Journal of Athletic Training最新文献

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.

The performing arts industry places unique pressures on individuals, often leading to higher rates of mental health issues. Minimal information exists about how to create on-site intervention strategies for undergraduate performing art students. Athletic trainers at a dedicated university performing arts campus searched their electronic medical record (EMR) for reports of mental health-related issues in the dance, musical theater, and theater undergraduate students. The data analysis revealed anxiety and overstress conditions were primarily reported among dance and musical theater students. After communicating with stakeholders, the athletic trainers implemented a multi-faceted mental health intervention strategy for academic majors across the performing arts campus. The athletic trainers worked with the stakeholders and university counseling offices to destigmatize mental health conditions, reduce barriers, and implement mental health referrals and counseling across the campus. Reviewing internal data and listening to patient concerns enhanced mental health services in this undergraduate performing arts student population.

Context: Numerous studies report deficits in hip muscle performance in individuals with patellofemoral pain (PFP). However, the exact stage at which these deficits emerge and the impact of symptom duration remain unclear.

Objective: To compare hip abductor strength and endurance based on the presence or absence of PFP and its duration.

Design: Cross-sectional study.

Patients or other participants: 68 with PFP and 29 pain-free controls.

Main outcome measure(s): We evaluated isometric maximal strength, isometric endurance, and dynamic endurance of hip abductors. Comparisons were made between participants with PFP and pain-free controls and among different PFP duration subgroups (< 12 months, ≥ 12 months, ≤ 6 months, > 24 months) and pain-free controls.

Results: Hip abductor isometric strength (% body mass [BM]) was significantly lower in the PFP group (203.8 ± 46.8) and all PFP subgroups (< 12 months: 203.9 ± 57.0; > 12 months: 203.7 ± 42.2) (≤ 6 months: 205.1 ± 59.6; > 24 months: 207.7 ± 41.9), compared to pain-free controls (254.6 ± 60.3). However, no significant differences were found between PFP subgroups. There were also no significant differences in hip abductor isometric or dynamic endurance between PFP group and pain-free controls, or between PFP subgroups and pain free controls.

Conclusions: Hip abductors strength deficits emerge early in the course of PFP. However, further studies are needed to understand the observed lack of difference in endurance.

Position statements are utilized by healthcare organizations to summarize evidence and clearly articulate consensus on best practices. The procedures for developing position statements by the National Athletic Trainers' Association and the NATA Research and Education Foundation have been updated to enhance transparency, reduce bias, and better incorporate the available research to support clinical care recommendations. The paper details the processes of topic selection, author group formation, evidence gathering, and recommendation building, emphasizing the systematic approach and the inclusion of diverse expertise. These changes ensure that future position statements, starting from June 2024, will be more rigorously developed and serve as a reliable resource for athletic trainers, other healthcare providers, and important stakeholders in various settings.

CONTEXT: Chronic ankle instability (CAI) is the most serious long-term complication following an ankle sprain. Taping and bracing are frequently employed in the return to sport (RTS) continuum to avoid injury recurrence and to maximize post-injury performance. The Ankle-GO score is a valid and reliable objective RTS criteria, but the influence of ankle supports on this score in CAI patients remains unknown.OBJECTIVES: We aimed to evaluate the induce effects of taping or bracing on the Ankle-GO score among patients suffering from CAI.DESIGN: Crossover StudySETTING: Sports medicine research laboratoryPATIENTS: Thirty CAI patients (13 males and 17 females, 33.4 ±11.7 years) performed the Ankle-GO score in three conditions (taping, bracing and no ankle support).MAIN OUTCOME MEASURES: The Ankle-GO is a 25-point score clustering 2 self-reported questionnaires (Foot and Ankle Ability Measure and Ankle Ligament Reconstruction-Return to Sport after Injury) and 4 functional tests (Single Leg Stance, Star Excursion Balance Test, Side Hop Test and Figure-of-eight test). Performances on each component as well as the total score were compared between conditions using repeated measures of ANOVA.RESULTS: Taping and bracing significantly and equally improved the Ankle-GO score compared with no support (12.8 ±5.3 and 11.2 ±4.2 vs. 8 ±4.5 points respectively, P<.001). However, significant improvements were found solely in self-reported questionnaires with ankle support (P<.001). No differences were found in functional tests, although both taping and bracing significantly lowered instability perception during the tests (+1.9 and +1.8 points, respectively).CONCLUSION: Ankle-GO scores were significantly enhanced with taping or bracing. However, only self-reported function and psychological readiness were improved. Functional performance was not altered, although external supports enhanced perceived stability. Both taping and bracing supports appear equally important in improving self-confidence and perceived ankle stability among individuals with CAI returning to sport.

Context: Recent studies exploring chronic ankle instability (CAI) have found alterations in cutaneous reflexes of musculature surrounding the ankle which may contribute to perceived instability and recurrent LAS seen in this population. CAI is considered a multifaceted condition, making it difficult to determine the underlying cause of these altered reflexes. Objective: To observe how mechanical laxity of the ankle affects lower limb cutaneous reflexes and perceived instability during gait and how surgical intervention to correct laxity affects these measures. Design: Clinical Case Report Setting: Research Laboratory Patient: A physically active 25-year-old female (64in;130lbs) with 7 previous lateral ankle sprains (LAS) and met CAI diagnostic criteria based on CAI questionnaire scores. The patient underwent a Broström reconstruction of the CFL via allograft and partial synovectomy. Main Outcome Measures: CAI questionnaire scores, middle latency lower limb cutaneous reflexes, and perceived instability following sural nerve stimulation during gait. Results: Post-surgery, the patient's CAIT and FAAM questionnaire scores aligned with those of a healthy individual. PL reflexes were diminished or inhibitory during the stance phases of gait. Pronounced variability of PL reflexes may have contributed to this lack of facilitation. BF facilitation at midstance was absent during both testing sessions while BF and RF facilitation was generally reduced post-surgical intervention. The patient's average perceived instability following sural stimulation was markedly reduced from the pre-surgical (6.5±0.48) to post-surgical (1.9±0.24) session. Conclusions: Mechanical instability likely contributed to the reflex variations seen in this patient pre- surgically, while the enhanced static stability provided by the surgical procedure may have reduced the need for dynamic stability via lower limb cutaneous reflexes observed in the follow-up session. Identifying the specific limitations experienced by an individual with CAI will allow for a more effective monitoring and treatment and provide improved long-term health-related quality of life outcomes.