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Determining Varying Levels of Cultural Competence in Athletic Trainers Compared to Other Healthcare Providers When Treating Lesbian or Gay Patients

Emily Madrak, Jennifer L. Volberding, and Ashley M. Harris

The lesbian, gay, bisexual, transgender, queer/questioning, intersex, and ally or asexual cultural competence has become a point of emphasis in patient care in the profession of athletic training. The purpose of this study was to determine the level of cultural competence (CC) in athletic trainers (ATs) compared with other health care providers when treating lesbian/gay (L/G) patients as well as at which sexual orientation and gender demonstrated greater CC in L/G patients by using the Gay Affirmative Practice Scale. Health care providers include physicians, nurses, and mental health counselors (MHC). Statistical analysis comparing the occupations, sexual orientations, and gender, each in one-way analysis of variances, (including nonparametric modifications) demonstrated significant results for occupation, χ2(8) = 69.888, p < .05 and sexual orientation χ2(3) = 22.250, p < .05, indicating post hoc analyses. Post hoc demonstrated significance in occupation (AT and MHC, AT and nursing, and MHC and nursing) and sexual orientation (heterosexual and L/G). The result of these analyses provides evidence that ATs have less CC when caring for L/G patients compared with MHC and nursing. Finally, L/G providers demonstrate a greater CC than their counterparts, when caring for L/G patients.

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The Effect of Maximalist Running Shoes on Impact Loading: A Critically Appraised Topic

Janice K. Loudon and Marcie Swift

Clinical Scenario: Running injuries are common in runners. The use of maximal cushioned shoes (MAX) has been suggested as a preventive measure for reducing impact loading and thus running-related injuries. Clinical Question: Do maximalist running shoes reduce impact loading compared to traditional shoes in runners? Summary of Key Findings: A search was performed for articles exploring MAX on impact loading in runners. Five articles were included in this critically appraised topic. All were case-controlled laboratory studies that compared the MAX to a traditional running shoe. None of the studies found a reduction in impact loading with use of the MAX. Clinical Bottom Line: Based on five case-controlled studies, a MAX does not reduce impact loading on level surfaces or downhill running. Based on mixed results, the MAX may increase impact forces during level and downhill running. Future research should include randomized controlled trials that assess impact forces after the runner has adapted to the MAX and after running ultradistances. Strength of Recommendation: In agreement with the Center of Evidence-Based Medicine, the consistent results from five Level III intervention studies designate that there is Level C evidence that MAX do not reduce impact loading during a single running trial.

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Effects of Physical Activity Timing and Intensity on the Occurrence and Risk of Nocturnal Hypoglycemia in Adolescents With Type 1 Diabetes

Rebecca L. Potter, Erin M. Moore, and Rebecca M. Lopez

Clinical Scenario: Athletic trainers should be aware of how physical activity may influence the risk of nocturnal hypoglycemia in adolescents with type 1 diabetes (T1D). Clinical Question: Does the timing and intensity of physical activity affect the occurrence and risk of nocturnal hypoglycemia in adolescents with T1D? Results of the Search: Four studies meeting the inclusion criteria were found and included in the appraisal. Three studies were prospective observational cohorts, and one was a randomized case-crossover study. Clinical Bottom Line: Adolescents with T1D may be at greater risk of nocturnal hypoglycemia after performing 30–60 minutes of moderate-to-vigorous physical activity during the late afternoon or evening. Implications: Athletic trainers should educate adolescents with T1D and their parents about the risk of nocturnal hypoglycemia after MVPA, and work in collaboration with the diabetes care physician to ensure prevention techniques are included in the patient'’s diabetes care plan. Level of Evidence: Strength of Recommendation Taxonomy Grade B.

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Efficacy of a Mulligan Concept Sustained Natural Apophyseal Glide Technique for Cervicogenic Headache: A Critically Appraised Topic

Kyle North, Koki Kawaguchi, Michelle Perri, Megan Mormile, Russell T. Baker, James May, and Alan Nasypany

Clinical Question : In adults with cervicogenic headache (CGH), what are the effects of a clinician-applied Mulligan Concept C1–C2 rotational sustained natural apophyseal glide on cervicogenic symptomology? Clinical Bottom Line: Both Level 2b and Level 4 evidence of Grade B quality exists to support using the C1–C2 rotational sustained natural apophyseal glide to decrease CGH severity and participant-reported neck disability immediately posttreatment, while also increasing cervical range of motion in adult patients with CGH headaches and a positive flexion–rotation test. Further research should examine the long-term effects of the C1–C2 rotational sustained natural apophyseal glide technique on cervical range of motion, flexion–rotation test results, and CGH frequency and severity. In addition, the flexion–rotation test should be explored as a standard diagnostic assessment in CGH cases.

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High-Load Squat Training Improves Sprinting Performance in Junior Elite-Level Soccer Players: A Critically Appraised Topic

Lars H. Lohmann, Konstantin Warneke, Stephan Schiemann, and Irene R. Faber

Practical Question: Is high-load squat training beneficial in improving sprinting performance in junior elite-level soccer players? Clinical Bottom Line: There is Level 3 evidence to support the validity of high-load squat training as a measure to improve sprinting performance in junior male elite-level soccer players. All three studies included showed significant increases in soccer-related sprinting performance.

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Unstable Osteochondral Fracture of the Talus, Osteochondritis Dissecans, and Chronic Lateral Ankle Instability in an Adolescent Athlete: A Case Report

Toby J. Brooks, Kevin Crawford, and Eugene E. Curry

A 15-year-old multisport athlete with chronic left ankle pain and instability 2 years following initial injury was diagnosed with an unstable osteochondral fracture of the lateral talar dome, osteochondritis dissecans, and lateral ligament instability. The patient underwent open surgical repair consisting of loose body excision, lateral ligament reconstruction, and talar dome debridement and microfracture followed by postoperative therapeutic exercise for 7 months. The patient successfully returned to competitive sports within a calendar year. Although not considered particularly rare among adult populations, osteochondral fracture of the talus is relatively rare in adolescents. This case demonstrates that a diagnosis of unstable osteochondral fracture and/or gross lateral ligament instability should be considered in cases involving adolescent athletes with significant ankle injury and prolonged pain and/or loss of function.

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Continuing Education Assessment

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Volume 27 (2022): Issue 5 (Sep 2022)

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Does Reactive Neuromuscular Training Increase Gluteal Musculature Activation During Squatting Movements? A Critically Appraised Topic

Ian Brewer, Josh Zimmerman, Marcie Fyock-Martin, Nelson Cortes, and Joel Martin

Clinical Question: Does reactive neuromuscular training (RNT) increase gluteal muscle activation during squatting movements? Clinical Bottom Line: The current best evidence suggests RNT may result in acute increases of gluteus maximus and gluteus medius muscle activation when performing the barbell back squat exercise; however, the findings were inconsistent and unclear for other types of squatting movements. Grades B and D evidence exists on the effects of RNT to increase gluteus maximus and medius muscle activation, respectively, during squatting movements. Given the methodological differences and mixed findings reported in this critically appraised topic, practitioners should carefully consider whether using RNT would be appropriate for a given clinical scenario.

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Clinical Decision Making in Athletic Training

Russell L. Muir

Athletic trainers frequently make decisions under uncertain conditions leading to the use of decisional shortcuts (heuristics). Heuristics can be useful decisional tools, but their use gives rise to predictable cognitive errors (cognitive bias), which can lead to diagnostic and injury management errors. This study assessed athletic trainers’ understanding of these topics and explored their presence in athletic training education. Few participants were taught about heuristics (11.6%) and cognitive bias (24.1%), although those taught about heuristics demonstrated greater understanding of both topics. To improve clinical efficacy and patient outcomes, athletic trainers should seek educational opportunities related to heuristics and cognitive bias.