Journal of Athletic Training最新文献

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.

Recently, the National Collegiate Athletic Association (NCAA) has placed more attention on the mental health of student-athletes because they are experiencing mental health challenges at a higher rate than their nonathlete peers. This led the NCAA to create a mental health initiative that encouraged athletic departments to hire a mental health professional to meet the psychological needs of student-athletes. Over the last 7 years, we have seen an increase in the number of psychological providers hired in NCAA Division I athletics to meet the varying needs of student-athletes. However, most universities are only hiring 1 professional to meet the mental health and mental performance needs of student-athletes. Mental health services focus on addressing pathological mental health concerns, whereas mental performance services are designed to assist student-athletes with performance-related challenges (eg, managing performance pressures). In addition to the mental health initiative, the NCAA Transformational Committee published a report that continued to emphasize the importance of meeting the mental health needs of student-athletes but did not acknowledge mental performance services as an essential resource. Therefore, student-athletes' mental performance needs may not be met. In this paper, we call on athletic trainers to assist in advocating for more education about the differences between services and for both mental performance and mental health services to be available to student-athletes. With athletic trainers often having strong relationships with student-athletes and sport-related administrators, foundational training competencies in both mental performance and mental health, and the desire to balance improving health and performance, they are in a unique position to advocate for better educational resources and the inclusion of both mental performance and mental health services to meet the varying psychological needs of student-athletes.

Context: Pain during movement screens is a risk factor for musculoskeletal injury (MSKI). Movement screens often require specialized or clinical expertise and large amounts of time to administer.

Objective: Evaluate if self-reported pain (1) with movement clearing screens is a risk factor for any MSKI, (2) with movement clearing screens is a risk factor for body region-specific MSKIs, and (3) with a greater number of movement clearing screens progressively increases MSKI risk.

Design: Retrospective cohort study.

Setting: Field-based.

Patients or other participants: Military service members (n = 4222).

Main outcome measure(s): Active-duty service members self-reported pain during movement clearing screens (Shoulder Clearing, Spinal Extension, Squat-Jump-Land). Musculoskeletal injury data were abstracted up to 180 days post-screening. A traffic light model grouped service members if they self-reported pain during 0 (Green), 1 (Amber), 2 (Red), or 3 (Black) movement clearing screens. Cox proportional hazards models adjusted for age, gender, body mass index, and prior MSKI determined the relationships between pain during movement clearing screens with any and body region-specific MSKIs.

Results: Service members self-reporting pain during the Shoulder Clearing (adjusted hazard ratio and 95% confidence interval [HRadj (95% CI)] = 1.58 [1.37, 1.82]), Spinal Extension (HRadj = 1.48 [1.28, 1.87]), or Squat-Jump-Land (HRadj = 2.04 [1.79, 2.32]) tests were more likely to experience any MSKI than service members reporting no pain. Service members with pain during the Shoulder Clearing (HRadj = 3.28 [2.57, 4.19]), Spinal Extension (HRadj = 2.80 [2.26, 3.49]), or Squat-Jump-Land (HRadj = 2.07 [1.76, 2.43]) tests were more likely to experience an upper extremity, spine, back, and torso, or lower extremity MSKI, respectively, than service members reporting no pain. The Amber (HRadj = 1.69 [1.48, 1.93]), Red (HRadj = 2.07 [1.73, 2.48]), and Black (HRadj = 2.31 [1.81, 2.95]) cohorts were more likely to experience an MSKI than the Green cohort.

Conclusions: Self-report movement clearing screens in combination with a traffic light model provide clinician- and nonclinician-friendly expedient means to identify service members at MSKI risk.

Context: Social determinants of health are known to affect overall access to youth sports, however, it is not fully understood how multiple social determinants of health may impact access to school-based athletic training services.

Objective: To determine the relationship between Social Vulnerability Index (SVI) scores on access to high school-based athletic trainers in California.

Design: Retrospective, cross-sectional study.

Setting: Online survey.

Patients or other participants: California Interscholastic Federation (CIF) high school respondents of the 2022-23 Participation Census.

Main outcome measures: Association between Social Vulnerability Index scores and access to school-based athletic trainer services.

Methods: This study uses data from CIF high school respondents of the 2022-23 Participation Census. School addresses were used to extract SVI scores from the U.S. Census Bureau. Separate multivariable logistic regressions and generalized linear mixed effects models assessed the relationships between access to school-based athletic training services and SVI scores at the census and county levels.

Results: There were 1,598 respondent schools (65% public, 24% private, and 11% charter). 49% of schools reported having an athletic trainer, of which 41% were certified. Adjusted analyses revealed that increased vulnerability in household characteristics was associated with lower odds of access to athletic trainers and certified athletic trainers at both county (OR: 0.89 (95% CI: 0.80, 0.99); p = .04) and census tract levels (OR: 0.93 (95% CI: 0.89, 0.97); p = .002). Increased vulnerability in socioeconomic status was associated with lower odds of having an certified athletic trainer at the census tract level (OR: 0.94 (95% CI: 0.89, 0.98); p = .006), but not the county level (p = .16).

Conclusions: Increased vulnerability in household characteristics is associated with decreased odds of access to high school-based athletic training services.