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 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.

Context: On average, individuals in early recovery after anterior cruciate ligament reconstruction (ACLr) improve limb loading symmetry (LLS) with instruction to equalize weight distribution between limbs during squats. However, the extent to which these instructions improve knee extensor loading symmetry (KLS) or reduce intralimb compensations is not known.

Objectives: Determine how limb loading instructions influence knee and intralimb loading in individuals 3-4 months post-ACLr and to explore variations in responses across individuals.

Design: Controlled laboratory study.

Setting: Research laboratory.

Patients or other participants: Individuals 109.4 days (18.2 days) post-ACLr (n = 20) and healthy matched controls (CTRL; n = 19).

Intervention: Participants performed double-limb squats in natural (no instruction) and instructed (instruction to evenly distribute weight between limbs) conditions.

Main outcome measure(s): Between-limbs and KLS were calculated as the ratio of vertical ground reaction force and knee extensor moment impulse, between surgical (Sx) : matched and nonsurgical (NSx) : matched limbs (ACLr : CTRL), respectively. Intralimb hip/knee (H/K) extensor loading distribution was calculated in Sx : matched limbs.

Results: Limb loading symmetry (natural = 0.86; instructed = 0.93, P < .001; effect size = 0.83) and KLS (natural = 0.54; instructed = 0.62, P = .007; effect size = 0.67) improved with instruction in the ACLr group with no change in the CTRL group. Hip/knee ratio did not change for either group. Here, k-means clustering, considering natural and change (natural-instructed) in LLS, KLS, and H/K ratio, described the response to instruction across 3 clusters: (1) ACLr: n = 3; CTRL: n = 9, were symmetrical in both conditions; (2) ACLr: n = 14, showed some improvement in symmetry, and (3) ACLr: n = 3, only improved LLS.

Conclusions: Average data suggest that weightbearing instruction improved LLS to within 7%, but a 38% knee loading deficit remained, and intralimb compensation did not improve. Data-driven clusters indicate that 3 ACLr participants were similar to CTRLs; 14 improved LLS, KLS, and H/K distribution; and 3 only improved LLS with worsening KLS and H/K.

A 26-year-old male international soccer player suffered a West Point Ankle Grade III syndesmosis injury leading up to the 2022 Fédération Internationale de Football Association (FIFA) World Cup. After surgical stabilization, the player completed an 11-phase return-to-performance pathway designed to ensure rapid and safe return to play. The pathway employs distinct phases that incorporate clinical, psychological, and sports-specific criteria to inform decision-making throughout the process. In this case report, we outline the phases and criteria used in conjunction with shared decision-making by the interdisciplinary team to ensure a successful return to play at the highest level. The effectiveness of this pathway was demonstrated by the player competing at the 2022 FIFA World Cup.

Context: Patellar tendinopathy (PT) is a highly prevalent overuse injury in volleyball. However, little is known if and how the risk for developing PT is increased through fatigue-induced alterations during repetitive jump-landing activities in volleyball.

Objective: The purpose of this study was to explore fatigue-induced risk factors for PT during a spike jump-landing task in volleyball.

Design: Prospective cohort study.

Setting: 3D biomechanical laboratory screening.

Patients or other participants: Seventy-nine adult, male volleyball players.

Main outcome measure(s): At baseline (pre-season), 3D full-body kinematics and kinetics were collected while performing a spike jump before and after a volleyball-specific fatigue protocol. Throughout the season, players were followed for the occurrence of PT and survival analysis with competing risks was performed to identify significant predictors for the development of PT (p < 0.05).

Results: During follow-up, 10 of the 79 players developed PT (13%). Players with significantly less hip flexion during the horizontal landing/push-off phase of the spike jump after fatigue were at higher risk for developing PT (HR = 0.898; 95% CI 0.826 to 0.977; p = 0.023) as well as players with a significantly more elongated rectus femoris muscle-tendon unit (HR = 3.258; 95% CI 1.136 to 9.343; p = 0.032).

Conclusions: Despite the low (injured) sample size of this study, preliminary research findings indicate less hip flexion and more elongated rectus femoris muscle-tendon units during landing after fatigue as potential risk factors for developing PT. Future prevention programs for PT may wish to focus on hip-specific exercises and technique modifications (e.g., more hip flexion during landing) under fatigued circumstances.

Context: As an essential core competency for high-quality healthcare, health information technology (HIT) leverages the use of technology, such as electronic record systems, to collect and use patient care information to make informed clinical decisions. There is a dearth of information regarding professional athletic training students' (ATSs') use of HIT professional behaviors during clinical experiences.

Objective: To assess HIT professional behaviors ATSs engage with during clinical experience patient encounters (PEs).

Design: Multisite panel design.

Setting: 12 professional athletic training programs.

Participants: 363 ATSs enrolled across the participating professional athletic training programs entered patient encounter information within E*Value during their scheduled clinical experiences.

Data collection and analysis: Characteristics of PEs (length of encounter, student role, clinical site type) were tracked in E*Value by students over three semesters. We used generalized estimating equation models to analyze the likelihood that students included HIT professional behaviors during 30,518 PEs.

Results: Clinical site type (p=0.04), length of encounter (p<0.001), and student role (p<0.001) had the greatest influence on students' documentation of PEs in electronic records systems; PEs occurring at the college/university setting, longer PEs, and full student autonomy increased the likely of this professional behavior. Length of encounter (p<0.001) and clinical site type (p<0.001) influenced students' use of information documented in electronic records systems to assist with clinical decision-making; PEs longer than 60 minutes and PEs in the clinic setting increased this professional behavior likelihood.

Conclusions: Since HIT is integral to providing high-quality patient care, and its use is developed and improved upon across the continuum of the professional career, program administrators and preceptors must seek out opportunities for students to engage in HIT behaviors during clinical experiences. Secondary school clinical sites, sites that typically have shorter patient encounters, and preceptors that offer less autonomy are most in need of intentional efforts toward HIT inclusion.

Context: The Open Landing Error Scoring System (OpenLESS) is a novel tool for automating the LESS to assess lower extremity movement quality during a jump-landing task. With the growing use of clinical measures to monitor outcomes and limited time during clinical visits, there is a need for automated systems. OpenLESS is an open-source tool that uses a markerless motion capture system to automate the LESS using 3D kinematics.

Objective: To describe the development of OpenLESS, examine its validity against expert rater LESS scores in healthy and clinical cohorts, and assess its intersession reliability in an athlete cohort.

Design: Cross-Sectional.

Participants: 92 total adult participants from three distinct cohorts: a healthy university student cohort (12 males, 14 females; age=23.0±3.8 years; height=171.9±8.3 cm; mass=75.4±18.9 kg), a post-anterior cruciate ligament reconstruction (ACLR) cohort (8 males, 19 females; age=21.4±5.7 years, height=173.5±12.5 cm; mass=73.9±13.1 kg; median 33 months post surgery), and a field-based athlete cohort (39 females; age=25.0±4.7 years, height=165.0±7.1cm; mass=63.5±8.6kg).

Main outcome measures(s): The OpenLESS software interprets movement quality from kinematics captured by markerless motion capture. Validity and reliability were assessed using intraclass correlation coefficients (ICC), standard error of measure (SEM), and minimal detectable change (MDC).

Results: OpenLESS agreed well with expert rater LESS scores for healthy (ICC2,k=0.79) and clinically relevant, post-ACLR cohorts (ICC2,k=0.88). The automated OpenLESS system reduced scoring time, processing all 353 trials in under 25 minutes compared to the 35 hours (~6 minutes per trial) required for expert rater scoring. When tested outside laboratory conditions, OpenLESS showed excellent reliability across repeated sessions (ICC2,k>0.89), with a SEM of 0.98 errors and MDC of 2.72 errors.

Conclusions: OpenLESS is a promising, efficient tool for automated jump-landing assessment, demonstrating good validity in healthy and post-ACLR populations, and excellent field reliability, addressing the need for objective movement analysis.