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Hannah L. Stedge and Theresa Miyashita

Clinical Scenario: Athletic trainers must be confident when performing life-saving skills, such as a cardiovascular assessment and cardiopulmonary resuscitation. Learning and performing skills on high-fidelity simulation manikins may improve athletic training students’ self-confidence and self-efficacy. Clinical Question: What are the effects of high-fidelity manikin simulation on athletic training students’ self-confidence and self-efficacy in performing emergency cardiovascular care? Summary of Key Findings: Three good-quality cohort studies were included. Two studies assessed the effect of high-fidelity cardiopulmonary resuscitation simulation, and one study assessed the effect of high-fidelity cardiovascular assessment. Two studies evaluated self-confidence, while the other study evaluated self-efficacy. All three studies found that high-fidelity simulation improved athletic training students’ self-confidence and self-efficacy. Clinical Bottom Line: There is currently consistent, good-quality evidence that supports the use of high-fidelity manikin simulation to improve athletic training students’ self-confidence and self-efficacy in performing cardiovascular skills and assessment. Future research should examine the effects of high-fidelity manikin simulation on the same academic levels of athletic training students to ensure generalizability of results. Strength of Recommendation: The grade of B is recommended by the Strength of Recommendation Taxonomy for consistent, good-quality evidence.

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Sophie E. Heywood, Benjamin F. Mentiplay, Ann E. Rahmann, Jodie A. McClelland, Paula R. Geigle, Kelly J. Bower, and Ross A. Clark

Context: Aquatic plyometric training may provide benefits due to reduced joint loading compared with land plyometric training; however, the reduced loading may also limit performance gains. Objective: To systematically review the effect of aquatic plyometric training on strength, performance outcomes, soreness, and adverse events in healthy individuals. Evidence acquisition: Five databases were searched from inception to June 2020. Quality assessment and data extraction were independently completed by 2 investigators. When similar outcome measures were used, standardized mean differences were calculated. Evidence synthesis: A total of 19 randomized controlled trials with 633 participants (mean age, range 14–30 y) were included. Aquatic plyometric training was most commonly performed in waist to chest deep water (12/19 studies), 2 to 3 times per week for 6 to 12 weeks (18/19 studies), with final program foot contacts ranging from 120 to 550. Meta-analyses were not completed due to the clinical and statistical heterogeneity between studies. Compared with land plyometric training, aquatic plyometric training exercises and dosage were replicated (15/16 studies) and showed typically similar performance gains (3/4 knee extensor strength measures, 2/4 leg extensor strength measures, 3/4 knee flexor strength measures, 7/10 vertical jump measures, 3/3 sprint measures). In total, 2 of 3 studies monitoring muscle soreness reported significantly less soreness following training in water compared with on land. Compared with no active training (no exercise control group or passive stretching), most effect sizes demonstrated a mean improvement favoring aquatic plyometric training (23/32 measures). However, these were not significant for the majority of studies measuring isokinetic knee strength, vertical jump, and sprinting. The effect sizes for both studies assessing leg press strength indicated that aquatic plyometric training is significantly more effective than no training. Conclusion: Aquatic plyometric training appears similarly effective to land plyometric exercise for improving strength, jumping, and sprinting and may be indicated when joint impact loading needs to be minimized. However, the low quality of studies limits the strength of the conclusions.

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Jacob J. Levy, Terrance L. Tarver, and Hannah R. Douglas

Changes in exercise behavior and negative emotional states (i.e., depression, anxiety, and stress) in combat sport (e.g., boxing, wrestling, martial arts) athletes were examined the month prior to gym closures related to the COVID-19 pandemic (February 2020), and approximately 1 month following gym closures (May 2020). A total of 312 combat sport athletes from 33 different countries responded to the study solicitation. Results indicated a significant decrease in combat sport training following gym closures; however, participation in other exercise activities did not significantly change. Significant mean increases in depression, anxiety, and stress were found following combat gym closures. Regression analyses revealed that number of hours of participants participated in combat sport training added significant incremental variance explained in depressive and stress symptoms above and beyond that accounted for by sex differences, preexisting conditions, and training level. Practical implications regarding losses to preferred exercise activities are discussed.

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Megan Drew, Trent A. Petrie, and Tess Palmateer

College student athletes face unique, sport-related stressors that may lead to, or exacerbate, mental health (MH) concerns and symptoms. Although the National Collegiate Athletic Association has identified MH screening as a best practice, minimal data exist regarding contemporary screening practices. We explored National Collegiate Athletic Association Division I (DI), Division II (DII), and Division III (DIII) athletic departments’ current MH screening practices (N = 264). Compared with DII/DIII (53%), a greater percentage of Division I (89%) conducted formal MH screening. At DII/DIII institutions, athletic trainers were more likely to both administer and review screeners than any other sports medicine professional; sport psychologists primarily oversaw these tasks at DI schools. DI, compared with DII/DIII, institutions were more likely to have had a student athlete attempt suicide (62% vs. 40%) and participate in inpatient treatment (69% vs. 43%). There is a clear need for the National Collegiate Athletic Association to continue to promote policies that support MH screening and to create mechanisms in which it can monitor institutional involvement.

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Zachary L. Mannes, Erin G. Ferguson, Nicole Ennis, Deborah S. Hasin, and Linda B. Cottler

Over 80% of National Football League (NFL) retirees experience daily pain. Pain acceptance is an important psychological construct implicated in the intensity of chronic pain, though these findings have not been extended to NFL retirees. Therefore, the current study examined the association between pain acceptance and pain intensity among former NFL athletes. NFL retirees (N = 90) recruited from 2018 to 2019 completed questionnaires that assessed pain, substance use, and NFL career information. Multiple linear regression examined the association between current pain acceptance and pain intensity while adjusting for other risk factors of pain. NFL retirees reported average scores of 33.31 (SD = 10.00), and 2.18 (SD = 2.40) on measures of pain acceptance and pain intensity, respectively. After covariate adjustment, greater pain acceptance (β = −0.538, p < .001) was associated with lower pain intensity. These findings can further inform the behavioral and mental health care of retired NFL athletes.

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Martin S. Davey, Matthew G. Davey, Robert Hurley, Eoghan T. Hurley, and Leo Pauzenberger

Context: The COVID-19 pandemic has had catastrophic impact on a global scale, affecting people from all walks of life including elite athletes. Objectives: The purpose of this study was to evaluate the reported rates of return to play (RTP) in conjunction with the expert-derived guidelines previously recommended to enable safe RTP post COVID-19 infection. Evidence Acquisition: Two independent reviewers searched the literature based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, utilizing the MEDLINE, Embase, and Scopus databases. Only studies that reported rates of RTP and/or recommended guidelines for safe RTP were included. Evidence Synthesis: Overall, 17 studies (3 level III and 14 level V) were included. A total of 3 studies reported rates of RTP in a total of 1255 athletes and 623 officials; 72 (30 symptomatic) were infected with COVID-19, 100% of whom were able to RTP post COVID-19 infection. Of the 14 studies recommending guidelines for safe RTP, 3 and 9 studies recommended 7 and 14 days of rest in isolation respectively for asymptomatic patients with COVID-19 infection, prior to safe RTP. In contrast, 7 studies recommended 3 to 6 months of rest (following 14 d isolation) in cases of COVID-19-induced myocarditis as a safe timeframe for safe RTP. Of the 11 studies reporting on whether blanket testing prior to RTP was recommended, only 7 studies recommended a negative test result as mandatory prior to RTP for athletes previously infected with COVID-19. Conclusions: Although excellent rates of RTP have been reported for elite athletes post COVID-19 infection, discrepancies in recommended rest periods, requirement for mandatory negative test results, and the magnitude of screening investigations required continue to exist in the literature, with a need for further standardized international guidelines required in future. Level of Evidence: Level V; systematic review of all forms of evidence.

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Shane P. Murphy, Zach B. Barrons, and Jeremy D. Smith

Context: The quality of running mechanics is often characterized by limb pattern symmetry and used to support clinical decisions throughout the rehabilitation of lower-extremity injuries. It is valuable to ensure that gait analyses provide stable measures while not asking an individual to complete an excessive number of running strides. The present study aimed to determine the minimum number of strides required to establish a stable mean symmetry index (SMSI) of discrete-level measures of spatiotemporal parameters, joint kinematics, and joint kinetics. Further, the study aimed to determine if differences occurred between random and consecutive strides for directional and absolute symmetry indices. Design: Descriptive laboratory study. Methods: A sequential average was used to determine how many strides were required to achieve a SMSI within a 60-second trial. Multiple 2-factor repeated-measure analysis of variances were used to determine if differences between bins of strides and symmetry calculations were significantly different. Results: A median SMSI was achieved in 15 strides for all biomechanical variables. There were no significant differences (P > .05) found between consecutive and random bins of 15 strides within a 60-second trial. Although there were significant differences between symmetry calculation values for most variables (P < .05), there appeared to be no systematic difference between the numbers of strides required for stable symmetry for either index. Conclusions: As 15 strides were sufficient to achieve a SMSI during running, a continued emphasis should be placed on the number of strides collected when examining interlimb symmetry.

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Reid Skeel, Anissa Maffett, Abigail Feder, Cayla Mitzkovitz, and Sofia Lesica

Context: Recovery protocols for treatment of sports concussion have received widespread adoption across the country. While stages of recovery and treatment are relatively clearly defined, there remains variability in implementation of specific recommendations, particularly regarding activities that constitute rest during stages calling for limitations on activity participation. Specific recommendations being employed by practitioners have not been previously assessed. In an aim to document current concussion management practices in the field, athletic trainers were surveyed regarding how activities that may constitute rest are utilized and defined. Design: The study was based on a cross-sectional vignette-based survey. Methods: The sample used was a geographically representative convenience sample of United States-based high school athletic trainers. E-mails were sent to 2146 potential survey respondents yielding a final sample of 226 athletic trainers. Data were gathered for questions concerning recommendations for follow-up care and rest based on provided vignettes, factors considered when developing recommendations, and differences in recommendations associated with varying symptom presentations. The percentage of practitioners that would utilize each potential recommendation was used to characterize results. Results: Participants demonstrated consensus on the importance of physical and cognitive rest as well as school accommodations (all greater than 97% endorsement). Greater variability was present for recommendations regarding pain medication for headache, repeating baseline cognitive testing, and engaging in subsymptom threshold activities. Recommendations for attending but not participating in games and practice yielded conflicting information. Conclusions: Responses indicated general consensus regarding factors considered when making recommendations. There was also consensus regarding general recommendations for activity limitation following recovery with almost all participants strongly recommending cognitive and physical rest, in accordance with consensus guidelines. However, substantial differences were found for specific activities that should be limited or encouraged following youth concussion. Further research concerning the relationship between community and social interaction and clinical outcomes after concussion is warranted.

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Brandon M. DeSantis, Victor R. Kalman, and Steven Browne

Antigravity treadmills are being used in rehabilitation programs but have not been used consistently with posthip labral repair arthroscopy surgeries. The purpose of this study was to review the posthip labral protocol used by eight National Collegiate Athletic Association Division I collegiate athletes (all ages 18–21) from multiple sports that used the antigravity treadmill as a bridge between “no running” and “on-ground running.” The authors found that athletes who did this returned to play between 4.5 and 7 months, had a better overall functional status, and had no re-injuries. This is the first known study of its kind available in the literature.