infection. Communication between the sports medicine physician and the athletic trainer is important to enable patient monitoring and treatment adjustments as well as patient follow-up throughout the course of healing.

Context: Although compromised shoulder posture impacts scapular biomechanics, the interplay between shoulder posture and scapular biomechanics during the dynamic pitching motion in high school baseball pitchers remains unexplored.

Objective: To characterize the shoulder postures of baseball pitchers and investigate their relationships with scapular biomechanics during pitching.

Design: Descriptive exploratory study.

Setting: Laboratory.

Participants: Thirty-eight high school baseball pitchers (age = 16.9 ± 0.9 years).

Main outcome measures: Shoulder posture was determined by acromial distance (AD), pectoralis minor index (PMI), scapular index (SI), and forward shoulder angle (FSA) in the dominant arm. The scapular kinematics and associated muscle activation (upper trapezius [UT], serratus anterior [SA], lower trapezius, biceps brachii [BB], triceps brachii [TB], anterior deltoid) during pitching were recorded.

Results: There was a moderate-to-strong negative correlation between AD and upward rotation (r = -0.47 to -0.55, P < .01) and a moderate negative correlation between AD and posterior tilt (r = -0.40 to -0.44, P < .01). Pectoralis minor index and FSA also showed moderate positive correlations with posterior tilt (PMI, r = 0.37, P < .05; FSA, r = 0.34-0.42, P < .04). Acromial distance had moderate-to-strong positive correlations with UT, SA, BB, TB, and anterior deltoid activation (r = 0.36 to 0.59, P < .03), whereas SI showed moderate negative correlations with UT, BB, and anterior deltoid activation (r = -0.33 to -0.40, P < .05). Forward shoulder angle displayed a moderate negative correlation with SA and BB activation (r = -0.32 to -0.40, P < .05).

Conclusions: Shoulder posture has significant moderate-to-strong correlations with scapular biomechanics during pitching in high school baseball pitchers. These findings provide a foundation for future research on optimizing shoulder posture to enhance efficient scapular movement patterns. Incorporating posture assessments into routine screenings may allow practitioners to gather valuable biomechanical insights without the need for extensive motion-capture systems.

Context: Trunk-stabilization exercises, especially when performed under unstable conditions, may be beneficial for low back pain (LBP) and related symptoms. However, more evidence is needed to determine whether adding a perturbation component to the training program contributes to greater improvement.

Objective: To determine the effects of perturbation training on trunk-muscle endurance, disability, pain, functional mobility, quality of life, fear-avoidance beliefs, and satisfaction in patients with nonspecific LBP.

Design: Randomized controlled clinical trial.

Setting: Physiotherapy laboratory.

Patients or other participants: A total of 44 patients with nonspecific LBP (30 women, 14 men; age = 33.06 ± 9.55 years) who had pain for at least 3 months (pain duration = 3.02 ± 3.25 years) was randomly assigned to either the exercise group (EG) or the perturbation group (PG).

Interventions: The EG received a 2-phase trunk-based exercise program, and the PG received a 4-phase training program with perturbations added to the exercises performed by the EG. All interventions were performed 2 days per week for 8 weeks.

Main outcome measures: Trunk endurance (McGill endurance tests) and LBP-related disability (Oswestry Disability Index) were the primary outcome measures. Pain intensity (visual analog scale), functional mobility (timed up-and-go test), quality of life (Short Form 12), fear-avoidance attitudes (Fear-Avoidance Beliefs Questionnaire), and patient satisfaction (Global Rating of Change) were the secondary outcome measures.

Results: Both groups showed improvement in all variables (P < .05). However, the PG was superior to the EG in improving trunk-muscle endurance (flexor: F _1,41 = 12.24, P = .001; extensor: F _1,41 = 17.67, P < .001; right lateral flexor: F _1,41 = 12.93, P = .001; left lateral flexor: F _1,41 = 15.02, P < .001) and the Oswestry Disability Index (P = .005). Between-groups effect sizes were large (partial η² range, 0.18-0.30). The timed up-and-go test (F _1,41 = 4.96, P = .03) and Fear-Avoidance Beliefs Questionnaire total score improved more in the PG (F _1,41 = 5.06, P = .03), with a medium effect size (partial η² = 0.11), and satisfaction was also higher in the PG ( ${\chi }_1^2$ = 4.46, P = .03).

Conclusions: An 8-week trunk-based exercise program, when combined with perturbation training, led to greater improvements in trunk-muscle endurance, function, total fear-avoidance belief scores, and satisfaction.

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.