Journal of Athletic Training最新文献

Context: Diverse representation in athletic training leadership is essential for fostering inclusion and innovation in the profession. Despite efforts to enhance leadership diversity, disparities persist, underscoring the need to explore barriers to leadership and the effectiveness of leadership in meeting the needs of athletic trainers (ATs).

Objective: To examine racial and ethnic differences in ATs' desire, pursuit, and attainment of leadership positions in the profession in addition to perceptions of current leadership effectiveness.

Design: Cross-sectional, web-based survey.

Participants: A purposeful sample of 1,173 racially and ethnically diverse ATs from an organized professional network followed by a random sample of 6,000 members of the National Athletic Trainers' Association (NATA). A total of 488 participants completed the survey for a 14.7% response rate.

Data collection and analysis: Data were collected via a web-based survey, including 7 demographic items, 4 Likert-scale items, and 5 open-ended questions. Independent samples Kruskal-Wallis tests, chi-square tests, and ANOVA tests were used to compare differences between subgroups, with pairwise testing conducted using the Bonferroni correction.

Results: Irrespective of race and ethnicity, most ATs expressed desire for and pursuit of leadership positions in the profession. 56.5% of ATs reported attaining such roles, primarily at departmental or institutional levels. African American ATs perceived greater barriers to attaining leadership positions due to their race and ethnicity and felt their needs were less met by current leadership as compared to white counterparts.

Conclusions: Systemic biases and in-group favoritism may impede attainment of leadership positions in athletic training organizations and influence perceptions of leadership effectiveness for racial and ethnic minority ATs. Consequently, there is a pressing need for intentional efforts to diversify leadership within athletic training and foster more inclusive leadership. Implementing strategies, such as diversifying selection processes and promoting allyship, are critical to ensuring equitable opportunities and advancing diversity within leadership.

Context: Psychosocial factors are important to consider throughout concussion recovery. Coping skills may play a role post-injury by influencing the stress response and health-promoting behaviors (e.g., rehabilitation adherence). However, limited evidence exists examining coping skills throughout concussion recovery in college-aged individuals.

Objective: To compare (1) changes in coping skills between acute and full medical clearance (FMC) visits in college-aged individuals diagnosed with concussion and healthy controls, and (2) determine the association between coping skills and recovery outcomes following concussion.

Design: Prospective cohort study.

Setting: University laboratory.

Patients or other participants: 96 college-aged individuals (concussion group: N=64, age=21.33±2.37 years; control group: N=32, age=21.54±2.54 years) were enrolled.

Main outcome measures: The Athletic Coping Skills Inventory (ACSI-28) was completed at acute (within 5 days of concussion) and FMC (within 3 days of clearance) visits. A 2 × 2 mixed ANOVA determined differences in total and subscale scores between groups (concussion vs. control) from acute to FMC visit. Multiple linear regressions determined the association between acute ACSI-28 scores and recovery for the concussion group, with statistical significance set a priori at p<0.05 for both tests.

Results: The concentration subscale was significantly lower for the concussion group at the initial visit (F(1,94)=7.28, p=0.01). The main effect of time showed both groups' ACSI-28 total score significantly increased from acute to FMC visit (F(1,94)=22.08, p<0.001). There were no significant differences in total scores between groups at either visit (p>0.05). Additionally, no associations were found between ACSI-28 scores and concussion recovery outcomes when controlling for sex, race, history of depression/anxiety, and acute visit symptom severity (symptom resolution: B=0.06, p=0.62; FMC: B=0.09, p=0.46).

Conclusions: Only coping-related concentration skills from the ACSI-28 are impaired during the acute stage of concussion recovery but improve by the FMC visit. Other coping skills associated with the ACSI-28 remain unaffected throughout concussion recovery in college-aged individuals.

Context: Mental health screenings are recommended during preparticipation physical examinations. The Mental Health-Related Survey (MHRS), a 9-item questionnaire adapted from the 18-item Mental Health Screening Form-III, is suggested in three consensus and/or position statements. However, there is no evidence on the effectiveness of the MHRS.

Objective: To assess the validity of the MHRS for mental health screening in collegiate student- athletes.

Design: Cross-sectional study.

Setting: University athletic program.

Patients: 515 NCAA Division II student-athletes (20±1 years old).

Main outcome measures: Participants completed the MHRS, PHQ-9 for depression, and GAD-7 for anxiety. A stratified sample underwent a neuropsychiatric interview (MINI). Descriptive statistics and Pearson correlations were performed. An area under the curve (AUC) analysis compared the MHRS to the MINI. Validity was determined using sensitivity, specificity, Youden's index, predictive values, and accuracy.

Results: 322 student-athletes (62.5%) indicated 'yes' to one or more items on the MHRS, suggesting they would require a mental health referral. Women indicated more 'yes' answers than men (p<0.001). Average scores were 2.21±3.06 on the PHQ-9 and 2.66±3.87 on the GAD-7. Using a cut score of 6, 68 individuals (13.2%) reported clinically relevant depression, and 76 (14.8%) reported anxiety. PHQ-9 and GAD-7 scores strongly correlated with MHRS scores (PHQ-9: r=0.713, p<0.001; GAD-7: r=0.745, p<0.001). The MHRS had a specificity of 24.6%, a sensitivity of 93.9%, and overall accuracy of 40.14%. The AUC score was 0.762. We identified a new cutoff score for the MHRS of ≥4; however, the sensitivity of 63.6% and specificity of 76.3% raise concerns regarding how well this tool can rule out and in clinically significant symptoms of mental health conditions.

Conclusion: Most student-athletes indicated 'yes' to at least one item on the MHRS, warranting a mental health referral. The MHRS showed high sensitivity but low specificity, indicating low clinical utility as a screening tool.

Context: Sport-related concussion is a common injury among National Collegiate Athletic Association football athletes. Beginning with the 2016 season, Ivy League Conference coaches voted to ban player- on-player tackling from all in-season practices. BLINDED have enforced a no-tackle approach in practices since 2010.

Objective: To examine the association between tackling technique and head contact risk, and compare base rates of techniques used in the 2016 season between an Ivy League team with a longstanding no- tackle practice policy vs. the rest of the league.

Design: Cross-sectional study.

Setting: Ivy League College Football Conference.

Patients or other participants: Two-hundred-thirty-seven Ivy League defensive football players that participated in the 2016 season.

Main outcome measure(s): Tackles (N=3,701) across 237 Ivy League defensive football players in the 2016 season were coded based on predetermined classifications, which were combined to create unique tackle combinations/techniques. Associations among tackling techniques, head impact risk, and team (BLINIDED vs. other Ivy League teams) were evaluated using logistic regression, yielding odds ratios (OR) for head contact.

Results: Low-risk tackle characteristics for head contact during a tackle were neutral neck position (OR=0.1), back contact area (OR=0.3), pursuing momentum (OR=0.5), and quarterback sack momentum (OR=0.3). Low-risk tackle techniques were high-back-neutral (OR=0.1), low-back-neutral (OR=0.2), and medium-back-neutral (OR=0.1). High-risk tackle characteristics were flexion (OR=14.2) and extension (OR=3.8) neck positioning, front contact (OR=2.2), blowup (OR=2.5), and cut (OR=3.0). High-risk tackle techniques included low-side-flexion (OR=4.9), low-front-flexion (OR=9.9), medium-side-flexion (OR=15.5), and medium-front-flexion (OR=11.4). Relative to BLINDED, other teams demonstrated higher odds of using high-risk techniques (low-side-flexion OR=3.5; low-front-flexion OR=3.9; medium- side-flexion OR=6.3; medium-front-flexion OR=2.3) and reduced odds of using low-risk tackle combinations (high-side-neutral OR=0.4; high-back-neutral OR=0.6; medium-side-neutral OR=0.8).

Conclusions: Tackling techniques are associated with head contact risk, and by extension, player safety. BLINDED, who have a longstanding policy of practicing without player-on-player tackling, showed reduced use of high-risk tackling techniques.

Context: Exertional heatstroke (EHS) is a leading cause of death in athletes and the warfighter. Polar Life Pod (PLP) and ice sheet cooling (ISC) are two of the more portable cooling techniques to treat EHS and show promise for treating patients when large volumes of water or immersion devices (e.g., tubs) are not available. "Ideal" cooling rates consistent with excellent EHS prognoses exceed 0.16°C/min while "acceptable" rates are between >0.08°C/min and 0.15°C/min. No research has compared the cooling effectiveness of the Polar Life Pod (PLP), a body bag-like device, to ISC following simulated military conditioning exercise.

Objective: Determine if PLP or ISC reduced rectal temperature (TREC) differently and at 'acceptable' or 'ideal' cooling rates.

Design: Randomized, counterbalanced, crossover study.

Setting: Laboratory.

Patients or other participants: Fourteen participants (10 men, 4 women; age: 22±3y; mass:73.8±17.8kg; ht:168.5±7.8cm).

Interventions: Participants donned a military uniform and rucksack and marched in the heat (temperature=∼37.5°C; relative humidity=∼40%) until TREC was 39.5°C. Then they undressed and were wrapped in bed sheets presoaked in ice water (≤0.89±0.33°C) or lay in PLP filled with water (151.4±3.8L; 4.22±0.95°C) until TREC was 38°C.

Main outcome measures: TREC and cooling durations; calculated TREC cooling rates.

Results: Participants exercised in similar clothing, environmental conditions, and durations (PLP=50.5±9.9min, ISC=48.9±10.9min, P=0.38). PLP cooling rates differed from ISC and were 'ideal' whilst ISC rates were 'acceptable' (PLP=0.22±0.08°C/min; ISC=0.11±0.05°C/min, P<0.001).

Conclusions: PLP lowered TREC twice as quickly as ISC and at rates consistent with favorable EHS outcomes. PLP's faster cooling rates were likely due to it utilizing conductive and convective cooling, treating a larger body surface area, and providing a larger heat sink than ISC. PLP and ISC can be utilized to treat EHS, but PLP is preferred because it reduced TREC faster, utilized less ice, and required the same number of personnel and coolers as ISC.

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.