Journal of Athletic Training最新文献

Context: There is a need for evidence-based clinical care guidelines for perinatal athletes in the athletic training profession. Limited research on perinatal athletes, in science, exercise, and sports medicine has resulted in barriers to providing patient-centered care for this population.

Objectives: To inspire discussions of female-centric healthcare among athletic trainers to better understand patient values, encourage clinician collaboration and shared decision-making, promote equal representation of males and females in sports medicine research, advocate for safe and effective training guidelines for perinatal athletes, and establish organizational support for providing patient-centered care to pregnant and postpartum athletes.

Description: General guidelines have been established by the American College of Obstetricians and Gynecologists (ACOG) for recreational exercise, but most of the current literature in sports medicine is lacking recommendations for perinatal competitive and elite athletes. A call to action is required from athletic training education, clinical practice, research, and professional organizations.

Clinical and research advantages: Examining perinatal athletes' needs will bring focus to a marginalized population in sports medicine. Comprehensive guidelines and practical coaching methods in the athletic training profession have the potential to improve the monitoring of perinatal health and patient outcomes.

Context: While researchers have previously identified that most athletic trainers (ATs) do not negotiate their salary, little is known about employers' expectations and behaviors relative to establishing and negotiating salaries for the ATs they hire.

Objective: To examine employers' expectations and behaviors regarding AT salary negotiation.

Design: Cross-sectional.

Setting: Web-based survey.

Patients or other participants: 413 employers who are in a role that requires them to negotiate salary offers with prospective AT employees and who have minimally hired one AT into the organization they work for accessed the survey from a random sample of 7,000 ATs (6% access rate); 324 employers (age=43.8±10.6 years) completed the entire survey (78% completion rate).

Main outcome measure(s): A validated survey was used to collect employer demographics, employment organization characteristics, and employer perspectives on negotiation. Chi-square analyses with Bonferonni adjustments were used to determine relationships between organizational factors or employer demographics on employers' negotiation expectations and behaviors.

Results: 67.3% of employers expect the candidate to negotiate their salary, and 66.3% reported they are provided the salary range by someone else from their organization. More employers of rurally-located organizations offer in the upper 1/3 of the available range when compared to suburban or urban settings (p=.014). Employers of public organizations also offer more in the upper 1/3 of the available salary range compared to private organizations (p=.025). More employers who were not healthcare providers have withdrawn an employment offer due to negotiation attempts (p=.005).

Conclusions: The lack of organizational influence on negotiation expectations indicates that negotiation attempts do not need to be tailored to specific work settings. ATs may need to adjust expectations when negotiating with publicly-funded or rurally-located organizations, as the offer may already be towards the upper end of the available range. Employers expect ATs to negotiate their salary when offered a position.

Congratulations to the winners of the 2024 Outstanding Manuscript Awards, as determined by the Editorial Board and the Editors of the Journal of Athletic Training.

Context: The training stress of heat acclimatization optimizing exercise performance in a hot environment can be demanding.

Objective: This study evaluated the efficiency of different single heating protocols to elevate core temperature.

Design: Nonrandomized controlled trial.

Setting: Laboratory.

Patients or other participants: Ten male participants (age = 25 ± 3 years) performed 4 different 60-minute heating strategies at least 1 week apart.

Interventions: Sixty minutes passive heating (PAS), 30 minutes active heating using a high-intensity bike protocol (HIBP) in a hot environment with 30 minutes passive heating (EH-PAS), 60 minutes HIBP in a hot environment (EH), or 60 minutes HIBP at room temperature (EM).

Main outcome measure(s): Body core temperature and heart rate.

Results: The highest peak gastrointestinal temperature occurred in EH-PAS (39.1 ± 0.4°C), followed by EH (38.9 ± 0.3°C), EM (38.4 ± 0.3°C), and PAS (38.1 ± 0.5°C). The average heart rate, measured as a control for intensity, was not different between exercise strategies (EH-PAS = 142 ± 12.3 beats per minute [bpm], EH = 146 ± 9.7 bpm, and EM = 142 ± 13.3 bpm; P > .05), but was different for PAS (98 ± 15.2 bpm; P < .05).

Conclusions: Adding passive heating to a shorter exercise protocol can be just as effective in keeping core temperature elevated as exercise in the heat alone during a 60-minute session. Therefore, a single-bout combination of exercise and passive heating may result in a similar body temperature induction compared with exercise heat stress alone.

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 nonlinear statistical analysis.

Design: Cross-sectional study.

Setting: Dance company facility and research laboratory.

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

Main outcome measure(s): The presence of Achilles tendon abnormality was investigated using gray-scale ultrasound. Tendons were classified as having an abnormality if presenting with 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. Classification and regression tree analysis was used to explore nonlinear interactions among clinical measures and their role in identifying tendon abnormality.

Results: Sixty-eight tendons were included in the analysis. Structural change was common in asymptomatic dancers, with 80% presenting with 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 the presence of tendon abnormality. Increased hip abductor torque was linked to a 59% reduction in the probability of tendon abnormality. The classification and regression tree 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 the combination of hip torque and ankle dorsiflexion range of motion accurately identified the presence of tendon abnormality.

Context: The demographic landscape of the United States is changing daily, and the demand for representation in today's 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: Semistructured 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 were collected through a web-based recruitment survey, which was also used to schedule a semistructured interview. We used the multiphased consensual qualitative research 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 participants described both. Only one-third of participants referenced diversity, equity, inclusion, and accessibility policies and procedures within their organization. The resources domain represented the existence and awareness of organizational diversity, equity, inclusion, and accessibility resources, or lack thereof. The perceptions domain characterized the beliefs of the supervisors relative to diversity, equity, inclusion, and accessibility.

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.

Background: The main cause for military training attrition is musculoskeletal injuries to the knee, such as patellofemoral pain (PFP).

Objective: To identify which factors increase the risk of PFP occurrence in military personnel.

Design: Systematic review with meta-analysis.

Data sources: Searches were performed in MEDLINE/PubMed, CINAHL, Embase, SPORTDiscus, Web of Science, Scopus, and OpenGray databases.

Study selection: Included studies included military personnel and had a prospective cohort design investigating at least 1 variable as a risk factor for PFP.

Data extraction: Extraction was performed by 2 independent evaluators, and the data were separated between the military personnel who developed PFP and those who did not.

Data synthesis: Meta-analyses were performed using standardized mean differences (SMDs) and 95% CIs, and levels of recommendation were determined.

Results: From 11 articles, this review grouped 7518 military personnel, of whom 572 (7.61%) developed PFP. We found moderate evidence that isokinetic knee-extensor weakness at 60°/s predicts PFP in the military (SMD = -0.69; 95% CI = -1.02, -0.35). A larger frontal-plane knee-projection angle during the single-legged squat was also identified as a risk factor for PFP in male military personnel (SMD = 0.55; 95% CI = 0.14, 0.97) with a moderate level of evidence. We found moderate evidence that sex, body mass index, isometric knee-extensor strength, and isokinetic knee-flexor strength do not predict PFP in military personnel. Finally, we found strong evidence that age and body mass do not predict PFP in this population.

Conclusions: Deficits in isokinetic knee-extensor strength and a greater frontal-plane knee-projection angle are risk factors for PFP in military personnel. Given that these are modifiable factors, these aspects should be considered in injury-prevention interventions in the military.

Background: Chronic ankle instability (CAI) is a condition known to negatively affect lower extremity gait biomechanics during walking. Gait-training interventions have been proposed as a potential strategy to improve faulty movement patterns associated with CAI.

Objective: To determine if gait-training interventions influence lower extremity biomechanics during walking in individuals with CAI.

Design: Systematic review and meta-analysis.

Data sources: Literature searches were conducted in PubMed, CINAHL, SPORTDiscus, and MEDLINE from database inception through September 15, 2022.

Study selection: Eligible studies were published in English and included randomized controlled trials, studies with a repeated-measures design, and descriptive laboratory studies in which authors measured the biomechanical outcomes (kinematics, kinetics, and electromyography) of a gait-training intervention during walking in individuals with CAI.

Data extraction: One author extracted study design, participant characteristics, sample size, intervention type (device and biofeedback), intervention length, and biomechanical outcome measures (kinematics, kinetics, and electromyography).

Data synthesis: Gait-training interventions were broadly categorized into device (destabilization and novel gait-training devices) and biofeedback (visual, auditory, and haptic delivery modes). When appropriate, meta-analyses were conducted using a random-effects model to compare mean differences and SDs before and after the gait-training intervention.

Results: Thirteen studies were included. Meta-analyses were conducted only for single-session gait-training studies. Authors of 11 studies reported kinetic outcomes. Meta-analyses showed the location of center of pressure was shifted medially from 0% to 90% of stance (effect size [ES] range, -0.35 to -0.82), contact time was decreased in the medial forefoot (ES = -0.43), peak pressure was decreased for the lateral midfoot (ES = -1.18) and increased for the hallux (ES = 0.59), and the pressure time integral was decreased for the lateral heel (ES = -0.33) and the lateral midfoot (ES = -1.22) and increased for the hallux (ES = 0.63). Authors of 3 studies reported kinematic outcomes. Authors of 7 studies reported electromyography outcomes. Meta-analyses revealed increased activity for 200 milliseconds after initial contact for the fibularis longus muscle (ES = 0.83).

Conclusions: Gait-training protocols improved some lower extremity biomechanical outcomes in individuals with CAI. Plantar-pressure outcome measures seemed to be most affected by gait-training programs, with improvements including decreasing the lateral pressure associated with increased risk for lateral ankle sprains. Gait training increased electromyographic activity after initial co

Context: The National Collegiate Athletic Association's 2016 and 2024 Mental Health Best Practices documents outline essential guidelines for athletic programs, including mental health recognition, referral pathways, and critical incident management. Despite these recommendations, there remains a significant gap in literature and practice regarding the response to and management of suicide bereavement among athletic trainers (ATs), highlighting the need for further exploration of their experiences and institutional responses after a student-athlete's death by suicide.

Objective: To explore the lived experiences of collegiate ATs after the death of a student-athlete by suicide.

Design: Qualitative.

Setting: Individual interview.

Patients or other participants: Twelve ATs (age = 37 ± 7 years; credentialed experience = 14 ± 7 years) who were providing patient care to a student-athlete who died by suicide.

Main outcome measure(s): Each AT completed a semistructured, audio-only interview. Interviews were audio recorded and transcribed verbatim. Analysis followed the consensual qualitative research tradition using a 3-person coding team. Credibility and trustworthiness were established through member checking, triangulation, and internal auditing.

Results: Participants revealed several experiences and reactions after the death of a student-athlete by suicide that focused on their institutional reaction, their emotional reaction and coping mechanisms, and shared advice for other ATs moving forward. After the student-athlete death by suicide, ATs shared their institutional reaction, which included a collaborative approach with resources and changes to policy, procedures, and their overall system. They also shared their emotional reaction and coping mechanisms after the death, which included a grief response influenced by guilt, concern for other student-athletes, and the use, and lack of use, of support systems and formal therapy. Finally, they provided shared advice concerning death by suicide that included taking care of oneself and taking mental health seriously.

Conclusions: After the death, most participants expressed grief and concern for others but often did not recognize themselves as needing help. Institutional policy and provider postvention strategies are recommended.

Congratulations to the winners of the 2024 Outstanding Manuscript Awards, as determined by the Editorial Board and the Editors of the Journal of Athletic Training.