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Yeargin S, Hirschhorn RM, Adams WM, Scarneo-Miller SE. Secondary School State Athletic Association Health and Safety Policy Development Processes. THE JOURNAL OF SCHOOL HEALTH 2024; 94:591-600. [PMID: 38621415 DOI: 10.1111/josh.13454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/07/2024] [Accepted: 03/17/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND The National Federation of State High School Associations provides recommendations regarding health and safety policies; however, policy development is governed at the state level. Given interstate differences in governance, the primary purpose was to describe processes that State High School Athletic Associations (SHSAAs) utilize to develop a new policy. The secondary objective was to determine what methods associations use to implement new policies. METHODS A cross-sectional survey requested SHSAA (n = 51) representatives to report how athlete health and safety policies are introduced, revised, approved, and implemented within their state. The 22-question survey was developed to gather variables for the aims of the study. Descriptive statistics were calculated for each survey item. RESULTS Of states who responded (n = 33), most reported a 2-committee (n = 24, 72.7%) process for developing and vetting policies, with initiation from the Sports Medicine Advisory Committee (n = 27, 81.8%), followed by an executive-level committee (n = 18, 66.7%). States reported total time from policy initiation to final approval ranged from 2 weeks to over 12 months. When a new policy was approved, most states indicated implementation began with an e-mail (n = 24, 72.7%) sent to Athletic Directors (n = 26, 78.8%). School principal or district superintendent were reported as the position in charge of compliance (36.4%, n = 12). CONCLUSIONS Most SHSAAs use a 2-step process to write and review an athlete health and safety policy before approval. SHSAAs that require a longer policy development time could delay the implementation of important health measures. SHSAAs could consider additional communication methods to ensure information reaches all stakeholders.
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Affiliation(s)
- Susan Yeargin
- University of South Carolina, 921 Assembly St, PHRC Rm 226, Columbia, SC, 29208
| | - Rebecca M Hirschhorn
- Louisiana State University, School of Kinesiology, 2213 Pleasant Hall, Baton Rouge, LA, 70803
| | - William M Adams
- Sports Medicine Research, Division of Sports Medicine, United States Olympic & Paralympic Committee, 1 Olympic Plaza, Colorado Springs, CO, 80917
| | - Samantha E Scarneo-Miller
- School of Medicine, Division of Athletic Training, West Virginia University, 1 Medical Center Drive, 8501A Health Science Center South, Morgantown, WV, 26508
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Broglio SP, Register-Mihalik JK, Guskiewicz KM, Leddy JJ, Merriman A, Valovich McLeod TC. National Athletic Trainers' Association Bridge Statement: Management of Sport-Related Concussion. J Athl Train 2024; 59:225-242. [PMID: 38530653 DOI: 10.4085/1062-6050-0046.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
OBJECTIVE To provide athletic trainers and team physicians with updated recommendations to the 2014 National Athletic Trainers' Association (NATA) concussion position statement regarding concussion management, specifically in the areas of education, assessment, prognostic factors, mental health, return to academics, physical activity, rest, treatment, and return to sport. BACKGROUND Athletic trainers have benefited from the 2 previous NATA position statements on concussion management, and although the most recent NATA position statement is a decade old, knowledge gains in the medical literature warrant updating several (but not all) recommendations. Furthermore, in various areas of the body of literature, current evidence now exists to address items not adequately addressed in the 2014 statement, necessitating the new recommendations. This document therefore serves as a bridge from the 2014 position statement to the current state of concussion evidence, recommendations from other organizations, and discrepancies between policy and practice. RECOMMENDATIONS These recommendations are intended to update the state of the evidence concerning the management of patients with sport-related concussion, specifically in the areas of education; assessment advances; prognostic recovery indicators; mental health considerations; academic considerations; and exercise, activity, and rehabilitation management strategies.
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Affiliation(s)
| | - Johna K Register-Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science and Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Kevin M Guskiewicz
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science and Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - John J Leddy
- UBMD Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY
| | | | - Tamara C Valovich McLeod
- Athletic Training Program, A.T. Still University, Mesa, AZ. Dr Guskiewicz is now at the Department of Kinesiology, Michigan State University, East Lansing
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Bowman TG, Thrasher AB, Kasamatsu TM, Lyons SM. Multistakeholder Perceptions of Young Professionals' Integration During Role Transition. J Athl Train 2024; 59:99-110. [PMID: 36583954 PMCID: PMC10783472 DOI: 10.4085/1062-6050-0505.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
CONTEXT The transition to autonomous clinical practice for early professionals (EPs) has been found to be a stressful time, but no studies with multiple stakeholder groups have been completed. OBJECTIVE To examine the perceptions of EPs' integration during role transition from multiple stakeholder groups. DESIGN Qualitative study. SETTING Online interviews. PATIENTS OR OTHER PARTICIPANTS Seventeen EPs in the first 2 years of their first job postcertification (9 women, 8 men, age = 26 ± 5 years, experience = 9.5 ± 5 months), 16 supervisors and mentors of EPs (6 women, 10 men, age = 52 ± 11 years), and 10 faculty members and 8 preceptors (11 women, 7 men, age = 43 ± 10 years). DATA COLLECTION AND ANALYSIS Semistructured interviews using a validated interview guide based on the current literature were conducted. We analyzed data using consensual qualitative research principles. Multiple-analyst triangulation (n = 3), member checking, and peer review served as trustworthiness strategies. RESULTS We identified 4 themes that defined the integration of EPs during role transition. The integration of EPs was facilitated through role inductance and mentoring. Early professionals struggle finding balance to avoid burnout as they are new to the profession and feel obligated to exceed expectations from a coverage standpoint rather than focusing on the quality of care delivered. Finally, stakeholders suggested a timeline by which EPs become fully integrated into autonomous professional practice and understand all aspects of their role that typically takes anywhere from 1 to 3 years. CONCLUSIONS Early professionals benefited from appropriate graded autonomy during clinical education to develop their clinical reasoning skills, confidence, and mentoring network with past preceptors. Ongoing personal and professional support are needed during the initial few years to ease EPs' role inductance while they gain more experience and establish their clinician identity. Expectations for EPs should be reasonable to allow for the provision of quality care, adequate work-life balance, and integration into the profession without guilt.
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Affiliation(s)
- Thomas G Bowman
- Department of Athletic Training, College of Health Sciences, University of Lynchburg, VA
| | - Ashley B Thrasher
- Athletic Training Program, School of Health Sciences, Western Carolina University, Cullowhee, NC
| | - Tricia M Kasamatsu
- Athletic Training Program, Department of Kinesiology, California State University, Fullerton
| | - Sarah M Lyons
- Department of Athletics, Physical Education, and Recreation, Stanford University, CA
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Pitney WA, Singe SM, Wood TA, Grahovec NE. Organizational-Professional Conflict in the Collegiate and Secondary School Practice Settings: A Sequential, Mixed-Methods Study. J Athl Train 2023; 58:1010-1020. [PMID: 36913647 PMCID: PMC10784879 DOI: 10.4085/1062-6050-0583.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
CONTEXT Athletic trainers (ATs) are employed in various settings, which may use 1 of 3 organizational infrastructure models: (1) the sport/athletic model, (2) the medical model, and (3) the academic model. These different settings and organizational infrastructure models may result in varying levels of organizational-professional conflict (OPC). However, how OPC may differ across infrastructure models and practice settings is not known. OBJECTIVE To examine the prevalence of OPC among ATs in various organizational infrastructures and explore ATs' perceptions of OPC, including its precipitating and mitigating factors. DESIGN Sequential explanatory mixed-methods study with equal emphasis on quantitative and qualitative components. SETTING Collegiate and secondary school institutions. PATIENTS OR OTHER PARTICIPANTS Five hundred ninety-four ATs from collegiate and secondary schools. DATA COLLECTION AND ANALYSIS We conducted a national cross-sectional survey using a validated scale to assess OPC. We then followed the quantitative survey with individual interviews. Trustworthiness was established with multiple-analyst triangulation and peer debriefing. RESULTS Athletic trainers experienced low to moderate degrees of OPC with no differences across practice settings or infrastructure models. Poor communication, others' unfamiliarity with the AT's scope of practice, and lack of medical knowledge were precipitating factors for OPC. Organizational relationships founded on trust and respect for one another; administrative support in that ATs were listened to, decisions were endorsed, and appropriate resources provided; and autonomy given to the AT were key components to preventing OPC. CONCLUSIONS Most ATs experienced primarily low to moderate OPC. However, OPC continues to permeate professional practice to some extent in collegiate and secondary school settings, regardless of the infrastructure model used. The findings of this study highlight the role of administrative support that allows for autonomous AT practice as well as effective communication that is direct, open, and professional to decrease OPC.
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Affiliation(s)
- William A Pitney
- Department of Kinesiology and Physical Education, Northern Illinois University, DeKalb
| | | | - Tyler A Wood
- Department of Kinesiology and Physical Education, Northern Illinois University, DeKalb
| | - Nicholas E Grahovec
- Department of Kinesiology and Physical Education, Northern Illinois University, DeKalb
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Marks A, Courtney CA, Healey WE. Perceptions of Physical Therapy and The Role of Physical Therapists In Injury Prevention Among Professional Basketball Players: A Qualitative Study. Int J Sports Phys Ther 2023; 18:1186-1195. [PMID: 37795332 PMCID: PMC10547088 DOI: 10.26603/001c.88137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/27/2023] [Indexed: 10/06/2023] Open
Abstract
Background Injury prevention is critical in competitive professional sports, however, the role of physical therapists in this aspect of healthcare is not fully understood. Purpose The purpose of this study was to describe professional basketball players' perceptions of physical therapy (PT) and physical therapists' role in injury prevention. Study Design Qualitative, semi-structured interview. Methods Thirty-five professional basketball players (mean age 23.1 years ± 3.9; 42% female; 72% African American; 90% college graduates) from over 20 teams participated. Athletes participated in semi-structured interviews that focused on injury prevention and utilization of PT services. Two researchers coded the transcripts, organized the findings into general categories, and created major themes. Data saturation was reached when no new information emerged. Results Over half (62.9%) stated that PT mainly addressed post-injury and return-to-sport rehabilitation. An overwhelming majority of players highlighted the use of an athletic trainer (AT) over physical therapists in injury prevention due to perceived expertise and trust. Conclusion While PTs are educated in preventive care and acute injury management, professional basketball players viewed their role primarily for return-to-sport rehabilitation. The organizational structure of healthcare in professional basketball may promote closer professional relationships with ATs while limiting those with physical therapists. The result is that elite athletes may miss out on treatment specific to the PT profession. Level of Evidence Level 4.
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Affiliation(s)
- Alison Marks
- Physical Therapy and Human Movement Science Northwestern University
| | - Carol A Courtney
- Physical Therapy and Human Movement Science Northwestern University
| | - William E Healey
- Physical Therapy and Human Movement Sciences Northwestern University
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Winkelmann ZK, Uriegas NA, Mensch JM, Montgomery CE, Torres-McGehee TM. Practices and Perceptions of Family-Centered Care: A Cross-Sectional Survey of Secondary School Athletic Trainers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4942. [PMID: 36981852 PMCID: PMC10049324 DOI: 10.3390/ijerph20064942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
Family-centered care (FCC) includes collaboration between families and healthcare providers, the creation of flexible policies, and the family taking an active role in the delivery of care. Secondary school athletic trainers provide care for underage patients in school-based health systems, making them responsible for maintaining communication with parents, guardians, and/or caregivers. This cross-sectional survey investigated the extent to which athletic trainers (n = 205) include aspects of FCC in their daily secondary school clinical practice (current practices = CP) and whether they believe that aspect of care is necessary for FCC to be provided in athletic training (perceived necessary = PN) in their everyday practice using the Family-Centered Care Questionnaire-Revised tool. The total mean score for the CP scale (mean = 26.83 ± 4.36) was significantly lower (p ≤ 0.01) than the PN scale (mean = 35.33 ± 4.17). All FCC subscales compared between CP and PN were significantly different (p ≤ 0.01), with each being of higher importance than CP in athletic training. Data analysis revealed four themes related to enhancing FCC in secondary schools: limited education and resources, staffing and space concerns, non-technical skills, and social determinants of health. Attention should be placed on developing resources and interventions for secondary school athletic trainers to collaboratively work with children and their support systems.
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Affiliation(s)
- Zachary K. Winkelmann
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA
| | - Nancy A. Uriegas
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA
| | - James M. Mensch
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA
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Nicholson CA, Shott S, Levy NB, Ghannad LA, Lagattuta L, McArdle E, Alland JA. Disparities in Sports Medicine Health Care Access in Illinois High Schools: Access to Team Physicians, Athletic Trainers, and Automated External Defibrillators. Curr Sports Med Rep 2023; 22:70-72. [PMID: 36866947 DOI: 10.1249/jsr.0000000000001041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
ABSTRACT High school athletes have higher rates of injuries and sudden death than their college counterparts. Medical care for these athletes should include access to team physicians, athletic trainers, and automated external defibrillators. Disparities in medical care access provided by high schools for their athletes may be due to school characteristics or socioeconomic or racial factors. This study investigated relationships between these factors and access to team physicians, athletic trainers, and automated external defibrillators. Medical care access is negatively related to the percentage of low-income students and positively related to the number of sports offered. Relationships between race and access to a team physician became nonsignificant when the percentage of low-income students was considered. Physicians who treat high school athletes should consider the medical care access provided by their schools when they educate these patients about preventing and treating sports injuries.
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Affiliation(s)
- Caitlin A Nicholson
- Division of Primary Care Sports Medicine, Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Chicago, IL
| | - Susan Shott
- Orion Statistical Consulting, Brookfield, WI
| | - Nicole Boniquit Levy
- Division of Primary Care Sports Medicine, Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Chicago, IL
| | - Leda A Ghannad
- Division of Primary Care Sports Medicine, Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Chicago, IL
| | - Lane Lagattuta
- Department of Physical Medicine and Rehabilitation, Rush University Medical Center, Chicago, IL
| | - Emily McArdle
- Division of Primary Care Sports Medicine, Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Chicago, IL
| | - Jeremy A Alland
- Division of Primary Care Sports Medicine, Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Chicago, IL
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Bullock G, Prats-Uribe A, Thigpen C, Martin H, Loper B, Shanley E. Influence of High School Socioeconomic Status on Athlete Injuries during the COVID-19 Pandemic: An Ecological Study. Int J Sports Phys Ther 2022; 17:1383-1395. [PMID: 36518837 PMCID: PMC9718687 DOI: 10.26603/001c.39610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/09/2022] [Indexed: 11/12/2023] Open
Abstract
Background It is presently unclear how the cessation of high school sport has affected injury incidence at different socioeconomic levels. The COVID-19 pandemic may have disproportionately affected athletes of lower socioeconomic status, potentially increasing injury risk in this population. Purpose To 1) Describe athlete injury incidence prior to and during the 2019-2020 and 2020-2021 school years in high school athletes by socioeconomic status; 2) Investigate the association between socioeconomic status and injury incidence in high school athletes. Study Design Ecological Study. Methods High schools were matched between the 2019-2020 and 2020-2021 school years. All athletes from all sports were included. High school socioeconomic status was determined by the school district median household income. Socioeconomic strata were defined as <$30,000, $30,000-50,000, $50,001-100,000, and >$100,000. Injury incidence proportion with 95% confidence interval (95% CI) was calculated for each academic year. Mixed effects negative binomial models with robust errors were performed to assess the association between the incidence proportion ratio and high school median household income. Six states and 176 high schools were included (2019-2020: 98,487 athletes; 2020-2021: 72,521 athletes). Results Injury incidence increased in three of four socioeconomic strata during the 2020-2021 year (<$30,000: 2019-2020: 15.6 (13.1-18.1), 2020-2021: 26.3 (23.1-29.6); $30,000-50,000: 2019-2020: 7.8 (7.1-8.6), 2020-2021: 14.9 (13.8-15.9); $50,001-100,000: 2019-2020: 15.1 (14.7-15.4), 2020-2021: 21.3 (20.9-21.8); >$100,000: 2019-2020: 18.4 (18.1-18.8), 2020-2021: 17.3 (16.8-17.7)). An association was observed between injury incidence ratio and log median high school household income in 2019-2020 [1.6 (1.1-2.5)] but not 2020-2021 [1.1 (0.8-1.6)] school years. Conclusions Athletes from lower socioeconomic high schools reported increased injury incidence compared to higher socioeconomic high schools during the 2020-2021 academic school year. These results highlight the increased COVID-19 pandemic vulnerability in athletes from lower socioeconomic high schools. High school sport stakeholders should consider how abrupt sport stoppage can affect lower socioeconomic athletes. Level of Evidence 2.
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Affiliation(s)
- Garrett Bullock
- Department of Orthopaedic Surgery & Rehabilitation, Wake Forest School of Medicine; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford
| | | | - Charles Thigpen
- ATI Physical Therapy; University of South Carolina Center for Effectiveness Research in Orthopedics
| | | | | | - Ellen Shanley
- ATI Physical Therapy; University of South Carolina Center for Effectiveness Research in Orthopedics
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Brooks TJ, Bradstreet TC, Partridge JA. Current concepts and practical applications for recovery, growth, and peak performance following significant athletic injury. Front Psychol 2022; 13:929487. [PMID: 36072042 PMCID: PMC9443689 DOI: 10.3389/fpsyg.2022.929487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/29/2022] [Indexed: 11/17/2022] Open
Abstract
For decades, physicians, athletic trainers, and other health care professionals have worked to standardize the recovery process following injury to enhance patient outcomes and to help set appropriate goals for return to competition. Traditionally, these efforts have focused primarily on physical and/or physiological aspects of healing with little consideration for psychological aspects. Concurrently, mental health professionals who work with athletes have developed strategies to enhance performance and minimize negative influences of mental aspects of recovery while promoting approaches that include mental as well as physical recovery. Several strategies have emerged that further encourage a multi-faceted and interdisciplinary approach when helping injured patients return to participation. While important in a healthy population, the practical applications of these strategies are likely more critical for an athlete working through the recovery process with an ultimate goal of returning to competition. Despite these realities, both practical experience and a dearth of literature point to the traditional athletic healthcare providers’ common focus on physical aspects of recovery and psychological professionals’ focus primarily on mental aspects has resulted in sub-optimal outcomes compared to the likely benefits of an integrated approach. This article is intended to characterize current concepts in the fields of sport psychology and mental health concerning the importance of mental aspects of recovery in returning to play. Next, the authors will examine how modern theories can influence practice and discuss how these strategies can be effectively integrated and leveraged to enhance recovery and the athlete’s enjoyment of the rehabilitation and ultimately restoration process.
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Affiliation(s)
- Toby J Brooks
- Department of Rehabilitation Sciences, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Tyler C Bradstreet
- Department of Intercollegiate Athletics, Texas Tech University, Lubbock, TX, United States
| | - Julie A Partridge
- College of Health and Human Sciences, School of Human Sciences, Southern Illinois University at Carbondale, Carbondale, IL, United States
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Schroeder LH, Richardson EL, Carroll RM. The Quantitative Examination of the Relationship Between Job Satisfaction and Organizational Fit in Athletic Trainers. J Athl Train 2022; 57:248-254. [PMID: 34404089 PMCID: PMC8935640 DOI: 10.4085/1062-6050-0006.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Athletic trainers' (ATs') job satisfaction has been extensively researched, yet little is known about how satisfaction relates to organizational culture. OBJECTIVE To examine ATs' level of job satisfaction with and organizational-fit perceptions of their employment setting. DESIGN Cross-sectional study. SETTING Web-based questionnaire. PATIENTS OR OTHER PARTICIPANTS A total of 5704 ATs (full-time employment, nonacademic appointment) were contacted via email; 841 participants began our survey (access rate = 14.7%), and 285 completed it (5.0% response rate; 33.9% completion rate). Demographic characteristics were men = 107 (37.5%), women = 178 (62.5%); age = 34.8 ± 9.9 years; and employment setting = 34.7% (n = 99) from National Collegiate Athletic Association Division I, 18.9% (n = 54) from Division II, 29.5% (n = 84) from Division III, and 16.9% (n = 48) other. MAIN OUTCOME MEASURE(S) Participants responded to an online survey consisting of demographic questions, a 36-item Likert-scale Job Satisfaction Survey, and the Cable and Judge revision of the O'Reilly, Chatman, and Caldwell 40-item ranking Organizational Culture Profile survey. Multiple linear regression models for total or subscale job satisfaction were used to analyze the data. All models adjusted for the same demographic measures, and the independent variables of interest were created from the organizational culture survey responses. RESULTS Coworkers (minimum [min] = 9, maximum [max] = 24, ρ = .79), communications (min = 9, max = 24, ρ = .78), and work itself (min = 4, max = 24, ρ = .71) were most correlated with the total job satisfaction score (min = 96, max = 175). Of the respondents, 54% selected adaptability, stability, and taking individual responsibility as 1 of their 2 most characteristic attributes in the organizational culture profile. In addition, 83% of respondents indicated being aggressive, receiving high pay for good performance, and being distinctive or different from others as their 2 least characteristic traits. CONCLUSIONS The job satisfaction of these ATs was affected most by organizational factors, such as coworkers and communication, as well as by individual attributes such as adaptability, stability, and taking personal responsibility.
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Affiliation(s)
| | - Eric L. Richardson
- Healthcare Administration Program, School of Health and Applied Human Sciences, University of North Carolina Wilmington
| | - Rachel M. Carroll
- Statistics and Data Science Program, Department of Mathematics and Statistics, University of North Carolina Wilmington
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Jones NS, Sethi N, Wieschhaus K, Mak R, Wesolowski M, Schiff A, Tonino PM. Medical Supervision of Illinois Public and Private High School Athletics. PHYSICIAN SPORTSMED 2022; 50:64-70. [PMID: 33356778 DOI: 10.1080/00913847.2020.1868954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND High-school sports participation in the United States has increased over the years with a corresponding increase in the number of injuries. Leading medical and sports organizations nationwide advocate for an increase in proper medical supervision of athletes. OBJECTIVES To analyze athletic medical coverage in Illinois high schools and compare differences between public and private Illinois high school. METHODS A survey addressing various components of sports medical coverage was distributed in 2018 to all 810 Illinois High School Association (IHSA) high schools to be completed electronically. RESULTS The response rate was 50% (407/810 schools). Of the responding schools, 14% were private high schools and 86% public high schools. An orthopedic surgeon, family doctor, pediatrician, or another type of physician were present on sidelines in 9.2% of private high schools and 8.5% of public high schools. Athletic trainers (ATs) were present on sidelines in 91% of private high schools and in 79% of public high schools. There was 68% of private high schools reporting coaches trained in CPR versus 85% in public high schools. Both private and public high schools had high rates of having written emergency action plans (89% vs 91%), AED on site (100% vs 99%), written concussion management protocols (96% vs 97%). CONCLUSION Our study found similar rates of high school medical coverage as compared to national studies, with some significant differences found between private and public high schools. Most Illinois high schools had high rates of having written EAPs, concussion management protocols and AEDs on site. Overall, an increase of medical supervision and emergency preparedness is needed, which should come in the form of increasing AT and physician presence alongside community and school engagement for improved implementation of coverage.
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Affiliation(s)
- Nathaniel S Jones
- Department of Orthopaedic Surgery and Anesthesiology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Neal Sethi
- Department of Orthopaedic Surgery and Anesthesiology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Kyle Wieschhaus
- Department of Orthopaedic Surgery and Anesthesiology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Ryan Mak
- Department of Orthopaedic Surgery and Anesthesiology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Michael Wesolowski
- Department of Orthopaedic Surgery and Anesthesiology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Adam Schiff
- Department of Orthopaedic Surgery and Anesthesiology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Pietro M Tonino
- Department of Orthopaedic Surgery and Anesthesiology, Loyola University Medical Center, Maywood, Illinois, USA
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12
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Pike Lacy AM, Eason CM, Stearns RL, Casa DJ. Secondary School Administrators' Knowledge and Perceptions of the Athletic Training Profession, Part I: Specific Considerations for Athletic Directors. J Athl Train 2021; 56:1018-1028. [PMID: 33150440 DOI: 10.4085/54-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Athletic directors are charged with making impactful decisions for secondary school athletic programs that mitigate risks for stakeholders. This includes decision making regarding the provision of medical care for student-athletes. To date, few researchers have explored athletic directors' perceptions of the athletic training profession. OBJECTIVE To evaluate public school athletic directors' knowledge and perceptions of the athletic trainer (AT) role. DESIGN Concurrent mixed-methods study. SETTING Cross-sectional online questionnaire. PATIENTS OR OTHER PARTICIPANTS Athletic directors representing all 50 states and the District of Columbia (N = 954; 818 men, 133 women, 3 preferred not to answer; age = 47.8 ± 9.1 years; time in current role = 9.8 ± 8.3 years). MAIN OUTCOME MEASURE(S) The questionnaire was composed of demographics, quantitative measures that assessed athletic directors' knowledge and perceived value of ATs, and open-ended questions allowing for expansion on their perspectives. Descriptive statistics were reported, with key quantitative findings presented as count responses and overall percentages. Qualitative data were analyzed using the general inductive approach. RESULTS A majority of respondents recognized ATs' role in injury prevention (99.8%), first aid and wound care (98.8%), therapeutic interventions (93.8%), and emergency care (91.6%). Approximately 61% (n = 582) identified AT employment as a top sport safety measure, and 77% (n = 736) considered an AT to be extremely valuable to student-athlete health and safety. Athletic directors appeared to recognize the value of ATs as they provided "peace of mind" and relieved coaches and administration of the responsibility for making medical decisions. CONCLUSIONS Athletic directors seemed to recognize the value ATs brought to the secondary school setting and demonstrated adequate knowledge regarding ATs' roles and responsibilities. Educational efforts for this population should focus on ATs' tasks that add to their perceived value but are not frequently in the public eye, which may influence hiring decisions.
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Affiliation(s)
- Alicia M Pike Lacy
- Department of Interdisciplinary Health Sciences, A.T. Still University, Mesa, AZ
| | - Christianne M Eason
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - Rebecca L Stearns
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - Douglas J Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
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Nicolozakes CP, Li X, Uhl TL, Marra G, Jain NB, Perreault EJ, Seitz AL. Interprofessional Inconsistencies in the Diagnosis of Shoulder Instability: Survey Results of Physicians and Rehabilitation Providers. Int J Sports Phys Ther 2021; 16:1115-1125. [PMID: 34386289 PMCID: PMC8329308 DOI: 10.26603/001c.25170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/18/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Clinicians of many specialties within sports medicine care for athletes with shoulder instability, but successful outcomes are inconsistent. Consistency across specialties in the diagnosis of shoulder instability is critical for care of the athlete, yet the extent of divergence in its diagnosis is unknown. HYPOTHESIS Physicians differ from rehabilitation providers in which findings they deem clinically important to differentiate shoulder instability from impingement, and in how they diagnose athlete scenarios with atraumatic shoulder instability. STUDY DESIGN Cross-sectional study. METHODS Physicians (orthopaedic surgeons, primary care sports medicine physicians) and rehabilitation providers (physical therapists, athletic trainers) were asked via an online survey to rate clinical factors used to diagnose shoulder instability. Clinicians were also asked to diagnose two athlete scenarios with concurrent clinical findings of atraumatic shoulder instability and impingement, differentiated by the absence or presence of a positive sulcus sign. RESULTS Responses were recorded from 888 clinicians. Orthopaedic surgeons (N=170) and primary care sports medicine physicians (N=108) ranked physical examination factors as more important for the diagnosis of shoulder instability than patient history factors, whereas physical therapists (N=379) and athletic trainers (N=231) preferred patient history factors. Orthopaedic surgeons differed from physical therapists and athletic trainers in their clinical diagnoses for both scenarios (P≤0.001). CONCLUSION A lack of consistency exists among sports medicine clinicians in recognizing which clinical factors are important when used to diagnose shoulder instability and in diagnoses given with concurrent findings of impingement. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Constantine P Nicolozakes
- Biomedical Engineering, Northwestern University; Shirley Ryan AbilityLab; Northwestern University Feinberg School of Medicine
| | | | | | - Guido Marra
- Northwestern University Feinberg School of Medicine
| | | | - Eric J Perreault
- Biomedical Engineering, Northwestern University; Shirley Ryan AbilityLab
| | - Amee L Seitz
- Northwestern University Feinberg School of Medicine
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Timpka T, Fagher K, Bargoria V, Gauffin H, Andersson C, Jacobsson J, Nyce J, Bermon S. 'The Little Engine That Could': A Qualitative Study of Medical Service Access and Effectiveness among Adolescent Athletics Athletes Competing at the Highest International Level. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147278. [PMID: 34299729 PMCID: PMC8304016 DOI: 10.3390/ijerph18147278] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/30/2021] [Accepted: 07/05/2021] [Indexed: 11/17/2022]
Abstract
Little is known about provision of medical services to adolescents prior to participating in international top-level sports. This study aimed to investigate experiences of medical service provision among high-level adolescent athletics (track and field) athletes from three continents. A thematic narrative analysis was applied to data collected from 14 athletes by semi-structured interviews. Although competing at the highest international level, these adolescent athletes had difficulties making sense of symptoms of ill health, especially on their own. With increasing exercise loads, the athletes’ medical support needs had extended beyond the capacity of parents and local communities. As there was no organized transfer of the responsibility for medical support to sports organizations, the athletes often had to manage their health problems by themselves. There were major variations among the adolescent athletes with regards to medical service access and quality. The services used ranged from sophisticated computer-assisted biomechanical analyses to traditional healers. Decreased exercise load was the common sports injury treatment. The results of this study demonstrate how the ethical standards underpinning youth sports as well as the equal provision of medical services to adolescents are challenged across the world. Further research on health service provision to adolescent top-level athletes is warranted.
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Affiliation(s)
- Toomas Timpka
- Athletics Research Center, Linköping University, 58183 Linköping, Sweden; (K.F.); (V.B.); (H.G.); (C.A.); (J.J.); (J.N.)
- Department of Health, Medicine and Caring Sciences, Linköping University, 58183 Linköping, Sweden
- Correspondence: ; Tel.: +46-13-28-10-00 or +46-705-36-43-57
| | - Kristina Fagher
- Athletics Research Center, Linköping University, 58183 Linköping, Sweden; (K.F.); (V.B.); (H.G.); (C.A.); (J.J.); (J.N.)
- Rehabilitation Medicine Research Group, Department of Health Sciences, Lund University, 22100 Lund, Sweden
| | - Victor Bargoria
- Athletics Research Center, Linköping University, 58183 Linköping, Sweden; (K.F.); (V.B.); (H.G.); (C.A.); (J.J.); (J.N.)
- Department of Health, Medicine and Caring Sciences, Linköping University, 58183 Linköping, Sweden
- Department of Orthopaedics and Rehabilitation, Moi University, Eldoret 30107, Kenya
| | - Håkan Gauffin
- Athletics Research Center, Linköping University, 58183 Linköping, Sweden; (K.F.); (V.B.); (H.G.); (C.A.); (J.J.); (J.N.)
- Department of Health, Medicine and Caring Sciences, Linköping University, 58183 Linköping, Sweden
| | - Christer Andersson
- Athletics Research Center, Linköping University, 58183 Linköping, Sweden; (K.F.); (V.B.); (H.G.); (C.A.); (J.J.); (J.N.)
- Department of Health, Medicine and Caring Sciences, Linköping University, 58183 Linköping, Sweden
| | - Jenny Jacobsson
- Athletics Research Center, Linköping University, 58183 Linköping, Sweden; (K.F.); (V.B.); (H.G.); (C.A.); (J.J.); (J.N.)
- Department of Health, Medicine and Caring Sciences, Linköping University, 58183 Linköping, Sweden
| | - James Nyce
- Athletics Research Center, Linköping University, 58183 Linköping, Sweden; (K.F.); (V.B.); (H.G.); (C.A.); (J.J.); (J.N.)
- Department of Health, Medicine and Caring Sciences, Linköping University, 58183 Linköping, Sweden
- Department of Anthropology, Ball State University, Muncie, IN 47306, USA
| | - Stéphane Bermon
- Health and Science Department, World Athletics, MC 98007 Monte-Carlo, Monaco;
- Laboratoire Motricité Humaine, Expertise, Sport, Santé (LAMHESS), Université Côte d’Azur, CEDEX 03, 06205 Nice, France
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15
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Redinger AS, Winkelmann ZK, Eberman LE. Collegiate Student-Athletes' Perceptions of Patient-Centered Care Delivered by Athletic Trainers. J Athl Train 2021; 56:499-507. [PMID: 33150412 DOI: 10.4085/130-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT The health care core competencies indicate that all medical professionals should provide patient-centered care (PCC), which is defined as care that is respectful and responsive to the patient's values and preferences, during each encounter. OBJECTIVE To identify collegiate student-athletes' definitions of PCC and measure their perceived level of PCC from an athletic trainer (AT). DESIGN Cross-sectional study. SETTING Mixed-methods survey. PATIENTS OR OTHER PARTICIPANTS A total of 610 (age = 19 ± 1 year) National Collegiate Athletic Association student-athletes completed the survey. MAIN OUTCOME MEASURE(S) The survey consisted of 1 open-ended question that prompted the participant to define PCC in his or her own words. The quantitative data were gathered using the Global Perceptions of Athletic Trainer PCC tool, which explores the overall agreement with the AT's use of PCC constructs. Finally, those participants who had received care from an AT completed the validated Patient Perception of Patient-Centeredness instrument. Qualitative analysis was completed through Text IQ technology with a mean sentiment score attributed to each of the coded statements. We calculated descriptive statistics for all quantitative data. RESULTS The qualitative analysis revealed 13 topics, with the most used being individual, priority, and best. Other topics were inconsistent with how the medical community has defined PCC. On the Global Perceptions of Athletic Trainer PCC tool, the participants expressed strong agreement (mode = 4) with 12 of the 15 statements. On the Patient Perception of Patient-Centeredness instrument, participants expressed that the AT was completely (mode = 4) patient centered for all dimensions during their most recent encounter. However, PCC behaviors, as defined by the medical community, may not be directly expressed according to collegiate student-athletes. CONCLUSIONS Student-athletes defined PCC as individualized and prioritized health care. They perceived that ATs provided care that kept their best interest in mind and practiced PCC during their encounters.
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Miller KC, Casa DJ, Adams WM, Hosokawa Y, Cates J, Emrich C, Fitzpatrick T, Hopper M, Jardine JF, LaBotz M, Lopez RM, O'Connor F, Smith MS. Roundtable on Preseason Heat Safety in Secondary School Athletics: Prehospital Care of Patients With Exertional Heat Stroke. J Athl Train 2021; 56:372-382. [PMID: 33290540 PMCID: PMC8063668 DOI: 10.4085/1062-6050-0173.20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE First, we will update recommendations for the prehospital management and care of patients with exertional heat stroke (EHS) in the secondary school setting. Second, we provide action items to aid clinicians in developing best-practice documents and policies for EHS. Third, we supply practical strategies clinicians can use to implement best practice for EHS in the secondary school setting. DATA SOURCES An interdisciplinary working group of scientists, physicians, and athletic trainers evaluated the current literature regarding the prehospital care of EHS patients in secondary schools and developed this narrative review. When published research was nonexistent, expert opinion and experience guided the development of recommendations for implementing life-saving strategies. The group evaluated and further refined the action-oriented recommendations using the Delphi method. CONCLUSIONS Exertional heat stroke continues to be a leading cause of sudden death in young athletes and the physically active. This may be partly due to the numerous barriers and misconceptions about the best practice for diagnosing and treating patients with EHS. Exertional heat stroke is survivable if it is recognized early and appropriate measures are taken before patients are transported to hospitals for advanced medical care. Specifically, best practice for EHS evaluation and treatment includes early recognition of athletes with potential EHS, a rectal temperature measurement to confirm EHS, and cold-water immersion before transport to a hospital. With planning, communication, and persistence, clinicians can adopt these best-practice recommendations to aid in the recognition and treatment of patients with EHS in the secondary school setting.
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Affiliation(s)
- Kevin C. Miller
- School of Rehabilitation and Medical Sciences, Central Michigan University, Mount Pleasant
| | - Douglas J. Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - William M. Adams
- Department of Kinesiology, University of North Carolina at Greensboro
| | - Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | | | | | | | | | - John F. Jardine
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | | | - Rebecca M. Lopez
- Department of Orthopaedics and Sports Medicine, University of South Florida, Tampa
| | - Francis O'Connor
- Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, MD
| | - M. Seth Smith
- Department of Orthopedics and Rehabilitation, University of Florida, Gainesville
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Concussion in the Athletic Training Room: a Team Physician Narrative. Curr Pain Headache Rep 2021; 25:24. [PMID: 33738547 DOI: 10.1007/s11916-021-00937-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF THE REVIEW Concussion evaluation and management has changed significantly. Understanding proper recognition, evaluation, and management allows for improved provision of care to patients. This paper will approach this topic from a sideline to training room management versus the traditional clinic evaluation RECENT FINDINGS: Research is continuing to refine and examine tools to assist in proper concussion evaluation. Concussion recovery protocols are becoming more conservative as patients are taking longer to recover than previously thought. Treatment of concussion is becoming more sophisticated and patient involved. Concussion research has increased dramatically over the last 30 years changing our approach to diagnosis and treatment. The area of concussion will continue to evolve as research continues to look at effective tools and markers for diagnosis and effective treatment protocols become substantiated through research.
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Winkelmann ZK, Eberman LE, Games KE. Telemedicine Experiences of Athletic Trainers and Orthopaedic Physicians for Patients With Musculoskeletal Conditions. J Athl Train 2021; 55:768-779. [PMID: 32693404 DOI: 10.4085/1062-6050-388-19] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Telemedicine is the delivery of medical care from a distance using technology. The integration of telemedicine as a supplement to musculoskeletal-based patient encounters may be feasible in sports medicine. OBJECTIVE To investigate health care professionals' perceptions of and experiences with telemedicine. DESIGN Cross-sectional explanatory sequential mixed-methods study. PATIENTS OR OTHER PARTICIPANTS A purposeful sample of 17 athletic trainers from a National Collegiate Athletic Association Division I institution and 5 orthopaedic physicians from a sports medicine clinic located 92 miles from the campus. INTERVENTION(S) Participants were trained on the telemedicine platform and used it over 5 months for initial, follow-up, and discharge patient encounters. MAIN OUTCOME MEASURE(S) Participants completed a preintervention survey containing the Theory of Planned Behavior and Technology Acceptance Model tool. Responses were analyzed using descriptive statistics and an independent-samples t test. After the intervention period, participants completed individual semistructured interviews that we coded using the consensual qualitative research tradition. RESULTS From the interviews, the clinicians were characterized as telemedicine adopters (n = 14) or nonadopters (n = 8). The adopters reported higher levels of agreement on the Theory of Planned Behavior and Technology Acceptance Model tool as compared with nonadopters for all constructs. When comparing adoption status, we identified a difference (P < .01), with nonadopters reporting a low level of agreement for the subjective norm construct. The interviews revealed 5 domains: integration challenges, integration opportunities, collaborative practice, anticipatory socialization to future use, and benefits of integration. The participants indicated that integration challenges centered on "buy in," whereas opportunities aligned with the patient's condition and technology ease of use. They reflected that the telemedicine encounters required more preparation and yet allowed for cooperative behaviors between clinicians. The benefits of telemedicine included convenience and scheduling preferences that encouraged future use. CONCLUSIONS The integration of telemedicine in sports medicine brought about both challenges and opportunities for collaboration among athletic trainers and physicians that were heavily predetermined by the social pressures of colleagues.
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Affiliation(s)
| | - Lindsey E Eberman
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute
| | - Kenneth E Games
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute
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Tayne S, Hutchinson MR, O'Connor FG, Taylor DC, Musahl V, Indelicato P. Leadership for the Team Physician. Curr Sports Med Rep 2020; 19:119-123. [PMID: 32141907 DOI: 10.1249/jsr.0000000000000696] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Physician leadership of the interdisciplinary sports medicine team depends on fundamental leadership skills that often are overlooked in medical school. These leadership skills include effective communication, emotional intelligence, teamwork, selfless service, integrity, and critical thinking while utilizing an athlete-centered approach. Development of these skills will help to navigate team management and important decisions, such as return to play. The leadership session at the Advanced Team Physician Course sought to acknowledge the gap in medical training regarding leadership education and began to address it in a forum specifically for team physicians. Here we provide a summary of the lectures and presentations from the 2018 Advanced Team Physician Course in an effort to benefit a broader physician audience. This material should act as a framework for current and future team physicians to solidify their role as the leader of the medical team in caring for the athlete.
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Affiliation(s)
- Samantha Tayne
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL
| | - Mark R Hutchinson
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL
| | - Francis G O'Connor
- Department of Orthopaedic Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Dean C Taylor
- Department of Orthopaedic Surgery, Duke University, Durham, NC
| | - Volker Musahl
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Peter Indelicato
- UF Orthopaedics and Sports Medicine Institute, Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL
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Boden BP, Fine KM, Spencer TA, Breit I, Anderson SA. Nontraumatic Exertional Fatalities in Football Players, Part 2: Excess in Conditioning Kills. Orthop J Sports Med 2020; 8:2325967120943491. [PMID: 32913873 PMCID: PMC7444123 DOI: 10.1177/2325967120943491] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/23/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The incidence of nontraumatic fatalities in high school (HS) and National Collegiate Athletic Association (NCAA) football players has continued at a constant rate since the 1960s. PURPOSE To describe the causes of nontraumatic fatalities in HS and NCAA football players and provide prevention strategies. STUDY DESIGN Descriptive epidemiology study. METHODS We reviewed 187 fatalities in HS and NCAA nontraumatic football players catalogued by the National Registry of Catastrophic Sports Injuries during a 20-year period between July 1998 and June 2018. RESULTS The majority (n = 162; 86.6%) of fatalities occurred during a practice or conditioning session. Most fatalities, when timing was known, (n = 126; 70.6%) occurred outside of the regular playing season, with the highest incidence in the August preseason (n = 64; 34.2%). All documented conditioning sessions were supervised by a coach (n = 92) or strength and conditioning coach (n = 40). The exercise regimen at the time of the fatality involved high-intensity aerobic training in 94.7%. Punishment was identified as the intent in 36 fatalities. The average body mass index of the athletes was 32.6 kg/m2. For athletes who died due to exertional heat stroke, the average body mass index was 36.4 kg/m2, and 97.1% were linemen. CONCLUSION Most nontraumatic fatalities in HS and NCAA football players occurred during coach-supervised conditioning sessions. The primary cause of exertion-related fatalities was high-intensity aerobic workouts that might have been intended as punishment and/or excess repetitions. Exertion-related fatalities are potentially preventable by applying standards in workout design, holding coaches accountable, and ensuring compliance with the athlete's health and current welfare policies.
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Affiliation(s)
- Barry P. Boden
- The Orthopaedic Center, Centers for Advanced Orthopaedics, Rockville, Maryland, USA
| | - Ken M. Fine
- The Orthopaedic Center, Centers for Advanced Orthopaedics, Rockville, Maryland, USA
| | - Tiahna A. Spencer
- The Orthopaedic Center, Centers for Advanced Orthopaedics, Rockville, Maryland, USA
| | - Ilan Breit
- The Orthopaedic Center, Centers for Advanced Orthopaedics, Rockville, Maryland, USA
| | - Scott A. Anderson
- Department of Athletics, University of Oklahoma, Norman, Oklahoma, USA
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Pike Lacy AM, Singe SM, Bowman TG. Collegiate Athletic Trainers' Experiences With External Pressures Faced During Decision Making. J Athl Train 2020; 55:409-415. [PMID: 32196378 DOI: 10.4085/1062-6050-165-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Conflict is prevalent between sports medicine professionals and coaching staffs regarding return-to-play decisions for athletes after injury in the National Collegiate Athletic Association (NCAA) Division I setting. The firsthand experiences of athletic trainers (ATs) regarding such conflict have not been fully investigated. OBJECTIVE To better understand the outside pressures ATs face when making medical decisions regarding patient care and return to play after injury in the NCAA Division I Football Bowl Subdivision (FBS) setting. DESIGN Qualitative study. SETTING Semistructured one-on-one telephone interviews. PATIENTS OR OTHER PARTICIPANTS Nine ATs (4 men, 5 women; age = 31 ± 8 years [range = 24-48 years]; years certified = 9 ± 8). DATA COLLECTION AND ANALYSIS Interviews were audio recorded and later transcribed. Thematic analysis was completed phenomenologically. Researcher triangulation, peer review, and member checks were used to establish trustworthiness. RESULTS Two major themes emerged from the qualitative analysis: (1) pressure is an expected component of the Division I FBS AT role, and (2) strategies can be implemented to mitigate the negative effects of pressure. Three subthemes supported the second major theme: (1) ensuring ongoing and frequent communication with stakeholders about an injured athlete's status and anticipated timeline for return to play, (2) providing a rationale to coaches or administrations to foster an understanding of why specific medical decisions are being made, and (3) establishing positive relationships with coaches, athletes, and administrations. CONCLUSIONS External pressure regarding medical decisions was an anticipated occurrence for our sample. Such pressure was described as a natural part of the position, not negative but rather a product of the culture and environment of the Division I FBS setting. Athletic trainers who frequently face pressure from coaches and administration should use the aforementioned strategies to improve the workplace dynamic and foster an environment that focuses on patient-centered care.
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Affiliation(s)
- Alicia M Pike Lacy
- Department of Kinesiology, University of Connecticut, Storrs.,Dr Pike Lacy is now at A.T. Still University, Mesa, AZ
| | | | - Thomas G Bowman
- Department of Athletic Training, University of Lynchburg, VA
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Lacy AMP, Bowman TG, Singe SM. Challenges Faced by Collegiate Athletic Trainers, Part I: Organizational Conflict and Clinical Decision Making. J Athl Train 2020; 55:303-311. [PMID: 31986099 DOI: 10.4085/1062-6050-84-19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Organizational conflict, particularly between coaches and medical professionals, has been reported in collegiate athletics. Different values create room for conflict between coaches and athletic trainers (ATs); however, ATs' experiences when making medical decisions are not fully understood. OBJECTIVE To investigate the presence of organizational conflict regarding medical decision making and determine if differences exist across athletic affiliations. DESIGN Cross-sectional study. SETTING Collegiate athletics (National Collegiate Athletic Association [NCAA], National Association of Intercollegiate Athletics [NAIA], National Junior College Athletic Association [NJCAA]). PATIENTS OR OTHER PARTICIPANTS A total of 434 ATs responded (age = 27.7 ± 3.2 years, years certified = 5.2 ± 2.7), representing the NCAA Division I (DI; n = 199), Division II (DII; n = 67), Division III (DIII; n = 108); NAIA (n = 37); and NJCAA (n = 23) settings. MAIN OUTCOME MEASURE(S) The survey instrument contained quantitative measures and open-ended questions, with affiliation as our primary independent variable. Responses to Likert-scale questions (1 = strongly agree, 5 = strongly disagree) regarding organizational pressures within athletics served as the dependent variables. Kruskal-Wallis analysis-of-variance and Mann-Whitney U post hoc tests assessed differences in organizational conflict across affiliations. Open-ended questions were analyzed inductively. RESULTS We obtained a 14.47% (434 of 3000) response rate. National Collegiate Athletic Association DI ATs disagreed less than NCAA DII and DIII and NJCAA ATs that they would worry about job security if turnover in the head coaching position occurred (P < .05). Regarding the influence of coaches on job performance, differences were found between NCAA DI and DIII and between DI and NJCAA ATs (P < .01). Visibility of the injury and situational factors influenced the level of perceived pressure. CONCLUSIONS Athletic trainers perceived pressure from coaches regarding medical decision making. Division I ATs placed greater emphasis on the role that coaches played in their job performance and job security. Athletic departments should consider transitioning to patient-centered models of care to better align values and reduce the external pressures placed on ATs.
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Affiliation(s)
| | - Thomas G Bowman
- Department of Athletic Training, University of Lynchburg, VA. Dr Pike Lacy is now at A.T. Still University, Mesa, AZ
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Bowman TG, Singe SM, Pike Lacy AM, Register-Mihalik JK. Challenges Faced by Collegiate Athletic Trainers, Part II: Treating Concussed Student-Athletes. J Athl Train 2020; 55:312-318. [PMID: 31986101 DOI: 10.4085/1062-6050-85-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Conflict between athletic trainers (ATs) and other stakeholders can occur because of competing interests over medical decisions regarding concussion. However, we are unaware of any studies specifically exploring these situations across various collegiate athletic affiliations. OBJECTIVE To investigate the challenges faced by ATs when treating concussed student-athletes. DESIGN Qualitative study. SETTING Online questionnaire. PATIENTS OR OTHER PARTICIPANTS A total of 434 ATs (267 women, 166 men, 1 missing data; age = 27.73 ± 3.24 years, experience = 5.17 ± 2.67 years) completed the questionnaire (response rate = 14.47%). Our participants represented multiple employment settings within intercollegiate athletics. DATA COLLECTION AND ANALYSIS We sent an online questionnaire to 3000 ATs working in the collegiate and university setting across the United States. A survey expert verified face, content, and construct validity of the questionnaire in 2 rounds of review, and 3 ATs completed a content-validity tool before we finalized the survey. We analyzed the qualitative data using a general inductive approach and ensured trustworthiness through multiple-analyst triangulation and peer review. RESULTS When we examined the responses from our participants regarding their work with student-athletes who had sustained concussions, we found 2 major themes, each with subthemes. First, educational efforts appeared to be only modestly effective because of a lack of honesty, noncompliant actions, and coach interference. Second, return to learn was challenging because of a lack of communication among stakeholders, athletes being anxious about needing accommodations, and difficulty convincing faculty to provide reasonable accommodations. CONCLUSIONS Based on our findings, we recommend continued efforts to improve the culture surrounding concussion in collegiate athletes. Athletic trainers should include key stakeholders such as coaches, student-athletes, parents, faculty, and other educational administrators in their educational efforts to improve the policies and culture surrounding concussion treatment.
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Affiliation(s)
- Thomas G Bowman
- Department of Athletic Training, University of Lynchburg, VA
| | | | | | - Johna K Register-Mihalik
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill. Dr Pike Lacy is now at A.T. Still University, Mesa, AZ
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Jones NS, Wieschhaus K, Martin B, Tonino PM. Medical Supervision of High School Athletics in Chicago: A Follow-up Study. Orthop J Sports Med 2019; 7:2325967119862503. [PMID: 31448300 PMCID: PMC6691665 DOI: 10.1177/2325967119862503] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: High school sports participation in the United States has increased dramatically over the past 25 years. A corresponding increase in the number of injuries has been noted, particularly in contact sports such as football. This has led medical and sports organizations nationwide to advocate for proper medical supervision of athletes at games and practices. Purpose: To gather information from Chicago public high schools to gauge how medical supervision for high school sports has changed in 2017 compared with 2003. Study Design: Cross-sectional study. Methods: Survey questionnaires were sent to the athletic directors of all 99 Chicago public high schools to complete via email. The questionnaire survey contained the same questions as in a survey conducted in 2003 by Tonino and Bollier, with the addition of 4 novel questions relating to emergency action plans (EAPs), automated external defibrillators, concussion management policy, and tackling progression drills. Results: The response rate was 66.67% (66/99 schools). Of the 66 responding schools, all with football programs, no school had a physician on the sideline at home games (decrease from 10.6% in 2003), 37.9% had an athletic trainer present (increase from 8.5% in 2003), and 63.6% had a paramedic available (decrease from 89.4% in 2003). In 2017, 65.6% of responding schools had a coach certified in cardiopulmonary resuscitation (CPR) available at practice to handle medical problems, compared with 89.4% in 2003 (P < .001). Regarding the 4 novel questions, 93.9% of the responding schools had proper tackling progression drills in place, followed by 89.1% who had appropriate EAPs and 93.9% with concussion management protocols, including return-to-play and return-to-learn protocols. Conclusion: Although significant improvement was found in athletic trainer coverage, especially at games, physician coverage was lacking and fewer coaches were certified in CPR in 2017 compared with 2003. EAPs and concussion management protocols were present in most Chicago public high schools. Overall, greater medical supervision is needed, which we believe should come in the form of increased athletic training and physician involvement and coverage, given that expert, expedited medical care saves lives.
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Affiliation(s)
- Nathaniel S Jones
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Chicago-Stritch School of Medicine, Maywood, Illinois, USA
| | - Kyle Wieschhaus
- Loyola University Chicago-Stritch School of Medicine, Maywood, Illinois, USA
| | | | - Pietro M Tonino
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Chicago-Stritch School of Medicine, Maywood, Illinois, USA
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Caterisano A, Decker D, Snyder B, Feigenbaum M, Glass R, House P, Sharp C, Waller M, Witherspoon Z. CSCCa and NSCA Joint Consensus Guidelines for Transition Periods: Safe Return to Training Following Inactivity. Strength Cond J 2019. [DOI: 10.1519/ssc.0000000000000477] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Cooper L, Harper R, Wham GS, Cates J, Chafin SJ, Cohen RP, Dompier TP, Huggins RA, Newman D, Peterson B, McLeod TCV. Appropriate Medical Care Standards for Organizations Sponsoring Athletic Activity for the Secondary School-Aged Athlete: A Summary Statement. J Athl Train 2019; 54:741-748. [PMID: 31135211 DOI: 10.4085/1062-6050-544-18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To present the appropriate medical care standards for organizations that sponsor athletic activities for secondary school-aged athletes. DATA SOURCES To develop the current standards and identify current best-practices evidence, the task force used a multistep process that included reviewing the existing 2004 Appropriate Medical Care for Secondary School-Aged Athletes consensus points and cross-referencing of National Athletic Trainers' Association (NATA) statements and official documents from the strategic alliance (the NATA, NATA Foundation, Board of Certification, and Commission on Accreditation of Athletic Training Education). Gaps in the recommendations from the 2004 Appropriate Medical Care for Secondary School-Aged Athletes document were identified by the task force, and the new appropriate medical care standards were developed and refined. CONCLUSIONS AND RECOMMENDATIONS Twelve standards, with supporting substandards, were developed that encompassed readiness to participate in activity; facilities; equipment; protective materials; environmental policies; nutrition, hydration, and dietary supplementation; wellness and long-term health; comprehensive emergency action plans; on-site immediate care; on-site therapeutic interventions; psychological concerns; and athletic health care administration. Collectively, these standards describe a comprehensive approach to providing appropriate health care to secondary school-aged athletes and should serve as a framework with which organizations can evaluate and improve the medical care supplied to adolescent athletes.
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Affiliation(s)
| | | | | | | | - Scott J Chafin
- Gregorio, Chafin, Johnson, Poolson, & Tabor, LLC, Shreveport, LA
| | - Randy P Cohen
- Department of Intercollegiate Athletics, University of Arizona, Tucson
| | - Thomas P Dompier
- Department of Athletic Training, Lebanon Valley College, Annville, PA
| | - Robert A Huggins
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - Dan Newman
- Department of Athletics, Union High School, Tulsa, OK
| | | | - Tamara C Valovich McLeod
- Athletic Training Programs and School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa
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Sports neurology as a multidisciplinary field. HANDBOOK OF CLINICAL NEUROLOGY 2019. [PMID: 30482338 DOI: 10.1016/b978-0-444-63954-7.00002-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
A multidisciplinary approach within sports neurology fills a critical role in the management of athletes with neurologic injury. This model promotes streamlined access to sports medicine providers who can offer high-quality multispecialty care in a collaborative manner, to provide optimal outcomes for athletes. This chapter highlights the rise of the multidisciplinary care approach in nonathletic healthcare settings and introduces the concept of the interdisciplinary sports medicine care model. Next, we review the roles of medical providers who are integral in effective management of sport-related concussion, followed by a discussion of the athletic healthcare teams that treat other sport-related neurologic injuries and athletes with pre-existing neurologic conditions. Finally, we note important educational, legal, and independent medical care issues in athletic healthcare settings, and summarize the applicability of multidisciplinary and interdisciplinary care models to the subspecialty of sports neurology.
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Manspeaker SA, Hankemeier DA. Challenges to and Resources for Participation in Interprofessional Collaborative Practice: Perceptions of Collegiate Athletic Trainers. J Athl Train 2019; 54:106-114. [PMID: 30721095 DOI: 10.4085/1062-6050-507-17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Health care systems are increasing their emphasis on interprofessional collaborative practice (IPCP) as a necessary component to patient care. However, information regarding the challenges athletic trainers (ATs) perceive with respect to participating in IPCP is lacking. OBJECTIVE To describe collegiate ATs' perceptions of challenges to and resources for participation in IPCP. DESIGN Qualitative study. SETTING College and university. PATIENTS OR OTHER PARTICIPANTS The response rate was 8% (513 ATs [234 men, 278 women, 1 preferred not to disclose sex], years in clinical practice = 10.69 ± 9.33). DATA COLLECTION AND ANALYSIS Responses to survey-based, open-ended questions were collected through Qualtrics. A general inductive qualitative approach was used to analyze data and establish relevant themes and categories for responses. Multianalyst coding and an external auditor confirmed coding saturation and assisted in triangulation. RESULTS Challenges were reported in the areas of needing a defined IPCP team structure, respect for all involved health care parties, and concerns when continuity of care was compromised. Communication was reported as both a perceived challenge and a resource. Specific resources seen as beneficial to effective participation in IPCP included communication mechanisms such as shared patient health records and educational opportunities with individuals from other health care professions. CONCLUSIONS As ATs become more integrated into IPCP, they need to accurately describe and advocate their roles, understand the roles of others, and be open to the dynamic needs of team-based care. Development of continuing interprofessional education opportunities for all relevant members of the health care team can help to delineate roles more effectively and provide more streamlined care with the goal of improving patient outcomes.
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McLeod TCV, Cardenas JF. Emergency Preparedness of Secondary School Athletic Programs in Arizona. J Athl Train 2018; 54:133-141. [PMID: 30517023 DOI: 10.4085/1062-6050-35-18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Schools that sponsor athletic programs have an obligation to provide a safe environment with appropriate policies for addressing emergencies. OBJECTIVE To describe the emergency preparedness of secondary schools in Arizona specific to emergency action plans (EAPs), cardiac arrest, concussion, and heat illness. DESIGN Cross-sectional study. SETTING Online survey. PATIENTS OR OTHER PARTICIPANTS Athletic directors from 143 Arizona secondary schools (response rate = 54%). INTERVENTION(S) A 6-section survey that included questions related to athletic trainer (AT) access, EAPs, automated external defibrillators (AEDs), concussion, heat illness, and other policies. MAIN OUTCOME MEASURE(S) Descriptive statistics were reported. Comparisons of responses between schools with and without AT access were conducted with Mann-Whitney U tests. RESULTS Most respondents (81%, n = 116) indicated their school had access to an AT, and 95% (n = 125) of respondents reported their school had a written EAP. The AEDs were available at most (93%, n = 121) schools. All respondents were familiar with the interscholastic concussion policy, and 98% (n = 123) indicated they had a school-specific policy. Almost all respondents (99%, n = 121) reported being familiar with the state heat-illness policy. Environmental measures were taken before practices at 48% (n = 60) of schools. Schools with access to an AT were more likely to have an EAP, venue-specific EAPs, physician approval of EAPs, AEDs, heat-illness policies, and cold-water immersion tubs and to take environmental measures. CONCLUSIONS Whereas the majority of schools reported AT access, not all schools had adequate EAPs in place. Schools would benefit from educational opportunities regarding best practices and policy development to improve emergency preparedness.
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McGuine TA, Pfaller AY, Post EG, Hetzel SJ, Brooks A, Broglio SP. The Influence of Athletic Trainers on the Incidence and Management of Concussions in High School Athletes. J Athl Train 2018; 53:1017-1024. [PMID: 30403363 DOI: 10.4085/1062-6050-209-18] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT In many US high schools, the athletic trainer (AT) has the responsibility to identify and manage athletes with concussions. Although the availability of ATs varies a great deal among schools, how the level of AT availability in high schools affects the reported incidence and management of sport-related concussions (SRCs) is unknown. OBJECTIVE To determine how the presence of an AT affects the reporting and management of SRCs. DESIGN Prospective cohort study. PATIENTS OR OTHER PARTICIPANTS A total of 2459 (female = 37.5%, age = 16.1 ± 1.2 years) athletes from 31 Wisconsin high schools were categorized as having low availability (LoAT), mid availability (MidAT), or high availability (HiAT) of ATs. Athletic trainers recorded the incidence, days lost from sport, and postconcussion management through return to sport. The incidence of SRC reporting among categories was examined using a multivariate Cox proportional hazards model. Fisher exact tests were used to determine if postconcussion management differed based on AT availability. RESULTS The incidence of reported SRCs was lower for the LoAT schools (2.4%) compared with the MidAT (5.6%, hazard ratio = 2.59, P = .043) and HiAT (7.0%, hazard ratio = 3.33, P = .002) schools. The median time before the first AT interaction was longer for LoAT schools (24.0 hours) than for MidAT (0.5 hours, post hoc P = .012) and HiAT (0.2 hours, post hoc P = .023) schools. The number of post-SRC interactions was different in all groups (LoAT = 2 interactions, MidAT = 3, and HiAT = 4; all post hoc P values < .05). Days lost were greater for MidAT and HiAT (both 14 days lost) schools compared with LoAT schools (11.5 days lost, post hoc P = .231 and P = .029, respectively). Athletes at LoAT schools were less likely to undergo a return-to-play protocol (9/18 SRCs, 50.0%) than athletes at MidAT (44/47 SRCs, 93.6%; post hoc P = .001) or HiAT (64/64 SRCs, 100%; post hoc P < .001) schools. CONCLUSIONS The level of AT availability positively influenced the reported incidence of SRCs as well as postconcussion management activities in this sample of high schools.
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Affiliation(s)
- Timothy A McGuine
- Department of Orthopaedics and Rehabilitation, University of Wisconsin, Madison
| | - Adam Y Pfaller
- Department of Orthopaedics and Rehabilitation, University of Wisconsin, Madison
| | - Eric G Post
- School of Exercise and Nutritional Sciences, San Diego State University, CA
| | - Scott J Hetzel
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison
| | - Alison Brooks
- Department of Orthopaedics and Rehabilitation, University of Wisconsin, Madison
| | - Steven P Broglio
- NeuroTrauma Research Laboratory, University of Michigan, Ann Arbor
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Post E, Winterstein AP, Hetzel SJ, Lutes B, McGuine TA. School and Community Socioeconomic Status and Access to Athletic Trainer Services in Wisconsin Secondary Schools. J Athl Train 2018; 54:177-181. [PMID: 30398929 DOI: 10.4085/1062-6050-440-17] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Secondary schools have made significant progress in providing athletic trainer (AT) coverage to their student-athletes, but the levels of access at schools with ATs may vary widely. Socioeconomic disparities in medical coverage and access have been noted in other health care fields, but such disparities in the level of access to AT services have not been thoroughly examined. OBJECTIVE To determine if (1) access to AT services or (2) the level of access (AT hours per week and athletes per AT hour) differed based on the socioeconomic characteristics of secondary schools. DESIGN Cross-sectional study. SETTING Mailed and e-mailed surveys. PATIENTS OR OTHER PARTICIPANTS High school athletic directors and ATs from 402 Wisconsin high schools. MAIN OUTCOME MEASURE(S) Respondents provided information as to whether their school used the services of an AT and the number of hours per week that their school had an AT on-site. The number of athletes per AT hour was calculated by dividing the total number of athletes at the school by the number of hours of AT coverage per week. The socioeconomic status of each school was determined using the percentage of students with free or reduced-cost lunch and the county median household income (MHI). RESULTS Schools without an AT on-site were in lower MHI counties ( P < .001) and had more students eligible for a free or reduced-cost lunch ( P < .001). Lower levels of AT access (fewer hours of AT access per week and more athletes per AT hour) were observed at schools in the lowest third of the county MHI and with the highest third of students eligible for a free or reduced-cost lunch ( P < .001). CONCLUSIONS Socioeconomic disparities were present in access to AT services. New models are needed to focus on providing a high level of AT access for all student-athletes, regardless of socioeconomic status.
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Affiliation(s)
- Eric Post
- Department of Kinesiology, University of Wisconsin, Madison
| | | | - Scott J Hetzel
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison
| | - Blaire Lutes
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison
| | - Timothy A McGuine
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison
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DeFoor MT, Stepleman LM, Mann PC. Improving Wellness for LGB Collegiate Student-Athletes Through Sports Medicine: A Narrative Review. SPORTS MEDICINE-OPEN 2018; 4:48. [PMID: 30402672 PMCID: PMC6219993 DOI: 10.1186/s40798-018-0163-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 10/22/2018] [Indexed: 11/24/2022]
Abstract
In comparison to their heterosexual peers, lesbian, gay, and bisexual (LGB) student-athletes encounter substantial challenges during their intercollegiate and professional athletic careers including detrimental stereotypes, harassment, and discrimination. Such non-inclusive environments promoted throughout the current Western culture of sport are notably associated with higher incidences of mental health and substance use disorders among LGB athletes across youth, collegiate, and professional sports. There have been significant gains at the collegiate level to address LGB-inclusive practices aimed towards administrators, educators, coaches, and student-athletes; however, there is currently no literature that addresses the unique role of the sports medicine team. As first-line healthcare providers for student-athletes, sports medicine physicians and athletic trainers are uniquely positioned to support collegiate LGB athletes through affirming sexual identity, recognizing distinctive health risks, and advocating inclusivity within the athletic training room. By examining major themes of concern among current LGB student-athlete experiences across the unique setting of US colleges and universities, this review article aims to further identify opportunities for sports medicine providers to promote positive health outcomes and improve the overall wellness of collegiate LGB student-athletes.
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Affiliation(s)
- Mikalyn T DeFoor
- School of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA.
| | - Lara M Stepleman
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA
| | - Paul C Mann
- Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA.,Center for Bioethics and Health Policy, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA
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Chang CJ, Weston T, Higgs JD, Ohkubo M, Sauls A, Tedeschi F, White M, Young CC. Inter-Association Consensus Statement: The Management of Medications by the Sports Medicine Team. J Athl Train 2018; 53:1103-1112. [PMID: 30525936 PMCID: PMC6333221 DOI: 10.4085/1062-6050-53-11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Cindy J. Chang
- University of California, San Francisco
- American Medical Society for Sports Medicine
| | | | | | | | - Amy Sauls
- University of North Carolina at Chapel Hill
| | | | - Marianne White
- North Carolina State University. Ms White is now retired
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Adams WM, Scarneo SE, Casa DJ. Assessment of Evidence-Based Health and Safety Policies on Sudden Death and Concussion Management in Secondary School Athletics: A Benchmark Study. J Athl Train 2018; 53:756-767. [PMID: 30212234 DOI: 10.4085/1062-6050-220-17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT: Implementation of best-practice health and safety policies has been shown to be effective at reducing the risk of sudden death in sport; however, little is known about the extent to which these policies are required within secondary school athletics. OBJECTIVE: To examine best-practice health and safety policies pertaining to the leading causes of sudden death and to concussion management in sport mandated at the state level for secondary school athletics. DESIGN: Descriptive observational study. SETTING: State high school athletic associations (SHSAAs), state departments of education, and enacted legislation. PATIENTS OR OTHER PARTICIPANTS: United States (including the District of Columbia) SHSAAs. MAIN OUTCOME MEASURE(S): A review of SHSAA health and safety policies for the 2016-2017 academic year, state department of education policies, and enacted legislation was undertaken to assess the polices related to the leading causes of sudden death and concussion management in sport. Current best-practice recommendations used to assess health and safety policies were specific to emergency action plans, automated external defibrillators, heat acclimatization, environmental monitoring and modification, and concussion management. The total number of best-practice recommendations required for each SHSAA's member schools for the aforementioned areas was quantified and presented as total number and percentage of recommendations required. RESULTS: Four of 51 SHSAA member schools were required to follow best practices for emergency action plans, 7 of 51 for access to automated external defibrillators, 8 of 51 for heat acclimatization, and 3 of 51 for management of concussion. CONCLUSIONS: At the time of this study, SHSAA member schools were not required to follow all best-practice recommendations for preventing the leading causes of sudden death and for concussion management in sport. Continued advocacy for the development and implementation of best practices at the state level to be required of all secondary schools is needed to appropriately serve the health and well-being of our young student-athletes.
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Affiliation(s)
- William M Adams
- Department of Kinesiology, University of North Carolina at Greensboro
| | - Samantha E Scarneo
- Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs
| | - Douglas J Casa
- Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs
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Hankemeier D, Manspeaker SA. Perceptions of Interprofessional and Collaborative Practice in Collegiate Athletic Trainers. J Athl Train 2018; 53:703-708. [PMID: 30102070 DOI: 10.4085/1062-6050-308-17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT The ability to engage in interprofessional and collaborative practice (IPCP) has been identified as one of the Institute of Medicine's core competencies required of all health care professionals. OBJECTIVE To determine the perceptions of athletic trainers (ATs) in the collegiate setting regarding IPCP and current practice patterns. DESIGN Cross-sectional study. PATIENTS OR OTHER PARTICIPANTS Of 6313 ATs in the collegiate setting, 739 (340 men, 397 women, 2 preferred not to answer; clinical experience = 10.97 ± 9.62 years) responded (11.7%). MAIN OUTCOME MEASURE(S) The Online Clinician Perspectives of Interprofessional Collaborative Practice survey section 1 assessed ATs' perceptions of working with other professionals (construct 1), ATs engaged in collaborative practice (construct 2), influences of collaborative practice (construct 3), and influences on roles, responsibilities, and autonomy in collaborative practice (construct 4). Section 2 assessed current practice patterns of ATs providing patient care and included the effect of communication on collaborative practice (construct 5) and patient involvement in collaborative practice (construct 6). Between-groups differences were assessed using a Kruskal-Wallis H test and Mann-Whitney U tests ( P < .05). RESULTS Athletic trainers in the collegiate setting agreed with IPCP constructs 1 through 4 (construct 1 = 3.56 ± 0.30, construct 2 = 3.36 ± 0.467, construct 3 = 3.48 ± 0.39, construct 4 = 3.20 ± 0.35) and indicated that the concepts of constructs 5 and 6 (1.99 ± 0.46, 1.80 ± 0.50, respectively) were sometimes true in their setting. Athletic trainers functioning in a medical model reported lower scores for construct 5 (1.88 ± 0.44) than did those in an athletic model (2.03 ± 0.45, U = 19 522.0, P = .001). A total of 42.09% of the ATs' patient care was performed in collaborative practice. CONCLUSIONS Athletic trainers in the collegiate setting agreed that IPCP concepts were beneficial to patient care but were not consistently practicing in this manner. Consideration of a medical model structure, wherein more regular interaction with other health care professionals occurs, may be beneficial to increase the frequency of IPCP.
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Personal subjectivity in clinician discussion about retirement from sport post-concussion. Soc Sci Med 2018; 218:37-44. [PMID: 30336393 DOI: 10.1016/j.socscimed.2018.07.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 07/19/2018] [Accepted: 07/29/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is increasing focus on the number of concussions after which an athlete should discontinue participating in contact or collision sports. This is a clinically subjective and, in some cases, a preference-sensitive decision. PURPOSE Our goal was to assess whether there is personal subjectivity in when athletic trainers (ATs) discuss the possibility of sport retirement post-concussion with athletes. METHODS A national sample of ATs who provide clinical care to college athletes completed a questionnaire (n = 677, 34% response rate). Structural equation modeling was used to assess the association between risk perceptions, risk tolerance, social influences (beliefs about athlete, coach and parent preferences), expectancies about athlete success (on and off field), and the number of concussions after which retirement would be discussed. RESULTS There was a significant direct effect of AT risk tolerance on the number of concussions after which sport retirement would be discussed, among both male and female ATs (male B = 0.54, p < 0.001; female B = 0.31, p < 0.001). ATs who more strongly prioritized athletes' on-field achievements indicated that they would discuss sport retirement after a larger number of concussions compared to their peers who less strongly valued athletic achievement. CONCLUSIONS The results suggest the potential utility of standardized approaches to communicating concussion risk consistently to athletes. This can help ensure that all athletes are uniformly able to make informed decisions about continued exposure to concussion risk that are based on their values and preferences.
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Cohen IG, Lynch HF, Deubert CR. A Proposal to Address NFL Club Doctors' Conflicts of Interest and to Promote Player Trust. Hastings Cent Rep 2018; 46 Suppl 2:S2-S24. [PMID: 27870082 PMCID: PMC5215412 DOI: 10.1002/hast.651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
How can we ensure that players in the National Football League receive excellent health care they can trust from providers who are as free from conflicts of interest as realistically possible? NFL players typically receive care from the club's own medical staff. Club doctors are clearly important stakeholders in player health. They diagnose and treat players for a variety of ailments, physical and mental, while making recommendations to the player concerning those ailments. At the same time, club doctors have obligations to the club, namely to inform and advise clubs about the health status of players. While players and clubs share an interest in player health-both of them want players to be healthy so they can play at peak performance-there are several areas where their interests can diverge, and the divergence presents legal and ethical challenges. The current structure forces club doctors to have obligations to two parties-the club and the player-and to make difficult judgments about when one party's interests must yield to another's. None of the three parties involved should prefer this conflicted approach. We propose to resolve the problem of dual loyalty by largely severing the club doctor's ties with the club and refashioning that role into one of singular loyalty to the player-patient. The main idea is to separate the roles of serving the player and serving the club and replace them with two distinct sets of medical professionals: the Players' Medical Staff (with exclusive loyalty to the player) and the Club Evaluation Doctor (with exclusive loyalty to the club). We begin by explaining the broad ethical principles that guide us and that help shape our recommendation. We then provide a description of the role of the club doctor in the current system. After explaining the concern about the current NFL player health care structure, we provide a recommendation for improving this structure. We then discuss how the club medical staff fits into the broader microenvironment affecting player health.
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Thrasher AB, Walker SE. Orientation Process for Newly Credentialed Athletic Trainers in the Transition to Practice. J Athl Train 2018; 53:292-302. [PMID: 29466070 PMCID: PMC5894381 DOI: 10.4085/1062-6050-531-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Orientation is an important part of socialization and transition to practice, yet the orientation process for newly credentialed athletic trainers (ATs) is unknown. OBJECTIVE To determine how newly credentialed ATs are oriented to their roles. DESIGN Cross-sectional study. SETTING Online survey. PATIENTS OR OTHER PARTICIPANTS Three hundred thirty-two of 1835 newly credentialed ATs (18%) certified and employed between January and September of 2013 completed the survey (129 men, 203 women; age = 23.58 ± 2.54 years). DATA COLLECTION AND ANALYSIS The survey consisted of demographic information (eg, employment setting, job title) and 2 sections: (1) orientation tactics and (2) usefulness of orientation tactics. For the first section, participants identified if various orientation tactics were included in their orientations (eg, policies and procedures review). For the second section, participants identified how useful each orientation tactic was on a Likert scale (1 = not useful, 4 = very useful). Descriptive statistics were calculated for each survey item. Mann-Whitney U and Kruskal-Wallis tests were used to determine differences between demographic characteristics and orientation tactics. A Bonferroni correction accounted for multiple comparisons. A panel of experts established the content validity of the survey. The Cronbach α was used to establish internal consistency (α = 0.802) Results: The most common orientation tactics were meeting with supervisors (n = 276, 82.9%) and staff members (eg, coaches; n = 266, 79.9%) and learning responsibilities (n = 254, 76.2%). The least common orientation tactics were simulation of the emergency action plan (n = 66, 19.8%) and preceptor development (n = 71, 21.3%); however, preceptor development was not applicable to many participants. The most useful orientation tactics were simulating the emergency action plan (3.45/4.0) and meeting with staff members (3.44/4.0). Participants who felt their orientation prepared them for their roles were exposed to more tactics during orientation (Mann-Whitney U = 17 212, P < .001). CONCLUSIONS Many tactics were used to orient newly credentialed ATs to their roles, but orientations varied based on the practice setting.
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Disparities in Athletic Trainer Staffing in Secondary School Sport: Implications for Concussion Identification. Clin J Sport Med 2017; 27:542-547. [PMID: 28742604 DOI: 10.1097/jsm.0000000000000409] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE First, to assess whether teams at schools with an athletic trainer (AT) on staff had a higher number of diagnosed concussions than teams without medical personnel present. Second, to assess whether the variability in employment of a certified AT by Washington state high schools is patterned by socioeconomic and demographic characteristics. DESIGN Cross-sectional survey. SETTING Washington state public high schools. PARTICIPANTS Stratified random sample of football and soccer coaches (n = 270 teams, 144 schools). INDEPENDENT VARIABLES Presence of an AT and school characteristics (percentage of students qualifying for free or reduced price lunch, rural location, enrollment). RESULTS Football and boys' soccer teams at schools with an AT had a significantly greater number of athletes with diagnosed concussions compared to teams at schools without an AT (P < 0.05). There was no difference in number of athletes with diagnosed concussions by AT staffing for girls' soccer. Schools with an AT on staff were significantly more likely than schools without an AT to be in an urban location (P < 0.001), to have an enrollment of 1000 students or more (P < 0.001), and to have a smaller proportion of students eligible for school lunch (P = 0.005). CONCLUSIONS The present study provides empirical support for the benefit of ATs in diagnosing concussions in high school sport and underscores the challenges to AT staffing in lower resource settings. These findings cause us to critically reflect on the threshold for medical oversight in contact and collision sport from the perspective of risk prevention, and the extent to which disparities in this medical oversight are acceptable in the public school setting. CLINICAL RELEVANCE Strategies for increasing AT staffing in high school sports settings should be explored given their demonstrated benefit in diagnosing concussions.
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Nottingham SL, Lam KC, Kasamatsu TM, Eppelheimer BL, Bacon CEW. Athletic Trainers' Reasons for and Mechanics of Documenting Patient Care: A Report From the Athletic Training Practice-Based Research Network. J Athl Train 2017; 52:656-666. [PMID: 28574751 DOI: 10.4085/1062-6050-52.3.14] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Documenting patient care is an important responsibility of athletic trainers (ATs). However, little is known about ATs' reasons for documenting patient care and the mechanics of completing documentation tasks. OBJECTIVE To understand ATs' perceptions about reasons for and the mechanics of patient care documentation. DESIGN Qualitative study. SETTING Individual telephone interviews with Athletic Training Practice-Based Research Network members. PATIENTS OR OTHER PARTICIPANTS Ten ATs employed in the secondary school setting (age = 32.6 ± 11.4 years, athletic training experience = 7.1 ± 7.8 years) were recruited using a criterion-based sampling technique. Participants were Athletic Training Practice-Based Research Network members who used the Clinical Outcomes Research Education for Athletic Trainers electronic medical record system and practiced in 6 states. DATA COLLECTION AND ANALYSIS We used the consensual qualitative research tradition. One investigator conducted individual telephone interviews with each participant. Data collection was considered complete after the research team determined that data saturation was reached. Interviews were transcribed verbatim and independently analyzed by 4 research team members following the process of open, axial, and selective coding. After independently categorizing interview responses into categories and themes, the members of the research team developed a consensus codebook, reanalyzed all interviews, and came to a final agreement on the findings. Trustworthiness was established through multiple-analyst triangulation and member checking. RESULTS Participants identified 3 reasons for documenting patient care: communication, monitoring patient care, and legal implications. Four subcategories emerged from the mechanics-of-documentation theme: location, time of day, length of time, and criteria for documenting. The ATs described different criteria for documenting patient care, ranging from documenting every injury in the same manner to documenting time-loss and follow-up injuries differently. CONCLUSIONS Whereas ATs recognized individual mechanisms that enabled them to document patient care, they may need more guidance on the appropriate criteria for documenting various patient care encounters and strategies to help them document more effectively.
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Huggins RA, Scarneo SE, Casa DJ, Belval LN, Carr KS, Chiampas G, Clayton M, Curtis RM, Duffy AJ, Flury A, Gammons M, Hosokawa Y, Jardine JF, LaBella CR, Oats R, Ransone JW, Sailor SR, Scott K, Stearns RL, Vandermark LW, Weston T. The Inter-Association Task Force Document on Emergency Health and Safety: Best-Practice Recommendations for Youth Sports Leagues. J Athl Train 2017; 52:384-400. [PMID: 28430552 DOI: 10.4085/1062-6050-52.2.02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Robert A Huggins
- National Athletic Trainers' Association.,Korey Stringer Institute, University of Connecticut
| | - Samantha E Scarneo
- National Athletic Trainers' Association.,Korey Stringer Institute, University of Connecticut
| | - Douglas J Casa
- National Athletic Trainers' Association.,Korey Stringer Institute, University of Connecticut
| | - Luke N Belval
- National Athletic Trainers' Association.,Korey Stringer Institute, University of Connecticut
| | | | - George Chiampas
- Korey Stringer Institute, University of Connecticut.,US Soccer Federation.,Northwestern University
| | | | - Ryan M Curtis
- National Athletic Trainers' Association.,Korey Stringer Institute, University of Connecticut
| | - A J Duffy
- National Athletic Trainers' Association
| | | | | | - Yuri Hosokawa
- National Athletic Trainers' Association.,Korey Stringer Institute, University of Connecticut
| | | | | | | | | | | | | | - Rebecca L Stearns
- National Athletic Trainers' Association.,Korey Stringer Institute, University of Connecticut
| | - Lesley W Vandermark
- National Athletic Trainers' Association.,Korey Stringer Institute, University of Connecticut
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Eason CM, Mazerolle SM, Goodman A. Organizational Infrastructure in the Collegiate Athletic Training Setting, Part III: Benefits of and Barriers in the Medical and Academic Models. J Athl Train 2016; 52:35-44. [PMID: 27977302 DOI: 10.4085/1062-6050-51.12.25] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Academic and medical models are emerging as alternatives to the athletics model, which is the more predominant model in the collegiate athletic training setting. Little is known about athletic trainers' (ATs') perceptions of these models. OBJECTIVE To investigate the perceived benefits of and barriers in the medical and academic models. DESIGN Qualitative study. SETTING National Collegiate Athletic Association Divisions I, II, and III. PATIENTS OR OTHER PARTICIPANTS A total of 16 full-time ATs (10 men, 6 women; age = 32 ± 6 years, experience = 10 ± 6 years) working in the medical (n = 8) or academic (n = 8) models. DATA COLLECTION AND ANALYSIS We conducted semistructured telephone interviews and evaluated the qualitative data using a general inductive approach. Multiple-analyst triangulation and peer review were completed to satisfy data credibility. RESULTS In the medical model, role congruency and work-life balance emerged as benefits, whereas role conflict, specifically intersender conflict with coaches, was a barrier. In the academic model, role congruency emerged as a benefit, and barriers were role strain and work-life conflict. Subscales of role strain included role conflict and role ambiguity for new employees. Role conflict stemmed from intersender conflict with coaches and athletics administrative personnel and interrole conflict with fulfilling multiple overlapping roles (academic, clinical, administrative). CONCLUSIONS The infrastructure in which ATs provide medical care needs to be evaluated. We found that the medical model can support better alignment for both patient care and the wellbeing of ATs. Whereas the academic model has perceived benefits, role incongruence exists, mostly because of the role complexity associated with balancing teaching, patient-care, and administrative duties.
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Affiliation(s)
- Christianne M Eason
- Department of Athletic Training and Exercise Science, Lasell College, Newton MA
| | - Stephanie M Mazerolle
- Department of Kinesiology, Athletic Training Program, University of Connecticut, Storrs
| | - Ashley Goodman
- Department of Health & Exercise Science, Appalachian State University, Boone, NC
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Goodman A, Mazerolle SM, Eason CM. Organizational Infrastructure in the Collegiate Athletic Training Setting, Part II: Benefits of and Barriers in the Athletics Model. J Athl Train 2016; 52:23-34. [PMID: 27977301 DOI: 10.4085/1062-6050-51.12.24] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT The athletics model, in which athletic training clinical programs are part of the athletics department, is the predominant model in the collegiate athletic training setting. Little is known about athletic trainers' (ATs') perceptions of this model, particularly as it relates to organizational hierarchy. OBJECTIVE To explore the perceived benefits of and barriers in the athletics model. DESIGN Qualitative study. SETTING National Collegiate Athletic Association Divisions I and III. PATIENTS OR OTHER PARTICIPANTS Eight full-time ATs (5 men, 3 women; age = 41 ± 13 years, time employed at the current institution = 14 ± 14 years, experience as a certified AT = 18 ± 13 years) working in the collegiate setting using the athletics model. DATA COLLECTION AND ANALYSIS We conducted semistructured interviews via telephone or in person and used a general inductive approach to analyze the qualitative data. Multiple-analyst triangulation and peer review established trustworthiness. RESULTS Two benefits and 3 barriers emerged from the data. Role identity emerged as a benefit that occurred with role clarity, validation, and acceptance of the collegiate AT personality. Role congruence emerged as a benefit of the athletics model that occurred with 2 lower-order themes: relationship building and physician alignment and support. Role strain, staffing concerns, and work-life conflict emerged as barriers in the athletics model. Role strain occurred with 2 primary lower-order themes: role incongruity and role conflict. CONCLUSIONS The athletics model is the most common infrastructure for employing ATs in collegiate athletics. Participants expressed positive experiences via character identity, support, trust relationships, and longevity. However, common barriers remain. To reduce role strain, misaligning values, and work-life conflict, ATs working in the athletics model are encouraged to evaluate their relationships with coaches and their supervisor and consider team physician alignment. Moreover, measures to increase quality athletic training staff from a care rather than a coverage standpoint should be considered.
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Affiliation(s)
- Ashley Goodman
- Department of Health and Exercise Science, Appalachian State University, Boone, NC
| | - Stephanie M Mazerolle
- Department of Kinesiology, Athletic Training Program, University of Connecticut, Storrs
| | - Christianne M Eason
- Department of Athletic Training and Exercise Science, Lasell College, Newton, MA
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Lam KC, Valier ARS, Anderson BE, McLeod TCV. Athletic Training Services During Daily Patient Encounters: A Report From the Athletic Training Practice-Based Research Network. J Athl Train 2016; 51:435-41. [PMID: 27315222 DOI: 10.4085/1062-6050-51.8.03] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Athletic training services such as taping, wrapping, and stretching are common during routine care but rarely captured in traditional patient documentation. These clinical data are vital when determining appropriate medical coverage and demonstrating the value and worth of athletic trainers (ATs). OBJECTIVE To analyze clinical data from daily encounter forms within the Athletic Training Practice-Based Research Network (AT-PBRN). DESIGN Descriptive study. SETTING Secondary school athletic training clinics. PATIENTS OR OTHER PARTICIPANTS Adolescent patients (n = 4888; age = 16.3 ± 1.4 years) seeking care from ATs. MAIN OUTCOME MEASURE(S) We used Web-based electronic medical records from December 1, 2009, to July 1, 2015, to obtain patient characteristics via deidentified data. Descriptive data regarding practice characteristics from patient encounter forms were analyzed and reported as percentages and frequencies. RESULTS A total of 36 245 patient encounters (mean = 7.5 ± 11.6 encounters per patient) were recorded. Football, basketball, soccer, track, and volleyball accounted for 85.1% of all encounters. Most encounters were for preventive services (48.8%, n = 22 329), followed by care for a current injury (37.2%, n = 17 027) and care for a new injury (13.9%, n = 6368). Of the preventive encounters, taping (52.7%) was the most common service provided, followed by ice- or hot-pack application (25.4%) and treatment (9.6%). Taping (28.7%) was also the most common service for current injuries, followed by treatment (26.7%) and ice- or hot-pack application (26.2%). CONCLUSIONS Our findings highlight the unique role of ATs as health care providers who provide substantial preventive services to their patients. Further, these results represent one of the first attempts to describe athletic training services related to nontime-loss injuries, emphasizing the significant role that ATs play in the health care of secondary school athletes. These findings should help clinicians and administrators make more informed decisions regarding appropriate medical coverage.
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Affiliation(s)
- Kenneth C Lam
- Department of Interdisciplinary Health Sciences, A.T. Still University, Mesa
| | - Alison R Snyder Valier
- Department of Interdisciplinary Health Sciences, A.T. Still University, Mesa.,School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa
| | - Barton E Anderson
- Department of Interdisciplinary Health Sciences, A.T. Still University, Mesa
| | - Tamara C Valovich McLeod
- Department of Interdisciplinary Health Sciences, A.T. Still University, Mesa.,School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa
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Diduch BK, Hudson K, Resch JE, Shen F, Broshek DK, Brady W, Cole SL, Courson R, Castens T, Shimer A, Miller MD. Treatment of Head and Neck Injuries in the Helmeted Athlete. JBJS Rev 2016; 4:01874474-201603000-00002. [PMID: 27500432 DOI: 10.2106/jbjs.rvw.15.00077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Sport-related concussion treatment includes three major phases: initial evaluation at the time of the injury, treatment while the patient is symptomatic, and evaluation of the readiness for a gradual return to participation. Each concussion evaluation should include similar elements: assessment of symptoms, assessment of cognitive ability, assessment of coordination (of the eyes, upper extremities, and lower extremities), and assessment for additional injuries. The spine-boarding recommendations from the American College of Emergency Physicians, National Association of EMS Physicians, and National Athletic Trainers' Association have changed. These recommendations include both decreased use of spinal immobilization and removal of the helmet and shoulder pads prior to securing the athlete to the board when sufficient numbers of trained providers are present. Preseason training and pregame meetings or "medical time outs" should become standard practice for the sidelines medical team (including the athletic trainer, team physician, emergency response personnel, and possibly others).
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Affiliation(s)
- B Kent Diduch
- Department of Health Sciences, James Madison University, Harrisonburg, Virginia
| | - Korin Hudson
- Department of Emergency Medicine, MedStar Georgetown University Hospital & Washington Hospital Center, Washington, DC
| | - Jacob E Resch
- Department of Kinesiology (J.E.R.), Spine Division, Spine Center, Department of Orthopaedic Surgery (F.S.), Department of Psychiatry and Neurobehavioral Sciences (D.K.B.), Department of Emergency Medicine, University of Virginia School of Medicine (W.B.), Orthopedic Inpatient Unit, Department of Orthopaedic Surgery (A.S.), Division of Sports Medicine (M.D.M.), University of Virginia, Charlottesville, Virginia
| | - Francis Shen
- Department of Kinesiology (J.E.R.), Spine Division, Spine Center, Department of Orthopaedic Surgery (F.S.), Department of Psychiatry and Neurobehavioral Sciences (D.K.B.), Department of Emergency Medicine, University of Virginia School of Medicine (W.B.), Orthopedic Inpatient Unit, Department of Orthopaedic Surgery (A.S.), Division of Sports Medicine (M.D.M.), University of Virginia, Charlottesville, Virginia
| | - Donna K Broshek
- Department of Kinesiology (J.E.R.), Spine Division, Spine Center, Department of Orthopaedic Surgery (F.S.), Department of Psychiatry and Neurobehavioral Sciences (D.K.B.), Department of Emergency Medicine, University of Virginia School of Medicine (W.B.), Orthopedic Inpatient Unit, Department of Orthopaedic Surgery (A.S.), Division of Sports Medicine (M.D.M.), University of Virginia, Charlottesville, Virginia
| | - William Brady
- Department of Kinesiology (J.E.R.), Spine Division, Spine Center, Department of Orthopaedic Surgery (F.S.), Department of Psychiatry and Neurobehavioral Sciences (D.K.B.), Department of Emergency Medicine, University of Virginia School of Medicine (W.B.), Orthopedic Inpatient Unit, Department of Orthopaedic Surgery (A.S.), Division of Sports Medicine (M.D.M.), University of Virginia, Charlottesville, Virginia
| | | | | | - Titus Castens
- Albemarle County Fire Rescue, Charlottesville, Virginia
| | - Adam Shimer
- Department of Kinesiology (J.E.R.), Spine Division, Spine Center, Department of Orthopaedic Surgery (F.S.), Department of Psychiatry and Neurobehavioral Sciences (D.K.B.), Department of Emergency Medicine, University of Virginia School of Medicine (W.B.), Orthopedic Inpatient Unit, Department of Orthopaedic Surgery (A.S.), Division of Sports Medicine (M.D.M.), University of Virginia, Charlottesville, Virginia
| | - Mark D Miller
- Department of Kinesiology (J.E.R.), Spine Division, Spine Center, Department of Orthopaedic Surgery (F.S.), Department of Psychiatry and Neurobehavioral Sciences (D.K.B.), Department of Emergency Medicine, University of Virginia School of Medicine (W.B.), Orthopedic Inpatient Unit, Department of Orthopaedic Surgery (A.S.), Division of Sports Medicine (M.D.M.), University of Virginia, Charlottesville, Virginia
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Keeley K, Walker SE, Hankemeier DA, Martin M, Cappaert TA. Athletic Trainers' Beliefs About and Implementation of Evidence-Based Practice. J Athl Train 2016; 51:35-46. [PMID: 26845629 DOI: 10.4085/1062-6050-51.2.11] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Understanding the beliefs about and use of evidence-based practice (EBP) among athletic trainers (ATs) will help to determine appropriate strategies to improve implementation. OBJECTIVE To examine the ATs' beliefs about and use of EBP. DESIGN Cross-sectional study. SETTING Online survey instrument. PATIENTS OR OTHER PARTICIPANTS A total of 467 ATs responded to the survey request, a response rate of 11.67%. A total of 385 (9.6%) completed the EBP Beliefs Scale and 342 (8.5%) completed the EBP Implementation Scale. MAIN OUTCOME MEASURE(S) The EBP Beliefs Scale and EBP Implementation Scale were administered. The surveys collected demographic information in addition to information about participants' beliefs regarding EBP and implementation of EBP in clinical practice. RESULTS The ATs demonstrated a level of neither agree nor disagree (56.00 ± 7.86) on the EBP Beliefs Scale. Belief scores were higher among those ATs required to document for third-party reimbursement (P = .001), those with access to current research through professional journals other than the Journal of Athletic Training (P = .02), and those with a doctoral degree (P = .01). A low level of implementation (9.00 ± 11.38), representing the implementation of EBP approximately 0 times in the previous 8 weeks, was found on the EBP Implementation Scale. Implementation scores were higher among preceptors (P = .01), those required to document for third-party reimbursement (P < .001), those with access to current research through professional journals (P = .002), and those with a doctoral degree (P = .01). CONCLUSIONS Participants had a positive attitude toward EBP; however, they were not implementing EBP concepts when providing patient care. This suggests that additional information and EBP resources are needed so ATs can better implement EBP in practice. To provide the best patient care and to promote EBP within the profession, clinicians should make EBP a priority and advocate for EBP implementation.
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Affiliation(s)
- Kimberly Keeley
- Department of Exercise & Rehabilitative Sciences, Slippery Rock University, PA
| | - Stacy E Walker
- School of Kinesiology, Ball State University, Muncie, IN
| | | | - Malissa Martin
- Rocky Mountain University of Health Professions, Provo, UT
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Lombardi N, Freedman K, Tucker B, Austin L, Eck B, Pepe M, Tjoumakaris F. Economic analysis of athletic team coverage by an orthopedic practice. PHYSICIAN SPORTSMED 2015; 43:355-9. [PMID: 26414156 DOI: 10.1080/00913847.2015.1092858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Coverage of high school football by orthopedic sports medicine specialists is considered standard of care in many localities. Determining the economic viability of this endeavor has never been investigated. The primary purpose of the present investigation was to perform an economic analysis of local high school sports coverage by an orthopedic sports medicine practice. METHODS From January 2010 to June 2012, a prospective injury report database was used to collect sports injuries from five high school athletic programs covered by a single, private orthopedic sports medicine practice. Patients referred for orthopedic care were then tracked to determine expected cost of care (potential revenue). Evaluation and management codes and current procedure terminology codes were obtained to determine the value of physician visits and surgical care rendered. Overhead costs were calculated based on historical rates within our practice and incorporated to determine estimated profit. RESULTS 19,165 athletic trainer contacts with athletes playing all sports, including both those 'on-field' and in the training room, resulted in 473 (2.5%) physician referrals. The covering orthopedic practice handled 89 (27.9%) of the orthopedic referrals. Of orthopedic physician referrals, 26 (5.4%) required orthopedic surgical treatment. The covering team practice handled 17/26 (65%) surgical cases. The total revenue collected by the covering team practice was $26,226.14. The overhead cost of treatment was $9441.41. Overall estimated profit of orthopedic visits and treatment during this period for the covering practice was $16,784.73. CONCLUSIONS The covering team practice handled 28% of the orthopedic referrals, 65% of the surgical cases and captured 59% of the potential profit. An increase in physician referrals could increase the benefit for orthopedic surgeons.
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Affiliation(s)
- Nicholas Lombardi
- a 1 Rothman Institute of Orthopaedics at Thomas Jefferson University , Egg Harbor Township, NJ, USA
| | - Kevin Freedman
- a 1 Rothman Institute of Orthopaedics at Thomas Jefferson University , Egg Harbor Township, NJ, USA
| | - Brad Tucker
- a 1 Rothman Institute of Orthopaedics at Thomas Jefferson University , Egg Harbor Township, NJ, USA
| | - Luke Austin
- a 1 Rothman Institute of Orthopaedics at Thomas Jefferson University , Egg Harbor Township, NJ, USA
| | - Brandon Eck
- b 2 Mercy Suburban Hospital , Norristown, PA, USA
| | - Matt Pepe
- a 1 Rothman Institute of Orthopaedics at Thomas Jefferson University , Egg Harbor Township, NJ, USA
| | - Fotios Tjoumakaris
- a 1 Rothman Institute of Orthopaedics at Thomas Jefferson University , Egg Harbor Township, NJ, USA
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Wilkerson GB, Hainline BW, Colston MA, Denegar CR. The need for accountability and transparency in intercollegiate athletic medicine. J Athl Train 2015; 49:5-6. [PMID: 24499038 DOI: 10.4085/1062-6050-49.1.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kroshus E, Baugh CM, Daneshvar DH, Stamm JM, Laursen RM, Austin SB. Pressure on Sports Medicine Clinicians to Prematurely Return Collegiate Athletes to Play After Concussion. J Athl Train 2015. [PMID: 26207440 DOI: 10.4085/1062-6050-50.6.03] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
CONTEXT Anecdotal and qualitative evidence has suggested that some clinicians face pressure from coaches and other personnel in the athletic environment to prematurely return athletes to participation after a concussion. This type of pressure potentially can result in compromised patient care. OBJECTIVE To quantify the extent to which clinicians in the collegiate sports medicine environment experience pressure when caring for concussed athletes and whether this pressure varies by the supervisory structure of the institution's sports medicine department, the clinician's sex, and other factors. DESIGN Cross-sectional study. SETTING Web-based survey of National College Athletic Association member institutions. PATIENTS OR OTHER PARTICIPANTS A total of 789 athletic trainers and 111 team physicians from 530 institutions. MAIN OUTCOME MEASURE(S) We asked participants whether they had experienced pressure from 3 stakeholder populations (other clinicians, coaches, athletes) to prematurely return athletes to participation after a concussion. Modifying variables that we assessed were the position (athletic trainer, physician) and sex of the clinicians, the supervisory structure of their institutions' sports medicine departments, and the division of competition in which their institutions participate. RESULTS We observed that 64.4% (n = 580) of responding clinicians reported having experienced pressure from athletes to prematurely clear them to return to participation after a concussion, and 53.7% (n = 483) reported having experienced this pressure from coaches. Only 6.6% (n = 59) reported having experienced pressure from other clinicians to prematurely clear an athlete to return to participation after a concussion. Clinicians reported greater pressure from coaches when their departments were under the supervisory purview of the athletic department rather than a medical institution. Female clinicians reported greater pressure from coaches than male clinicians did. CONCLUSIONS Most clinicians reported experiencing pressure to prematurely return athletes to participation after a concussion. Identifying factors that are associated with variability in pressure on clinicians during concussion recovery can inform potential future strategies to reduce these pressures.
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Affiliation(s)
- Emily Kroshus
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA.,Sport Science Institute, National Collegiate Athletic Association, Indianapolis, IN.,Edmond J. Safra Center for Ethics, Harvard University, Boston, MA
| | - Christine M Baugh
- Edmond J. Safra Center for Ethics, Harvard University, Boston, MA.,Interfaculty Initiative in Health Policy, Harvard University, Boston, MA.,Division of Sports Medicine, Boston Children's Hospital, MA
| | - Daniel H Daneshvar
- Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine, MA.,Sports Legacy Institute, Boston, MA
| | - Julie M Stamm
- Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine, MA.,Department of Anatomy and Neurobiology, Boston University School of Medicine, MA
| | - R Mark Laursen
- Sargent College of Health and Rehabilitation Sciences, Boston University, MA
| | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA.,Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, MA.,Department of Pediatrics, Harvard Medical School, Boston, MA
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