Journal of Athletic Training最新文献

Context Lean sports, endurance running, have been at the forefront of disordered eating and body image research, particularly in female populations. Yet, little is known about how athletic men and women differ in body checking behaviors, a known risk factor for body dissatisfaction and disordered eating, across sport type and athletic status. Objective The purpose of this study was to examine gender differences on measures of eating behavior and body checking between full-time collegiate student-athletes and nonathletes. Design Cross-sectional study. Setting NCAA DI collegiate athletics. Participants Two-hundred fifty-nine full-time college students (n = 174 student-athletes, 85 nonathletes) Main Outcome Measures Primary outcomes included self-reported disordered eating behavior and body checking behavior through the EAT-26 and the Body Checking Questionnaire (BCQ) and the Male BCQ (MBCQ). We explored differences based on sport type, team, individual, or nonathlete, and gender identity. Results There was a statistically significant multivariate main effect of gender F(10, 464) = 9.219, p<0.001, 𝜂 2 = 0.166, and a significant multivariate interaction of gender and sport type F(15, 699) = 2.806, p=0.001, 𝜂 2 = 0.057. Follow-up comparisons for team sport athletes showed that women scored significantly higher (p<0.001) on the MBCQ compared to men. Women team sport athletes also scored significantly higher on the MBCQ than women nonathletes (p < 0.001). Conversely, nonathlete men scored significantly higher on the MBCQ than men team and individual sport athletes (p = 0.003 and p = 0.048, respectively). Conclusions Findings suggest that body checking behaviors traditionally studied as masculine occur more frequently in women than men. This effect seems to be driven by women team sport athletes, who reported engaging in more body checking behaviors on the MBCQ than nonathletes. Therefore, assessments based on traditional views of maleness and femaleness may overlook significant risk factors for eating disorders (ED) in college athletes.

Scientific inquiry aims to minimize bias and ensure accurate conclusions. A critical yet often overlooked issue in sports medicine and exercise science research is the family-wise error rate (FWER) and experimental-wise error rate (EWER), which increase with multiple statisticalinferences, inflating the risk of Type I errors. While FWER corrections are standard in post-hoc ANOVA tests, they are inconsistently applied in broader research contexts. Using an example from our research team of over 67 million regression models, we illustrate how failing to correct for FWER can create spurious findings. Approximately 3 million (4.4%) models werestatistically significant (p<0.05), aligning with the expected false-positive rate. This underscores the necessity of solutions such as preregistration, false discovery rate control, and Bayesian approaches. Without proper corrections, erroneous conclusions may mislead clinical decision- making and potentially harm patients, highlighting the importance of rigorous statistical methods in evidence-based sports medicine.

Context: Shoulder and elbow problems are common among athletes in overhead sports, making 7 it essential to understand the characteristics of active athletes with arm trouble to improve and prevent upper extremity disorders. The Kerlan-Jobe Orthopaedic Clinic (KJOC) Score is widely used to evaluate upper extremity functionality in this population. Objective: (1) To compare the KJOC score between athletes with and without arm trouble in various overhead sports; and (2) to clarify the relationship between subjective competitive levels and functional characteristics using correlation analysis of the KJOC score questions. Design: Cross-sectional study Setting: College athletes from baseball, basketball, swimming, tennis, and track and field 15 throwing teams completed the KJOC score questionnaire. Participants were categorized into two groups based on their responses regarding current functional status: (1) playing without arm trouble (asymptomatic group) and (2) playing with arm trouble (symptomatic group). Participants: 401 college athletes from overhead sports. Main Outcome Measure(s): The Mann-Whitney U test was used to compare the overall KJOC scores and the scores of individual questions between symptomatic and asymptomatic groups. Spearman's rank correlation analysis determined the relationships between Q10 (subjective competitive level) and Q1-9 (upper extremity functionality). Results: The symptomatic group had significantly lower KJOC scores than the asymptomatic group across all sports (P < 0.001). Several individual question scores also differed significantly between groups, although the specific questions varied by sport. Correlation analysis revealed the association between Q10 and other functional scores with sport-specific variations. Conclusions: These findings demonstrate that impaired upper extremity function and its relationship to competition levels in athletes with arm trouble vary across different sports disciplines.

Context: Shoulder injuries comprise the largest proportion of swimming injuries, and a large percentage of swimmers participate with pain. Therefore, it is assumed that shoulder pain decreases performance, but researchers have not compared collegiate swimmers' performance with and without pain.

Objectives: (1) To determine if individual swimmers' shoulder pain and function are associated with a change in normalized swimming performance over a season, (2) to determine if differences in normalized swimming performance exist among 3 collegiate teams, and (3) to qualitatively describe and compare each team's training regimes.

Design: Cross-sectional study.

Setting: Swimmers completed preseason (T1) and postseason (T2) surveys including pain ratings and shoulder function using the Kerlan-Jobe Orthopaedic Clinic (KJOC) shoulder and elbow questionnaire. Swimming times were obtained from published meet results. Coaches reported training programs through interviews and tracking logs.

Patients or other participants: Fifty-two National Collegiate Athletic Association Division III swimmers from 3 teams.

Main outcome measure(s): Stepwise linear regression was used to determine if pain and function related to performance. Team demographics and normalized swimming performance (reduction in time per lap from season beginning to end) were compared with analyses of variance with post hoc tests.

Results: Initial KJOC scores, but not pain, related to individual swimming performance. Differences in team performance were found (P = .006), with Team 3 having the greatest reduction in time (1.01 s/lap), a lower percentage of females, a more experienced coach, and a periodization schedule with large increases and decreases in yardage. A main effect (P = .043) was found for baseline demographics, with Team 3's swimmers being taller and having longer competitive experience.

Conclusions: The initial KJOC score predicting swimming performance improvement demonstrates the need for athletic trainers to prioritize enhancement of preseason function. Endurance training-induced hypoalgesia and motivation may explain the lack of effect of shoulder pain on performance. Further research is needed to elucidate optimal periodization and dry-land training.

Context: Chronic ankle instability (CAI) patients exhibit altered movement patterns during jump landing/cutting movements. Persistent pain is one of the residual symptoms that may affect movements. Calculating joint energetics affected by chronic pain offers a novel method to understand how chronic pain influences energetics of lower extremity joints in CAI patients.

Objective: To identify the effects of chronic pain on lower extremity energy dissipation and generation during jump landing and cutting in patients with CAI.

Design: Cross-sectional study.

Setting: Laboratory.

Patients or other participants: Fifteen CAI patients with higher pain (6 men and 9 women; age = 22.1 ± 2.1 years, height = 1.74 ± 0.09 m, mass = 71.3 ± 10.6 kg, pain = 66.9 ± 9.4), 15 patients with CAI and lower pain (6 men and 9 women; age = 22.3 ± 2.1 years, height = 1.74 ± 0.08 m, mass = 70.1 ± 10.7 kg, pain = 89.3 ± 2.6), and 15 healthy control individuals (6 men and 9 women; age = 21.3 ± 1.7 years, height = 1.73 ± 0.08 m, mass = 70 ± 10.3 kg, pain = 100 ± 0).

Main outcome measure(s): Ground reaction force data were collected during 5 trials of maximal jump landing/cutting tasks. Joint power was defined as the product of angular velocity and joint moment. Energy dissipation and generation by the ankle, knee, and hip joints were calculated by integrating regions of the joint power curve.

Results: CAI patients with higher pain displayed less ankle energy dissipation (P = .013 and P = .018) and generation in the ankle (P = .002 and P = .028) than CAI patients with lower pain and healthy control individuals during the jump landing/cutting phase. CAI patients with higher pain showed more hip energy generation than CAI patients with lower pain (P = .038) and healthy control individuals (P = .013) during the cutting phase.

Conclusions: CAI patients with higher pain changed both energy dissipation and generation in the lower extremities, reducing the burden of the ankle joint during jump landing/cutting and having a hip-dominant compensatory strategy during the cutting phase. Our results suggest that chronic pain could be one of the factors that affect motor strategies in the CAI population.

Context: Noncombat musculoskeletal conditions (MSKs) 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 MSKs, for up to 1 year postpregnancy. However, there is a paucity of information regarding the impact of pregnancy on MSKs.

Objective: To explore the association between the postpregnancy period and incident MSKs.

Design: Retrospective, longitudinal cohort study.

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

Patients or 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 individual. Subsequent MSKs were identified with relevant International Classification of Diseases-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 postpregnancy service members (65.8%) had an MSK diagnosis than the nonpregnant cohort (60.3%). Adjusting for covariates, the model suggests a temporal influence on postpregnancy MSK incidence, such that service members 3 to 4 months and 5 to 6 months postpregnancy were more likely to be diagnosed with an MSK than the nonpregnant cohort. However, service members <2 months postpregnancy were less likely to be diagnosed with an MSK, and the odds of an MSK beyond 6 months decreased out to 24 months postpregnancy.

Conclusions: Pregnancy may increase a service member's odds of sustaining an MSK 3 to 6 months postpregnancy. 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: 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.

Patients or other participants: Twenty-seven ATs (age = 34 ± 10 years; women = 15, men = 12) from the physician practice (n = 10), college (n = 9), and secondary school (n = 8) settings.

Main outcome measure(s): We interviewed the participants using a semistructured interview protocol. Three researchers coded the transcripts after the consensual qualitative research process for each job setting. Trustworthiness was achieved through multianalyst 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. Essential traits and skills varied widely between settings, and ATs needed different strategies 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: Individuals with anterior cruciate ligament (ACL) injury commonly experience injury-related stressors that can adversely impact subjective knee function after ACL reconstruction (ACLR). Due to the positive effect of active coping skills on perceived stressors, use of such strategies may influence clinical outcomes in individuals with ACLR, such as self-reported knee function. However, it is unknown whether active coping skills are associated with self-reported knee function in this population.

Objective: Examine the relationship between active coping skills and self-reported knee function in individuals with ACLR.

Design: Cross-sectional study.

Setting: Laboratory.

Patients or other participants: Forty-five participants (34 females; age = 20.0 [3.3] years) 4 months to 5 years after unilateral ACLR (time since ACLR = 12.0 [16.0] months).

Main outcome measure(s): The Athlete Coping Skills Inventory (ACSI) Confidence and Achievement Motivation (ACSI Confid), Goal Setting/Mental Preparation (ACSI Goal/Prep), and Coping with Adversity (ACSI Coping) subscales were used to measure active coping skill facets. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to measure self-reported knee function across 5 subscales: pain (KOOS-Pain), symptoms (KOOS-Symptoms), activities of daily living (KOOS-ADL), quality of life (KOOS-QOL), and sports/recreation (KOOS-Sport). Partial Spearman's correlations were used to examine relationships between active coping skills and self-reported knee function after controlling for time since ACLR and age.

Results: Moderate positive correlations were observed between the ACSI Confid and KOOS-Pain (r = 0.493, P = .001), ACSI Confid and KOOS-QOL (r = 0.505, P < .001), ACSI Confid and KOOS-Sport (r = 0.422, P = .007), and ACSI Goal/Prep and KOOS-Pain (r = 0.441, P = .004). Weak positive correlations were observed between the ACSI Goal/Prep and KOOS-ADL (r = 0.373, P = .018) and ACSI Goal/Prep and KOOS-QOL (r = 0.374, P = .017).

Conclusions: Individuals with ACLR who exhibited greater active coping skill facets reported better knee-related function. Assessing active coping skills among individuals with ACLR and poor self-reported knee function may provide clinicians with insight into the role of coping in perceived function and potential treatment approaches.

Context: Attention-deficit/hyperactivity disorder (ADHD) has been speculated to prolong concussion recovery; however, the evidence regarding concussion recovery for individuals with ADHD is limited.

Objective: To examine the concussion recovery time based on ADHD status, sex, and age.

Design: Cross-sectional study.

Setting: High school.

Patients or other participants: Nine hundred and thirty-five (female: n = 382, 40.1%) concussions, including 78 (female: n = 13, 20.0%) self-identified ADHD data, were analyzed.

Main outcome measure(s): A Poisson regression was used to estimate the return-to-learn and return-to-sport recovery outcomes with 3 predicting variables: ADHD status, sex, and age.

Results: The mean return-to-learn days of the ADHD and non-ADHD groups were 12.86 ± 10.89 (median = 11.0; interquartile range [IQR] = 8.0; 7.0-15.25) and 1.43 ± 8.39 (median = 9.0; IQR = 9.0; 6.0-14.0), respectively. The mean return-to-sport days of the ADHD and non-ADHD groups were 20.82 ± 15.25 days (median = 17.0; IQR = 9.0; 12.0-21.0) and 18.03 ± 11.42 days (median = 15.0; IQR = 10.0; 11.0-21.0), respectively. For return-to-learn, ADHD status (risk ratio [RR] = 1.16; 95% confidence interval [95% CI]: 1.08, 1.24; P < .001) and female sex (RR = 1.13; 95% CI: 1.08, 1.17; P < .001) were significant variables for longer recovery, whereas age was not (RR = 0.995; 95% CI: 0.98, 1.01; P = .056). For return to sport, ADHD status (RR = 1.17; 95% CI: 1.12, 1.23; P < .001), female sex (RR = 1.07; 95% CI: 1.04, 1.11; P < .001), and younger age (RR = 0.98; 95% CI: 0.96, 0.99; P < .001) were all significant variables for longer recovery.

Conclusions: Health care providers must be aware of the elevated risk of prolonged concussion recovery among high school athletes with ADHD.

Context: Anterior cruciate ligament (ACL) tears represent a significant health and economic burden in high school athletes. Despite evidence showing lower extremity injury prevention programs (IPPs) are effective at preventing ACL injury, IPPs lack widespread adoption.

Objective: Compare the cost-benefit of implementation of an injury prevention program versus standard warm-up in a national high school soccer population using a health system perspective.

Design: Cost Benefit Analysis.

Setting: Simulation of nationwide implementation of an IPP for United States high school soccer players.

Patients or other participants: Data for high school soccer players from the 2018-2019 season.

Main outcome measure(s): Return on investment was calculated using the cost of ACL treatment prevented with IPP use and the cost of IPP implementation.

Results: IPP implementation was the preferred strategy with a return on investment of $7.51 saved in ACL treatment costs prevented for every dollar spent on IPP implementation in our full model. When separating analysis by insurance type, private payors continued to show profitability while public payors failed to break even. The total net monetary benefit was over $60 million when simulating national-level IPP implementation.

Conclusions: IPP implementation has the potential to generate significant medical cost savings in short-term ACL treatment costs, especially for private payors, when implemented in a national high school soccer population. The expected cost-benefit of IPPs should encourage broader implementation efforts and the inclusion of economically relevant stakeholders.