Context: Emergency action plans (EAPs) are policies that improve response times and ensure access... more Context: Emergency action plans (EAPs) are policies that improve response times and ensure access to emergency equipment for the management of patients with acute injuries and medical conditions, yet the extent to which EAP standards are adopted and implemented is unknown. Objective: To describe the extent of EAP adoption and implementation in secondary school (SS) athletics with athletic trainer (AT) services in the United States. Design: Cross-sectional study. Setting: Web-based questionnaire. Patients or Other Participants: A national sample of ATs (n ¼ 9642) was invited to participate in a Web-based questionnaire. Main Outcome Measure(s): Twelve components of EAP minimum best practices were derived from the ''National Athletic Trainers' Association (NATA) Position Statement: Emergency Planning in Athletics.'' Emergency action plan components were analyzed using descriptive statistics with 95% confidence intervals (CIs) around proportions. Contingency tables (2 3 2) were used to calculate odds ratios (with 95% CIs) to assess adoption of the components (dichotomized as yes or no), employment factors (eg, full time versus part time, employed by clinic/district), and access to emergency equipment. Results: The response rate for the questionnaire was 13.2% (n ¼ 1273). A majority of ATs (89.1%) reported having an EAP; however, only 9.9% described implementing all 12 components cited in the NATA position statement. Athletic trainers stated that they created the EAP in 62.8% (95% CI ¼ 60.1%, 65.4%) of schools with an EAP. Athletic trainers employed full time were at greater odds of adopting 9 or more components of the EAP compared with ATs employed part time (odds ratio ¼ 2.42 [95% CI ¼ 1.66, 3.53]). A total of 85.7% of ATs noted access to an automated external defibrillator. Conclusions: Although a majority of SSs had EAPs, the EAPs were often incomplete and lacked the necessary components for full compliance with the NATA position statement. These findings demonstrate the need for efforts to promote the adoption and implementation of comprehensive EAPs in SS athletics.
The purpose of this study was to determine if a difference exists in the reproducibility of knee ... more The purpose of this study was to determine if a difference exists in the reproducibility of knee joint flexion angles in an open versus a closed kinetic chain. Thirty generally healthy subjects (12 males, 18 females; mean age 23.8 years) participated. Subjects actively reproduced small, medium, and large knee flexion angles (with target angles of 15°, 45°, and 75°, respectively) in an open and a closed kinetic chain while being videotaped. Goniometric measurements were taken from the videotape of initial and reproduced joint angles. Data were analyzed using ANOVA with repeated measures on kinetic chain test position and joint angle. Subjects more accurately reproduced knee flexion angles in a closed kinetic chain position. The main effect for angle and the interaction of angle and test position were nonsignificant. The results indicate that knee joint position is more accurately reproduced in closed kinetic chain. Closed kinetic chain testing is also a more functional assessment of joint position sense, and thus closed kinetic chain assessment of lower extremity joint position sense is recommended.
The reliability and precision of measurement in sports medicine are of concern in both research a... more The reliability and precision of measurement in sports medicine are of concern in both research and clinical practice. The validity of conclusions drawn from a research project and the rationale for decisions made about the care of an injured athlete are directly related to the precision of measurement. Through analysis of variance, estimates of reliability and precision of measurement can be quantified. The purpose of this manuscript is to introduce the concepts of intraclass correlation as an estimate of reliability and standard error of measurement as an estimate of precision. The need for a standardized set of formulas for intraclass correlation is demonstrated, and it is urged that the standard error of measurement be included when estimates of reliability are reported. In addition, three examples are provided to illustrate important concepts and familiarize the reader with the process of calculating these estimates of reliability and precision of measurement.
Context Athletic training is a multifaceted profession characterized by interpersonal relationshi... more Context Athletic training is a multifaceted profession characterized by interpersonal relationships and a team approach to care. Collaborative relationships, by nature, open the door to conflict, which has been reported frequently in the collegiate athletic setting. However, secondary school athletic trainers' (ATs') experiences with conflict and pressure in their role are not readily understood. Objective To measure the extent and sources of stress, pressure, and conflict within the secondary school athletic training setting and determine if differences exist across employment characteristics. Design Cross-sectional study. Setting Secondary school athletics. Patients or Other Participants Secondary school ATs (n = 725, age = 39.8 ± 10.5 years, years certified = 16.7 ± 9.7, years in current role = 10.6 ± 7.8). Main Outcome Measures Participants were asked to reply to an online questionnaire with quantitative measures pertaining to organizational conflict and workplace dynami...
There is growing evidence supporting the link between overtraining and increased injury risk. Th... more There is growing evidence supporting the link between overtraining and increased injury risk. The Landing Error Scoring System (LESS) is a neuromuscular control assessment of 17 lower extremity biomechanical risk factors. However, there is paucity in the literature focusing on the LESS across the competitive Division-1 men’s college soccer season. This investigation sought to determine if significant changes in LESS scores occur over a competitive men’s soccer season and whether these changes coincide with common training status indicators. Twenty-six healthy Division-1 college men’s soccer players (age: 20 ± 1 yr, height: 181.5 ± 6.4 cm) were assessed for body mass (BM), resting heart rate (RHR), body fat (BF%), countermovement jump height (CMJ), and LESS at five experiment visits (V0-V4). A mixed effects model was analyzed to detect significant interactions between the LESS and each of the dependent variables. LESS scores were significantly elevated at V1 (p < 0.001), which wa...
Background: Shoulder and elbow injuries in baseball pitchers, which can lead to significant pain ... more Background: Shoulder and elbow injuries in baseball pitchers, which can lead to significant pain and disability, have been on the rise at all levels of play for 3 decades. Despite anatomic and neurophysiological relationships, neck mobility has not been explored as a contributor to shoulder and elbow injuries in baseball pitchers. Hypothesis: Impaired neck mobility will increase the risk of shoulder and elbow injuries in college baseball pitchers. Study Design: Cohort study; Level of evidence, 2. Methods: Posture, neck mobility, and shoulder passive range of motion were measured in healthy college baseball pitchers during the 2018 preseason. Time loss (days lost because of shoulder or elbow injuries) and patient-reported disability via Functional Arm Scale for Throwers (FAST) scores were used to dichotomize pitchers into injured and uninjured groups. Receiver operating characteristic curves were generated, and accuracy values and risk ratios (RRs) were calculated to assess the diagn...
Context: Forming a professional identity is a process by which an individual achieves an awarenes... more Context: Forming a professional identity is a process by which an individual achieves an awareness of his or her own self-concept in the context of the profession. Identity in relation to an individual's profession includes the ability to articulate one's role as a professional and professional philosophy. Professional identity has been studied extensively in other fields, but currently no professional identity scales have been validated within the athletic training profession.Objective: To validate the Professional Identity and Values Scale (PIVS) among an athletic trainer population.Design: Cross-sectional study.Setting: Web-based questionnaire.Patients or Other Participants: Athletic trainers employed in National Collegiate Athletic Association Division I, II, III, or National Association of Intercollegiate Athletics colleges or universities (n = 299, 56.5% female, 43.5% male). The average age of the participants was 33.6 ± 8.3 years, and they had 10.3 ± 7.6 years of expe...
Context: The paradigm of evidence-based practice (EBP) is well established among the health care... more Context: The paradigm of evidence-based practice (EBP) is well established among the health care professions, but perspectives on the best methods for acquiring, analyzing, appraising, and using research evidence are evolving. Background: The EBP paradigm has shifted away from a hierarchy of research-evidence quality to recognize that multiple research methods can yield evidence to guide clinicians and patients through a decision-making process. Whereas the “frequentist” approach to data interpretation through hypothesis testing has been the dominant analytical method used by and taught to athletic training students and scholars, this approach is not optimal for integrating evidence into routine clinical practice. Moreover, the dichotomy of rejecting, or failing to reject, a null hypothesis is inconsistent with the Bayesian-like clinical decision-making process that skilled health care providers intuitively use. We propose that data derived from multiple research methods can be be...
Context Preventive training programs (PTPs) can reduce injury rates and improve neuromuscular con... more Context Preventive training programs (PTPs) can reduce injury rates and improve neuromuscular control and sport performance. However, PTPs must be implemented correctly and consistently over time for athletes to benefit. Coaches represent the best long-term option for implementing PTPs. Youth athletes are at the optimal age for developing good habits before maturation. Although frameworks have been proposed to guide implementation efforts, little is known regarding the feasibility and real-world context of PTP implementation at the youth sport level. Objective To evaluate the application of the 7-Step framework for promoting implementation of a preseason PTP workshop. Design Descriptive epidemiology study. Setting Youth soccer and basketball organizations. Patients or Other Participants Organizations with at least 1 team of athletes aged 8 to 14 years were invited to participate in a free preseason coaches' education workshop on PTP implementation. Intervention(s) The 7-Step fra...
Context: Emergency action plans (EAPs) are policies that improve response times and ensure access... more Context: Emergency action plans (EAPs) are policies that improve response times and ensure access to emergency equipment for the management of patients with acute injuries and medical conditions, yet the extent to which EAP standards are adopted and implemented is unknown. Objective: To describe the extent of EAP adoption and implementation in secondary school (SS) athletics with athletic trainer (AT) services in the United States. Design: Cross-sectional study. Setting: Web-based questionnaire. Patients or Other Participants: A national sample of ATs (n ¼ 9642) was invited to participate in a Web-based questionnaire. Main Outcome Measure(s): Twelve components of EAP minimum best practices were derived from the ''National Athletic Trainers' Association (NATA) Position Statement: Emergency Planning in Athletics.'' Emergency action plan components were analyzed using descriptive statistics with 95% confidence intervals (CIs) around proportions. Contingency tables (2 3 2) were used to calculate odds ratios (with 95% CIs) to assess adoption of the components (dichotomized as yes or no), employment factors (eg, full time versus part time, employed by clinic/district), and access to emergency equipment. Results: The response rate for the questionnaire was 13.2% (n ¼ 1273). A majority of ATs (89.1%) reported having an EAP; however, only 9.9% described implementing all 12 components cited in the NATA position statement. Athletic trainers stated that they created the EAP in 62.8% (95% CI ¼ 60.1%, 65.4%) of schools with an EAP. Athletic trainers employed full time were at greater odds of adopting 9 or more components of the EAP compared with ATs employed part time (odds ratio ¼ 2.42 [95% CI ¼ 1.66, 3.53]). A total of 85.7% of ATs noted access to an automated external defibrillator. Conclusions: Although a majority of SSs had EAPs, the EAPs were often incomplete and lacked the necessary components for full compliance with the NATA position statement. These findings demonstrate the need for efforts to promote the adoption and implementation of comprehensive EAPs in SS athletics.
The purpose of this study was to determine if a difference exists in the reproducibility of knee ... more The purpose of this study was to determine if a difference exists in the reproducibility of knee joint flexion angles in an open versus a closed kinetic chain. Thirty generally healthy subjects (12 males, 18 females; mean age 23.8 years) participated. Subjects actively reproduced small, medium, and large knee flexion angles (with target angles of 15°, 45°, and 75°, respectively) in an open and a closed kinetic chain while being videotaped. Goniometric measurements were taken from the videotape of initial and reproduced joint angles. Data were analyzed using ANOVA with repeated measures on kinetic chain test position and joint angle. Subjects more accurately reproduced knee flexion angles in a closed kinetic chain position. The main effect for angle and the interaction of angle and test position were nonsignificant. The results indicate that knee joint position is more accurately reproduced in closed kinetic chain. Closed kinetic chain testing is also a more functional assessment of joint position sense, and thus closed kinetic chain assessment of lower extremity joint position sense is recommended.
The reliability and precision of measurement in sports medicine are of concern in both research a... more The reliability and precision of measurement in sports medicine are of concern in both research and clinical practice. The validity of conclusions drawn from a research project and the rationale for decisions made about the care of an injured athlete are directly related to the precision of measurement. Through analysis of variance, estimates of reliability and precision of measurement can be quantified. The purpose of this manuscript is to introduce the concepts of intraclass correlation as an estimate of reliability and standard error of measurement as an estimate of precision. The need for a standardized set of formulas for intraclass correlation is demonstrated, and it is urged that the standard error of measurement be included when estimates of reliability are reported. In addition, three examples are provided to illustrate important concepts and familiarize the reader with the process of calculating these estimates of reliability and precision of measurement.
Context Athletic training is a multifaceted profession characterized by interpersonal relationshi... more Context Athletic training is a multifaceted profession characterized by interpersonal relationships and a team approach to care. Collaborative relationships, by nature, open the door to conflict, which has been reported frequently in the collegiate athletic setting. However, secondary school athletic trainers' (ATs') experiences with conflict and pressure in their role are not readily understood. Objective To measure the extent and sources of stress, pressure, and conflict within the secondary school athletic training setting and determine if differences exist across employment characteristics. Design Cross-sectional study. Setting Secondary school athletics. Patients or Other Participants Secondary school ATs (n = 725, age = 39.8 ± 10.5 years, years certified = 16.7 ± 9.7, years in current role = 10.6 ± 7.8). Main Outcome Measures Participants were asked to reply to an online questionnaire with quantitative measures pertaining to organizational conflict and workplace dynami...
There is growing evidence supporting the link between overtraining and increased injury risk. Th... more There is growing evidence supporting the link between overtraining and increased injury risk. The Landing Error Scoring System (LESS) is a neuromuscular control assessment of 17 lower extremity biomechanical risk factors. However, there is paucity in the literature focusing on the LESS across the competitive Division-1 men’s college soccer season. This investigation sought to determine if significant changes in LESS scores occur over a competitive men’s soccer season and whether these changes coincide with common training status indicators. Twenty-six healthy Division-1 college men’s soccer players (age: 20 ± 1 yr, height: 181.5 ± 6.4 cm) were assessed for body mass (BM), resting heart rate (RHR), body fat (BF%), countermovement jump height (CMJ), and LESS at five experiment visits (V0-V4). A mixed effects model was analyzed to detect significant interactions between the LESS and each of the dependent variables. LESS scores were significantly elevated at V1 (p < 0.001), which wa...
Background: Shoulder and elbow injuries in baseball pitchers, which can lead to significant pain ... more Background: Shoulder and elbow injuries in baseball pitchers, which can lead to significant pain and disability, have been on the rise at all levels of play for 3 decades. Despite anatomic and neurophysiological relationships, neck mobility has not been explored as a contributor to shoulder and elbow injuries in baseball pitchers. Hypothesis: Impaired neck mobility will increase the risk of shoulder and elbow injuries in college baseball pitchers. Study Design: Cohort study; Level of evidence, 2. Methods: Posture, neck mobility, and shoulder passive range of motion were measured in healthy college baseball pitchers during the 2018 preseason. Time loss (days lost because of shoulder or elbow injuries) and patient-reported disability via Functional Arm Scale for Throwers (FAST) scores were used to dichotomize pitchers into injured and uninjured groups. Receiver operating characteristic curves were generated, and accuracy values and risk ratios (RRs) were calculated to assess the diagn...
Context: Forming a professional identity is a process by which an individual achieves an awarenes... more Context: Forming a professional identity is a process by which an individual achieves an awareness of his or her own self-concept in the context of the profession. Identity in relation to an individual's profession includes the ability to articulate one's role as a professional and professional philosophy. Professional identity has been studied extensively in other fields, but currently no professional identity scales have been validated within the athletic training profession.Objective: To validate the Professional Identity and Values Scale (PIVS) among an athletic trainer population.Design: Cross-sectional study.Setting: Web-based questionnaire.Patients or Other Participants: Athletic trainers employed in National Collegiate Athletic Association Division I, II, III, or National Association of Intercollegiate Athletics colleges or universities (n = 299, 56.5% female, 43.5% male). The average age of the participants was 33.6 ± 8.3 years, and they had 10.3 ± 7.6 years of expe...
Context: The paradigm of evidence-based practice (EBP) is well established among the health care... more Context: The paradigm of evidence-based practice (EBP) is well established among the health care professions, but perspectives on the best methods for acquiring, analyzing, appraising, and using research evidence are evolving. Background: The EBP paradigm has shifted away from a hierarchy of research-evidence quality to recognize that multiple research methods can yield evidence to guide clinicians and patients through a decision-making process. Whereas the “frequentist” approach to data interpretation through hypothesis testing has been the dominant analytical method used by and taught to athletic training students and scholars, this approach is not optimal for integrating evidence into routine clinical practice. Moreover, the dichotomy of rejecting, or failing to reject, a null hypothesis is inconsistent with the Bayesian-like clinical decision-making process that skilled health care providers intuitively use. We propose that data derived from multiple research methods can be be...
Context Preventive training programs (PTPs) can reduce injury rates and improve neuromuscular con... more Context Preventive training programs (PTPs) can reduce injury rates and improve neuromuscular control and sport performance. However, PTPs must be implemented correctly and consistently over time for athletes to benefit. Coaches represent the best long-term option for implementing PTPs. Youth athletes are at the optimal age for developing good habits before maturation. Although frameworks have been proposed to guide implementation efforts, little is known regarding the feasibility and real-world context of PTP implementation at the youth sport level. Objective To evaluate the application of the 7-Step framework for promoting implementation of a preseason PTP workshop. Design Descriptive epidemiology study. Setting Youth soccer and basketball organizations. Patients or Other Participants Organizations with at least 1 team of athletes aged 8 to 14 years were invited to participate in a free preseason coaches' education workshop on PTP implementation. Intervention(s) The 7-Step fra...
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