Journal of Athletic Training最新文献

Context: As new athletic trainers (ATs) transition into their roles, some employers provide orientation and onboarding to assist with the transition to practice. There is a lack of research outlining the ideal onboarding process for new ATs transitioning to practice.

Objective: Examine the onboarding process for new ATs.

Design: Grounded theory.

Setting: College/university, secondary school, hospital/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 twelve 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 semi-structured interview guide. Employees were interviewed approximately 3, 6, 9, and 13-15 months after beginning employment. Employers were interviewed one 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 multi-analyst triangulation.

Results: Two themes emerged: initial orientation and continued onboarding. Participants reported receiving organizational, departmental, and site-specific orientations for initial orientation. For continued onboarding, participants reported mentoring, site visits, feedback and evaluation, regular meetings, and continuing education and professional development.

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.

Context: Recent epidemiological data indicates a potential connection between sport-related concussion (SRC) and elevated anterior cruciate ligament (ACL) injury risk. Limited research exists quantifying 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: 47 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 measures: Participants completed a neurological battery using the C3 Logix application and TRAZER system for neuromechanical reaction time (RT). C3 Logix sub-tests consisted of the Trail Making Test (TMT) A,B, and B -/minus A, simple and choice RT, and processing speed. TRAZER sub-tests 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, (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 Trail A (p=.02) times when compared to those with no ACLR. No differences were noted for 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 reaction time. Individuals with a history of SRC or ACLR had worse TMT, leading to inquiry about potential long-term neurological deficits, despite no differences in those with a combined history.

Context: Extensive research has exposed healthcare disparities regarding socioeconomic status (SES) and race/ethnicity demographics. Previous research has shown significant differences in access to athletic training services (AT access) in the secondary school setting based on SES, but with limited samples.

Objective: This study investigated differences in AT access based on race/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 (NCES), Athletic Training Location and Services (ATLAS) database, and US Census Bureau.

Patients or other participants: 10,983 public schools.

Main outcome measure: Descriptive data was summarized by measures of central tendency. A one-way ANOVA determined differences between school characteristics: median household income (MHI), percent of students eligible for free and reduced lunch (%FRL), percent white students, and percent non-white students based on AT access: Full-time (FT-AT), part-time (PT-AT), and no athletic trainer (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=4,812), 23.5% had PT-AT access (n=2,581), and 32.7% had FT-AT access (n=3,590). There were significant effects between AT access and MHI (p<.001), %FLR (p<.001), percent white (p<.001), and percent non-white (p<.001). FT-AT schools had a higher SES when compared to PT-AT and no-AT schools. Significant differences existed between AT access groups and race/ethnicity of schools. Schools with FT-AT had a significantly lower percent of non-white students (31.3%) compared to schools with no-AT (46.0%) (p<.001). No significant differences between FT-AT and PT-AT based on race/ethnicity demographics presented (p≥.13).

Conclusion: 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 healthcare extends to athletic healthcare as well. To increase AT access, future initiatives should address the inequities where larger minority populations and counties of lower SES exist.

Objective: This review aimed to determine if gait training interventions influence lower extremity biomechanics during walking in individuals with chronic ankle instability (CAI).

Methods: A literature search was conducted in PubMed, CINAHL, SPORTDiscus, and MEDLINE to identify English-language studies from inception through September 2022. Eligible studies included randomized control trials, repeated measures design, and descriptive laboratory studies measuring the effects during or following a gait training intervention on biomechanical outcomes (kinematics, kinetics, electromyography) during walking in individuals with CAI. Gait training interventions were broadly categorized into devices (destabilization devices, novel gait training device) and biofeedback (visual, auditory, and haptic delivery modes). Meta-analyses were conducted when appropriate using random-effects to compare pre-and post- gait training intervention mean differences and standard deviations.

Results: Thirteen studies were included. Meta-analyses were conducted for single session gait training studies only. Eleven studies reported kinetic outcomes. Our meta-analyses showed location of center of pressure (COP) was shifted medially from 0-90% (Effect Size [ES] range=0.35-0.82) of stance, contact time was decreased in medial forefoot (ES=0.43), peak pressure was decreased for lateral midfoot (ES=1.18) and increased for hallux (ES=0.59), pressure time integral was decreased for lateral heel (ES=0.33) and lateral midfoot (ES=1.22) and increased for hallux (ES=0.63). Three studies reported kinematic outcomes. Seven studies reported electromyography outcomes. Our meta-analyses revealed increased activity following initial contact (IC) for fibularis longus (ES=0.83).

Conclusions: Gait training protocols improved some lower extremity biomechanical outcomes in individuals with CAI. Plantar pressure outcome measures seem to be most impacted by gait training programs with improvements in decreasing lateral pressure associated with increased risk for lateral ankle sprains. Gait training increased EMG activity post-IC for the fibularis longus. Few studies have assessed the impact of multi-session gait training on biomechanical outcome measures. Targeted gait trainning should be considered when treating patients with CAI.

Context: Immediate athletic trainer (AT) availability for acute injuries is essential as worse long-term outcomes are associated with delays in receiving medical care. Several factors have been found to influence AT availability between secondary schools, but few studies have evaluated how medical coverage varies between athlete groups.

Objective: The purpose of this project was to identify factors that impact the time to AT evaluation following acute sport-related injury in secondary school setting.

Design: Cross-Sectional Study.

Setting: Retrospective analysis of de-identified patient records via the Athletic Training Practice-Based Research Network.

Patients: High school athletes diagnosed with an acute sport related injury during in-season play from 2010-2023.

Main outcome measure: Time to AT evaluation was measured as the number of days between injury onset, reported by the patient, to AT evaluation.

Results: This report consists of 17,354 patient cases representing 20 different sports. Overall, 46.9% (n=8,138) of patients who sustained an injury during in-season play were evaluated by an AT the same day (range=0-14days). Significant group differences were reported for sex (p <. 001), setting (p <. 001), and sport level (p < .01), with females and in-game injuries associated with longer times to AT evaluation. Freshmen were evaluated sooner than JV (p < .01) and varsity (p < .001) athletes. No difference was observed between JV and varsity athletes (p=0.34).

Conclusions: Almost half of patients received medical care within 24 hours following an acute injury during in-season play, highlighting how qualified health care is accessible for many student athletes through ATs in the secondary school setting. Differences in time to AT evaluation may be attributable to sex discrepancies in immediate medical coverage between sports and injury reporting patterns among athletes.

In patients with musculoskeletal injury, changes have been observed within the central nervous system that contribute to altered movement planning. This maladaptive neuroplasticity potentially explains the clinical disconnect where residual neuromuscular dysfunction and high rates of reinjury that are often observed even after individuals clear return-to-activity functional testing. An improved understanding of these neural changes could therefore serve as a guide for facilitating a more complete recovery and minimizing risk of re-injury. Therefore, we propose a paradigm of neural-targeted rehabilitation to augment commonly used therapeutic techniques targeting sensorimotor function in order to better address maladaptive plasticity. While most treatments have the capability to modify neural function, optimizing these treatments and combining them with integrative therapies (e.g. implementation of motor learning strategies, transcranial direct current stimulation) may enhance neural efficiency and facilitate return-to activity in patients with musculoskeletal injury. To complete this model, consideration of affective aspects of movement and associated interventions must also be considered to improve the durability of these changes.

Context: Scapular dyskinesis is a shoulder dysfunction that can be asymptomatic or associated with pain or weakness. Reduced strength and fatigue resistance of the scapular protractor and retractor muscles that stabilize the scapula might contribute to dyskinesis.

Objectives: To determine the strength and fatigue resistance profiles of participants with symptomatic or asymptomatic scapular dyskinesis and compare them with healthy control (HC) individuals using isokinetic assessment.

Design: Cross-sectional study.

Setting: University hospital.

Patients or other participants: Twenty HC individuals and 21 overhead athletes with symptomatic (n = 10) or asymptomatic (n = 11) scapular dyskinesis.

Main outcome measure(s): Strength (peak torque, maximum work), fatigue resistance (total work), and protraction:retraction ratios measured during a closed chain isokinetic protocol (40 repetitions in concentric mode at 24.4 cm/s).

Results: The scapular protractors' strength and fatigue resistance were higher (P < .01) in HC individuals (peak torque = 5.0 ± 0.9 N/kg, maximum work = 2.4 ± 0.5 J/kg, total work = 72.4 ± 0.6 J/kg) than in asymptomatic (peak torque = 3.4 ± 0.7 N/kg, maximum work = 1.7 ± 0.4 J/kg, total work = 50.0 ± 13.7 J/kg) or symptomatic (peak torque = 3.8 ± 0.6 N/kg, maximum work = 1.8 ± 0.3 J/kg, total work = 58.1 ± 12.9 J/kg) dyskinetic participants. The symptomatic dyskinetic group presented the highest retractor strength and fatigue resistance (P < .01) values (peak torque = 5.2 ± 0.6 N/kg, maximum work = 2.9 ± 0.8 J/kg, total work = 87.7 ± 22.7 J/kg), followed by the HC individuals (peak torque = 4.7 ± 1.0 N/kg, maximum work = 2.1 ± 0.5 J/kg, total work = 65.3 ± 17.9 J/kg) and the asymptomatic dyskinetic participants (peak torque = 3.9 ± 1.0 N/kg, maximum work = 1.9 ± 0.6 J/kg, total work = 58.6 ± 18.5 J/kg). The protraction:retraction ratios showed a gradual decrease (P < .001) from the HC individuals (1.1) to the asymptomatic (0.9) and symptomatic (0.7) dyskinetic participants.

Conclusions: Scapular dyskinesis is characterized by weaker scapular protractors and reduced agonist:antagonist ratios, especially when patients are symptomatic. Targeting the scapular protractors to achieve a better balance of scapular musculature in rehabilitation and strengthening programs may improve shoulder symptoms and function, but more interventional studies are required.

Context: The National Collegiate Athletic Association and Department of Defense (NCAA-DoD) Mind Matters Challenge created "useful and feasible" consensus recommendations to improve concussion care-seeking behavior in collegiate athletes and military cadets. Given athletic trainers' (ATs') role as providers of concussion education and medical care, it is important to understand if they agree with the expert panel that the recommendations are useful and feasible.

Objective: To describe and compare the perceptions of ATs in the secondary school (SS) and collegiate settings of the utility and feasibility of the NCAA-DoD Mind Matters Challenge recommendations on improving concussion education.

Design: Cross-sectional study.

Setting: Electronic survey.

Patients or other participants: Five hundred fifteen (515) ATs (age = 40.7 ± 12.4 years, 53.1% female gender) practicing in the SS (60.6%) or collegiate (38.4%) setting.

Main outcome measure(s): An online survey asked participants about their awareness of the statement followed by 17 pairs of Likert-item questions regarding each recommendation's utility and feasibility with responses ranging from no (1) to yes (9). Mimicking the consensus process, we defined consensus as a mean rating of ≥7.00. We compared utility and feasibility rating responses between SS and collegiate setting participants using Mann-Whitney U tests with α = .05.

Results: Two-thirds (66.6%) of participants were unaware of the consensus statement. Participants felt all recommendations were useful (all means ≥ 7.0); however, 4 recommendations related to collaborating with stakeholders did not meet the feasibility cutoff (mean range = 6.66-6.84). Secondary school ATs rated lower feasibility related to educational content (P value range = .001-.014), providing patient education throughout recovery (P = .002), and promoting peer intervention (P = .019) but higher utility (P = .007) and feasibility (P = .002) for providing parent education than collegiate ATs.

Conclusions: The NCAA-DoD Mind Matters Challenge recommendations require further dissemination. Athletic trainers rated collaboration with stakeholders as a feasibility barrier. Secondary school ATs require more resources for educational content, messaging, and promoting peer intervention but find educating athletes' parents more useful and feasible than collegiate ATs.

Context: Individuals with chronic ankle instability (CAI) demonstrate altered movement patterns when their vision is disturbed during simple tasks, such as single-legged standing and walking. However, it remains unclear whether visual disruption by stroboscopic glasses alters movement patterns during landing-cutting movements, considered highly demanding sport maneuvers that mimic a typical athletic movement.

Objectives: To identify altered lower extremity kinematics and muscle activation when vision is disrupted by stroboscopic glasses during landing-cutting tasks in individuals with CAI.

Design: Case-control study.

Setting: Laboratory.

Patients or other participants: A total of 18 individuals with CAI (age = 22.3 ± 2.3 years, height = 1.75 ± 0.1 m, mass = 72.5 ± 9.8 kg) and 18 matched healthy controls (age = 21.7 ± 2.3 years, height = 1.75 ± 0.1 m, mass = 71.9 ± 10.3 kg).

Intervention(s): All participants performed 5 trials of a landing-cutting task with (SV) and without (NSV) stroboscopic glasses.

Main outcome measure(s): Frontal- and sagittal-plane lower extremity kinematics and 6 lower extremity muscle activations during the stance phase of a landing-cutting task in the SV and NSV conditions.

Results: Individuals with CAI demonstrated more ankle-inversion angle from 18% to 22% and from 60% to 100% of the stance phase and more peroneus longus activation from initial contact to 18% of the stance phase under the SV condition than under the NSV condition. We observed no differences in knee- and hip-joint angles between the visual conditions for both groups.

Conclusions: When wearing stroboscopic glasses, individuals with CAI showed altered movement patterns, including increased ankle-inversion angle and peroneus longus activation during the stance phase of a landing-cutting task. The results suggest that they may lack the ability to reweight sensory information to adapt their movement to visual disruption.

Context: Few authors have investigated sport-related concussion (SRC) awareness and knowledge among athletes in Japan. Sport-related concussion research is scarce among Asian compared with North American and European cohorts.

Objective: To examine previous SRC history, level of SRC knowledge, and previous exposure to SRC education among collegiate athletes in Japan by the level of contact and access to medical staff.

Design: Cross-sectional study.

Setting: Single-university study in Japan.

Patients or other participants: A total of 2103 athletes (48 varsity teams) were contacted to participate in an anonymous survey. Data from athletes with (1) SRC history in the past 3 months, (2) persistent SRC symptoms, (3) nontraditional sports, or (4) incomplete surveys were excluded. As a result, data from 593 athletes representing 43 varsity teams were included in this analysis.

Main outcome measure(s): Outcome measures were level of contact (contact [CON], limited contact [LTD], noncontact [NC]), access to medical staff (MEDYES, MEDNO), SRC knowledge (maximum score of 49), previous SRC history (self-report; yes, no), and previous SRC education (self-report; yes, no).

Results: The average SRC knowledge total score was 33.4 ± 6.1 (range, 18-48). The knowledge score in CON was higher than in LTD and NC (P < .001) and in MEDYES than MEDNO (median, MEDYES = 34.0, MEDNO = 32.0; U = 27 841.5, P < .001). Sport-related concussion history was statistically different by the level of contact ( = 27.95, P < .001) and by access to medical staff ( = 4.5, P = .034). The presence of an SRC history and previous SRC education contributed to higher SRC knowledge, independent of the level of contact and access to medical staff (P < .001).

Conclusions: Japanese athletes who participated in CON sports had a higher prevalence of SRC history, higher knowledge, and greater exposure to SRC education than those in LTD or NC sports. Access to medical staff was associated with higher SRC knowledge.