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Continuing Education Assessment

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Volume 28 (2023): Issue 1 (Jan 2023)

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Efficacy of Helmet Use on Head Injury Reduction in Snow Sports: A Critically Appraised Topic

Kaelin Agar, Spencer DeMedal, Abbigail Delmonte, Lauren Bell, Kyle Fisher, and Erica Beidler

Context: Review articles published in 2010 concluded that there was strong evidence to support the use of helmets as a way to decrease the risk of sustaining a head injury during snow sport participation. However, new research published over the last decade on this relationship warrants revisiting this primary injury prevention approach. Clinical Question: What is the effect of helmet use on the occurrence of head injuries in snow sports? Clinical Bottom Line: The results from the included studies did not consistently find a reduction in head injury occurrence with helmet use in snow sports. Rather, the collective findings were more supportive of a neutral relationship between helmet use and head injuries. Therefore, these heterogeneous findings indicate there is SORT Level B evidence to support the use of helmets as a primary head injury prevention approach in snow sports. Future initiatives should acknowledge the multifaceted nature of injury occurrence and seek to educate the public more clearly on the limitations of helmet use during skiing and snowboarding.

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Perceived Stress as an Indicator of Work–Family Conflict and Burnout Among Secondary School Athletic Trainers

Alexandrya H. Cairns, Stephanie M. Singe, and Christianne M. Eason

Burnout and work–family conflict (WFC) are stressors faced by secondary school athletic trainers, however, the concept of perceived stress and its relationship to burnout or WFC is not well understood. The purpose of this study was to investigate perceived stress’ relationship with burnout and WFC. Participants reported a WFC score of 40.36 (±15.63), low burnout (40.1 ± 16.28), and moderate stress (15.99 ± 7.02). Perceived stress predicted WFC, but not burnout (b = 1.13, t 572 = 14.132, p ≤ .001). One’s level of perceived stress impacts WFC, which indicates higher stress will equal greater work–family conflict.

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Test–Retest Reliability and Minimum Detectable Change of the Athletic Trainers’ Self-Confidence Scale

Hannah L. Stedge, Thomas Cappaert, Valerie W. Herzog, Beth Kinslow, and Malissa Martin

The Athletic Trainers’ Self-Confidence Scale (ATSCS) is a nine-item Likert-scale questionnaire assessing the respondent’s level of agreement with statements regarding confidence in recognizing and managing exertional heat illnesses. Test–retest reliability of this instrument has not yet been established. The purpose of this study was to investigate the internal consistency, test–retest reliability, and minimum detectable change score for the composite score of the ATSCS. A total of 18 professional master of science in athletic training students (nine first-year and nine second-year students) completed the ATSCS at three testing sessions with 48 hr between sessions. The nine items of the ATSCS demonstrated good internal consistency (α = .86; 95% confidence interval [.78, .94]). The composite scores of the ATSCS demonstrated moderate test–retest reliability (intraclass correlation coefficient = .75; 95% confidence interval [.497, .893]). The calculated minimal detectable change for the composite change score was 6.19. The ATSCS has good internal reliability as well as test–retest reliability. These results display that the tool will provide consistent, reliable results of changes in athletic training students’ self-confidence.

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The Inclusion of a Complementary Running Progression Program in the Rehabilitation of Acute Hamstring Injuries: A Critically Appraised Topic

Michelle A. Sandrey

Introduction/Clinical Scenario : As many hamstring injuries occur when the hamstrings are in a lengthened state during the deceleration phase of running when the muscle is eccentrically contracting to slow the body down this functional aspect needs to be addressed. Thus, a rehabilitation program with a focus on progressive targeted eccentric hamstring exercises by gradually placing and exposing the muscle to eccentric force in a lengthened state supplemented with progressive running drills should be evaluated. Focused Clinical Question : Does the inclusion of a complementary running progression program for the rehabilitation of an acute hamstring injury reduce the time to safe return to sport with less hamstring reinjury occurrence for an athletic population? Summary of Key Findings: Three studies assessed the inclusion of a progressive running program with several types of running progression parameters addressed. Progressive running drills will load the hamstring in a functional manner, with a gradual increase in velocity of movement and lengthening of the muscle. Clinical Bottom Line : It appears that a complementary progressive running program within an acute hamstring rehabilitation program should be included as it caused no further harm and does not tend to increase hamstring reinjury occurrence. Strength of Recommendation : There is grade B evidence to include a complementary running progression program within an acute hamstring rehabilitation program.

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The Relationship Between Stress Fractures and Bone Turnover Markers Is Unclear in Athletic and Military Populations: A Critically Appraised Topic

Karrie L. Hamstra-Wright, Eddin Djelovic, and Justin Payette

Clinical Scenario: Having an indication of how bone is remodeling in response to training load could help identify athletes and military personnel at increased stress fracture (SFx) risk. Direct assessment of bone remodeling is impractical. Biochemical markers of bone turnover are used as an indirect measure of bone remodeling and have potential to inform prevention and treatment efforts. To date, the relationship between bone turnover markers and SFxs in athletes or military personnel remains unclear. Clinical Question: Are SFxs related to bone turnover markers in athletes and military personnel? Summary of Key Findings: Seven met eligibility criteria. In five studies, an association between SFxs and bone turnover markers existed. Clinical Bottom Line: The evidence supporting a relationship between SFxs and bone turnover markers in athletes and military personnel is mixed. While five of the seven studies reported some type of relationship, no studies prospectively measured bone turnover markers in a group of athletes or military personnel without an SFx or without SFx history and followed them over time to reassess bone turnover markers upon SFx occurrence. Strength of Clinical Recommendation: In accordance with the Strength of Recommendation Taxonomy, Grade C is the most appropriate strength of recommendation rating.

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Effectiveness of Kinesiotaping in Reducing Postoperative Knee Edema and Pain Compared to Other Standard Treatments: A Critically Appraised Topic

Erin Frey, Kayla Ruszin, and Emily E. Hildebrand

Focused Clinical Question: Does the application of kinesiotape compared with standard treatments result in greater/faster postoperative edema reduction after total knee replacement or anterior cruciate ligament repair?Clinical Bottom Line: There was sufficient evidence to support the application of kinesiotape to reduce postoperative edema brought on by a total knee replacement or anterior cruciate ligament repair. Patients who received kinesiotaping, applied to the skin with a pattern to enhance lymphatic drainage, showed significant decreases in postoperative knee circumference measurements and pain levels. Kinesiotaping application under these acute conditions offers an evidence-based approach for clinicians to optimize the physiological environment and promote progress through a patient’s phases of healing.

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The Effects of the Mulligan Concept on Adults With Lateral Epicondylalgia Compared With Traditional Physiotherapy: A Critically Appraised Topic

Shayane Santiago, Moni Syeda, Jason Bartholomew, and Russell T. Baker

Focused Clinical Question: What are the effects of the Mulligan Concept combined with traditional physiotherapy on lateral elbow pain and grip strength in adults with lateral epicondylalgia (LE) compared with traditional physiotherapy? Clinical Bottom Line: Grade B evidence supports positive effects of the Mulligan Concept combined with traditional physiotherapy on LE compared with traditional physiotherapy alone. However, the effects of the Mulligan Concept as a standalone intervention in the treatment of LE are not well known. Therefore, additional research is warranted to determine the individual effects of the Mulligan Concept compared with its use in a comprehensive rehabilitation protocol to treat LE in adults.

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