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Concussion Management Among National Collegiate Athletic Association Swim Programs

Katie Ritter, Ashley N. Marshall, Keenan Robinson, Dilaawar J. Mistry, Meeryo C. Choe, and Tamara Valovich McLeod

The nuances of swimming make the application of traditional return-to-play progressions following concussion challenging. Our purpose was to describe athletic training services and concussion management protocols among National Collegiate Athletic Association swim programs and compare them between the National Collegiate Athletic Association divisions. We surveyed 228 athletic trainers assigned to or with knowledge of their institution’s swim programs from a convenience sample of 539 (response rate = 42.3%) athletic trainers. Athletic training services were provided to 98.6% (214/217) of the programs. Nearly 80% (164/207) of the programs administered baseline concussion testing to swimmers, with differences observed between divisions (p < .001). No differences (p = .108) in the number of concussions sustained by swimmers in the past academic year were noted between divisions. Specific return-to-swim protocols were reported by 51.8% (115/222) of respondents with no differences in the presence of a specific return-to-swim protocol between divisions (p = .790). While concussions are reported less frequently in swimming than other sports, appropriate medical care, including a specific return-to-swim protocol, is warranted and provided for future use.

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Health-Related Quality of Life Among Patients With Painful Chronic Ankle Instability

Kyle B. Kosik, Matthew C. Hoch, Stacey Slone, Katherine A. Bain, and Phillip A. Gribble

More than half of individuals with chronic ankle instability (CAI) experience lingering pain from a previous injury. However, there is little empirical evidence investigating the role pain has on health-related quality of life (HRQL). The purpose of this cross-sectional study was to compare physical and psychological HRQL between CAI individuals with and without pain. Group comparisons demonstrated that CAI individuals with pain displayed a lower physical and mental HRQL than those without pain. In addition, CAI individuals with pain reported greater injury-related fear. These findings suggest that persistent pain compounds the negative effect that ankle joint instability has on physical and mental HRQL outcomes. Therefore, conservative therapies should consider multimodal approaches rather than focusing on joint stability alone.

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The Need for Contextual Intelligence in Athletic Training

Matthew R. Kutz

Athletic training and the environment in which it is practiced is constantly changing. The emergent environment is volatile, uncertain, complex, and ambiguous. This new environment necessitates an adjustment to athletic training education particularly as it pertains to the instruction and development of the nonclinical skills (meta-skills) needed for clinical settings. One such meta-skill is contextual intelligence. Contextual intelligence is the capacity to recognize the convergence of different variables and respond to the emerging context as it is developing. Practicing contextual intelligence includes integrating 12 specific behaviors and the 3D thinking framework of hindsight, insight, and foresight into clinical decision making.

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NATA News & Notes

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Athletic Trainers’ Perceptions of Patient-Reported Outcomes After Completing a Clinic-Wide Implementation Program

Lauren M. Gardner, Tricia M. Kasamatsu, and Melissa M. Montgomery

Patient-reported outcomes (PROs) are important for capturing patients’ perspectives on quality of life and aiding in provision of whole-person patient care; yet, PROs are not routinely used in athletic training practice. We investigated the athletic trainers’ perceptions of using PROs after they had completed a required PRO implementation program. Athletic trainers had positive perceptions after integrating PROs into clinical practice. Barriers associated with PRO use may be improved with a support structure that requires accountability and provides resources such as reminders and professional development to recognize ways that PROs can be used to improve patient care.

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The Neuromatrix Theory of Pain and Transactional Theory of Stress and Coping: Improving Understanding of Pain Catastrophizing in Individuals With ACL Reconstruction and Knee Osteoarthritis

Francesca M. Genoese, Matthew S. Harkey, and Shelby E. Baez

Individuals with anterior cruciate ligament reconstruction and early knee osteoarthritis symptoms commonly exhibit psychological impairments, such as pain catastrophizing. Pain catastrophizing is a negative cognitive–affective response to anticipated or actual pain and has been linked to greater pain intensity and decreased function in this population. However, an examination of the neuromatrix theory of pain and the transactional theory of stress and coping may help to explain the development and consequences of pain catastrophizing in individuals with anterior cruciate ligament reconstruction and early knee osteoarthritis symptoms. Exploration of these theoretical models will help clinicians better understand the impact of pain catastrophizing on post-injury outcomes, as well as help to identify intervention strategies to address maladaptive psychological responses and improve outcomes for individuals with anterior cruciate ligament reconstruction and early knee osteoarthritis symptoms.

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Clinician Impact on Athlete Recovery and Readiness in a 24-Hour Training Cycle

Dana P. Golden and Jay N. Hertel

This paper explores a 24-hr training cycle and how clinicians contribute to an athlete’s transition from recovery to readiness. The cycle is divided into three phases: immediate, intermediate, and extended. Phase break down is meant to provide wellness prioritization for the athlete and how the clinician can facilitate sustainable performance during a competitive season.

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Influence of Self-Reported Concussion History and a Dual-Task Paradigm on Multidirectional Gait and Cognitive Performance of Athletes

Maria K. Talarico, Matthew P. Brancaleone, Kayla E. Berezne, James A. Onate, and Laura C. Boucher

Single-task assessments may not identify lingering effects following a concussion that may be detected under dual-task (DT) paradigms. The purpose of this study was to determine the effects of a novel DT paradigm and concussion history on gait and cognitive performance. Hockey and rugby club college athletes (n = 26) completed a box drill and the color and word Stroop test under single task and DT. Distance ambulated around the box, response rate, and accuracy were recorded to calculate dual-task cost. Mean comparisons and linear mixed-effects regression models were performed. Compared to athletes with no concussion history, those with a history had a greater motor than cognitive dual-task cost and were 3.15% less accurate in Stroop responses (p < .01). Athletes walked 0.72-m shorter distance under DT compared to single task (p = .04). A multidirectional, low-tech DT assessment may highlight long-term motor and cognitive deficits among athletes with a concussion history, which will provide valuable information to prepare and track performance within an athletic season.

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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.