Journal of Athletic Training最新文献

A female NCAA Division I track athlete experienced non-localized shin pain midway through her first season, which was diagnosed as medial tibial stress syndrome. Treatments included strengthening and range of motion exercises, reduced training volume, and pain control modalities, but symptoms worsened. It was revealed she had been suffering from severe sleep deprivation (<3 hours/night) contributing to bilateral tibial and fibular stress reactions. Months of trial and error eventually resulted in the implementation of sleep interventions which improved her total body bone mineral density and bilateral stress reactions. Two years after successful sleep interventions this athlete has remained injury-free and continues to set personal bests in her events. Our standard injury screening protocols did not include questioning sleep quality and quantity early in the process and this case highlights the need for these measures to be considered initially and throughout the treatment and recovery phases of sports-related injuries.

Context: Student-run health clinics (SRHC) are commonly utilized to provide clinical experiences to students in healthcare education programs as well as healthcare services to a target community. Recent reports on athletic training SRHCs (AT-SRHCs) with a client population of university students, employees and/or community members have reported positive patient outcomes and high patient satisfaction, however there is limited data about the treated conditions, services and value provided by AT-SRHC.

Objective: To track utilization of athletic training services at a free AT-SRHC.

Design: Retrospective chart review from September 2022-May 2024.

Setting: University-based AT-SRHC.

Patients: 97 patients (52 males, 44 females, 1 not documented; age 32.6±13.7 years, range: 18-65 years old; 50 employees, 47 students).

Main outcome measures: Data were extracted from an electronic medical record and scheduling software. Variables extracted included patient demographics, appointment numbers, mechanism of injury, injured body part, days since injury, injury diagnosis, injury severity, and common procedural terminology (CPT) codes. Data were analyzed descriptively.

Results: Sixty-four percent (226/352) of available appointment sessions were reserved. The 3 most commonly injured body areas were the knee (n=26, 23.9%), shoulder (n=23, 21.1%), and thigh (n=13, 11.9%). The 3 most common diagnoses were sprains/strains (n=51, 46.8%), overuse conditions (e.g. epicondylitis, impingement, tendonitis; n=18, 16.5%), and nonspecific joint pain (n=22, 20.2%). The 3 most common CPT codes were for therapeutic exercise (n=136), athletic training evaluation (n=98), and manual therapy (n=78). Estimates for the total value of services range from $6,901 to $13,498 ($39.89-78.03 per session).

Conclusions: Services at an AT-SRHC were utilized by a small portion of the campus population during its first 2 years of operation. Data provides preliminary insight into AT-SRHC service utilization and value. Additional organizations may benefit from developing an AT-SRHC to provide access to affordable care and student clinical experiences.

Context: Athletic trainers (ATs) are in a unique position to mitigate the negative impact of social determinants of health (SDH) in their patients. In the secondary school setting, understanding common SDH may inform strategies that reduce these impacts. However, little is known about the types of SDH that ATs observe in patients in this setting.

Objective: To investigate SDH observed by ATs at the point-of-care in the secondary school setting.

Design: Descriptive, observational card study.

Setting: Secondary schools.

Participants: Twenty-seven ATs (mean [SD] age = 29.9 (5.6) years, 23 [85.2%] female).

Main outcome measure: Athletic trainers recorded SDH on a standardized observation card during patient interactions. Cards provided instructions for completion and had a 4-column table with a list of 19 predetermined SDH, a checkbox for observed SDH, a checkbox for perceived negative impact of observed SDH on patient health, and an open box to write in actions taken to address the observed SDH.

Results: Overall, 676 cards with 748 observed SDH were collected from 27 secondary schools. Of those, 46.9% (351/748) were perceived to have a negative impact on patient health. The top 3 observed SDH were academic stressors (14.2%, 106/748), access to social media (12.6%, 94/748), and lack of health literacy (11.4%, 85/748). The ATs reported acting on 37.7% of negatively perceived SDH 24 through counseling and education (48.6%, 137/282), additional resources (20.6%, 58/282), referral to others (17.4%, 49/282), and communication with others (13.5%, 38/282).

Conclusions: Our results indicated ATs in the secondary school setting were observing and acting to mitigate the negative impact of SDH. However, these ATs should be prepared to provide resources for patients negatively impacted by academic stressors, social media, and lack of health literacy. Resources, referrals, and additional education for patients may support a healthier community and positively impact athlete health and well-being.

Context: A patient-centered care (PCC) environment allows athletic trainers (ATs) to develop trusting relationships with patients, enabling them to make the most informed care decisions. To provide PCC, the AT should assess health literacy and deliver quality patient education.

Objective: To explore the lived experiences of ATs from different job settings to identify how they deliver PCC specific to health literacy and patient education.

Design: Qualitative.

Setting: Virtual interviews.

Patient or other participants: 27 ATs (age=34±10 y; women=15, men=12) from the physician practice (n=10), college (n=9), and secondary school (n=8) settings.

Main outcome measures: We interviewed the participants using a semi-structured interview protocol. Three researchers coded the transcripts following the consensual qualitative research process for each job setting. Trustworthiness was achieved through multi-analyst triangulation, member checking, and internal auditing.

Results: Four domains emerged from all interviews: 1) work environment, 2) essential traits and skills, 3) health literacy assessment strategies, and 4) patient education materials and delivery. In the work environment, ATs described the patient load, interprofessional relationships, and patient characteristics across settings. For essential traits and skills, ATs from the settings varied widely, and different strategies were needed based on differing patient needs. For health literacy assessment strategies, ATs did not formally assess health literacy and relied on perceptions and assumptions. Effective digital information and health informatics strategies were described for patient education materials and delivery.

Conclusions: ATs from physician practice, college, and secondary school settings describe using various strategies to create a patient-centered environment. Participants shared their behaviors in assessing health literacy and delivering patient education from various job settings.

Context: Parents are key decisionmakers for 1 the health and wellness of their children. Despite the benefits of engaging in physical activity, parental concerns about concussion may create hesitancy towards sport participation. The magnitude of concussion-related anxiety perceptions and factors that influence these beliefs in parents of youth athletes are largely unknown.

Objective: To determine the prevalence of concussion-related anxiety perceptions in parents of youth athletes and establish the associations among concussion-related anxiety and demographic variables (i.e., parent sex, parent concussion history, child concussion history, parent concussion education).

Design: Cross-sectional paper survey.

Setting: Youth sports.

Patients or other participants: 452 parents (60% female; mean age = 40.4±13.0 years) of youth athletes (8-14 years old) who participated in soccer, ice hockey, lacrosse, and football (i.e., higher concussion risk sports) in Pennsylvania and Michigan.

Main outcomes measures: Survey items were adapted from the Perceptions of Concussion Inventory for Athletes (PCI-A) to pertain to perceptions about their child. Parents also completed a demographic survey regarding concussion-related topics.

Results: Overall, 73.2% of parents found the possibility of their child sustaining a concussion to be upsetting, 61.5% were fearful of their child sustaining a concussion, and 45.1% reported that the thought of their child having a concussion makes them feel anxious. Only 4.6% of parents suggested that concussions do not worry them. The lack of a personal concussion history and being female were associated with greater concussion-related anxiety in parents.

Conclusions: This study provides evidence that parents of youth athletes have anxiety about their child sustaining a concussion, while also contributing to the understanding of what factors are related to such anxiety (i.e., female parent; no parent history of concussion). Negative parental concussion beliefs may contribute to the reduction in contact sport participation and should be directly addressed in concussion education specific to youth sport participation.

Context: Non-combat musculoskeletal conditions are endemic among service members and disproportionately affect females. Pregnancy and childbirth contribute to lower physical fitness assessment scores and higher body mass index, both risk factors for musculoskeletal conditions, for up to one-year post-pregnancy. However, there is a paucity of information regarding the impact of pregnancy on musculoskeletal conditions.

Objective: To explore the association between the post-pregnancy period and incident musculoskeletal conditions (MSK).

Design: Retrospective, longitudinal cohort study.

Setting: Medical and administrative data from the Medical Assessment and Readiness System.

Other participants: Female military service members with and without a pregnancy.

Main outcome measure(s): Months since pregnancy end, health history, and demographic and military service data were abstracted for each subject. Subsequent MSKs were identified with relevant ICD-10 codes. A multivariable logistic regression model assessed the association between the time since pregnancy end and MSK incidence.

Results: A total of 298,607 female service members were identified, of which 19,980 had a pregnancy. A larger percentage of post-pregnancy service members (65.8%) had a MSK diagnosis as compared to the non-pregnant cohort (60.3%). Adjusting for covariates, the model suggests a temporal influence on post-pregnancy MSK incidence, such that service members 3- to 4-months and 5- to 6-months post-pregnancy were more likely to be diagnosed with a MSK as compared to the non-pregnant cohort. However, service members <2 months post-pregnancy were less likely to be diagnosed with an MSK, and the odds of an MSK beyond 6-months decreased out to 24-months post-pregnancy.

Conclusions: Pregnancy may increase a service member's odds of sustaining an MSK 3- to 6- months post-pregnancy. Understanding the relationships between pregnancy and MSK risks may lead to changes in postpartum return-to-duty/activity policies, better enabling service members to care for themselves and their families.

Context: The demographic landscape of the United States is changing daily and the demand for representation in todays 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: Semi-structured 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 was collected through a web-based recruitment survey which was also used to schedule a semi-structured interview. We used the multi-phased CQR 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 pa rticipants described both. Only one-third of participants referenced DEIA policies and procedures within their organization. The resources domain represented the existence and awareness of organizational DEIA resources, or lack thereof. The perceptions domain characterized the beliefs of the supervisors relative to DEIA.

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.

Context: The importance of analyzing head impact exposure among football players is well established, yet few studies have explored the differences across position groups in high school athletes. Better understanding of these differences may provide optimized intervention strategies for coaches and healthcare providers.

Objective: To quantify the difference of head impacts per exposure (Imp/E) and impact burden high school football player position groups.

Design: Prospective observational.

Setting: High school athletic fields during Fall sports seasons.

Patients and participants: 200 football players from three high school varsity teams including 69 offensive/defensive linemen, 51 linebackers/running backs/tight ends and 80 cornerbacks/safeties/wide receivers (16.1±0.9yrs, 177.9±7.8cm, 86.4±22.7) categorized as linemen, backers, and skills players respectively.

Main outcome measures: Imp/E across positions, teams, session type, and seasons. Cumulative head impact burden per location (front, top, right, left, back) across position groups.

Results: Significant differences in Imp/E were found between position groups (P<0.001), where the backers group, (3.77[95% CI: 3.146, 4.395]) experienced higher total Imp/E compared to linemen (1.47[ 95% CI: 0.983, 1.96]) and skill players (1.56[95% CI: 1.11, 2.01]). Total accumulated burden of head impacts was significant (F(2,194) = 4.938, P<0.008), with backers (4622.85g's [95% CI: 3077.43, 6168.27]) significantly (P=0.011) higher than linemen (2657.70g's [95% CI: 2045.61, 3269.19 ]) and skill players (2875.7g's [95% CI: 2216.38, 3535.01]) (P=0.022). Front location impact burden (F(2, 194) = 7.784, P<0.001) revealed backers (1606.24g's [95% CI: 977.89, 2234.58]) also significantly (P=0.008) higher than both linemen (768.24g's [95% CI: 433.84, 1102.64]) and skill players (567.75g's [95% CI: 360.71, 774.78]) (P<0.001).

Conclusion: Linebackers, tight ends, and running backs experienced more Imp/E and higher cumulative burden than other positions, which highlights the potential influence of specific positional requirements during football participation. Coaches and healthcare providers should be aware that a position's role during play may directly relate to changes in head impact risk.

Objective: Our aim was to perform a systematic review of Return-to-Learn literature with the intent of determining what items are necessary to form a comprehensive Return-to-Learn policy.

Data sources: We searched CINAHL, Embase, PubMed, Scopus, Google Scholar, and WorldWideScience.org using 25 search terms including return to learn, adolescents, concussion management, concussion AND children, concussion AND department of education, concussion AND secondary schools, concussion AND middle school, concussion AND primary school, concussion AND policy AND procedures, concussion AND 504 plans.

Study selection: Eligible studies were (i) published between 2009 and 2022; (ii) originally published in English in a peer-reviewed journal; (iii) have a full text available; (iv) discuss the K-12 population; (v) contain one of the following terms in the body of the document: Return to Learn, RTL, Return to School, Return to Classroom, or Return to Academics; (vi) identify RTL as a primary aim of the document.

Data extraction: The Qualitative Assessment and Review Instrument and JBI Meta-Analysis of Statistics Assessment and Review Instrument tools were used to extract data from eligible studies. Extraction occurred independently by two researchers.

Data synthesis: Review yielded 32,766 articles, with 58 meeting inclusion criteria. Two qualitative themes and five subthemes aggregated with six quantitative narratives to produce five converged findings: 1) members and point person, 2) overcoming barriers to communication, 3) increasing concussion knowledge and training in the school system, 4) recommendations in the classroom, and 5) tackling the invisible injury.

Conclusions: Less than one-third of included articles reported data from younger (K-8) cohorts, therefore, the converged findings represent significant facets of high school Return-to-Learn that stakeholders should embed into novel and revised state concussion legislation. Subsequent efforts should seek to appraise current state Return-to-Learn laws for existing use of evidence-based practice and begin accumulating data specific to younger students and school professionals that monitor and teach these individuals such that commensurate policy recommendations can then be made.

Context: Postoperative muscle weakness contributes to the development of aberrant gait biomechanics that persist following traditional anterior cruciate ligament reconstruction (ACLR). However, it is unknown if quadriceps weakness impedes the ability of ACLR patients to modify gait biomechanics using a real-time gait biofeedback (RTGBF) intervention.

Objective: The purpose was to determine if quadriceps strength associates with the ability to modify vertical ground reaction force (vGRF) during a RTGBF intervention.

Design: Cross-Sectional Study.

Setting: Research Laboratory.

Participants: 35 individuals with unliateral ACLR (Time since ACLR= 32 ± 16 months; 22 Females, 13 Males).

Main outcome measures: Peak vGRF was evaluated during a baseline walking trial, and three 250-step randomized RTGBF walking trials which cued an increased average peak vGRF of the baseline walking trial by 5%, 10%, or 15%. The ability to modify gait was reported as changes in pvGRF (ΔpvGRF; BW) and root mean square error (RMSE) of the peak vGRF relative to the feedback target (pvGRF RMSE; BW). We also calculated quadriceps strength.

Results: There were no significant associations between strength (Mean: 2.56 ± 0.75 Nm/kg, Range: 0.84-4.6 Nm/kg) and ΔpvGRF (5% ΔpvGRF: 0.04 ± 0.03 BW, 10% ΔpvGRF: 0.10 ± 0.03 BW, 15% ΔpvGRF: 0.15 ± 0.04 BW) nor strength and RMSE (5% RMSE: 0.04 ± 0.02 BW, 10% RMSE: 0.05 ± 0.02 BW, 15% RMSE: 0.08 ± 0.04 BW) for any of the 3 RTGBF trials (R2: 0.003-0.025; P: 0.37-0.77).

Conclusions: The magnitude of quadriceps strength did not influence the ability to modify gait using RTGBF. These data suggest that it may be unnecessary to wait for quadriceps full strength recovery to capitalize on the benefits of RTGBF following ACLR.