Contemporary health care emphasizes interprofessional collaborative practice (IPCP), described as when providers from two or more professions work together to achieve the highest-quality patient care. Historically, athletic trainers have naturally collaborated with physicians, in part due to our defined scope of practice, but more importantly as a benefit to achieving positive patient outcomes. Athletic trainers also collaborate with nurses, physical therapists, physician assistants, and other health care professionals when providing care to physically active patients and populations. Due to the oftentimes continuous contact with patients while engaging these other health care professionals, athletic trainers are well suited to expand their interprofessional collaborations to other disciplines and serve as key stakeholders in the IPCP team. To assist in this expansion of IPCP, there are several professional organizations and a substantial body of literature focusing on effective engagement in IPCP that can serve as resources for athletic training. This commentary will address the background of IPCP and the relevance of the athletic trainer within the interprofessional team, as well as identify resources for additional information.
Preparing the Athletic Trainer for Interprofessional Collaborative Practice: A Report From the Association for Athletic Training Education-Research Network
Sarah A. Manspeaker, Justin P. Young, Nicole A. Wilkins, Chad Clements, Dorice A. Hankemeier, Richelle M. Williams, Stacy E. Walker, and Lindsey E. Eberman
Influence of Chronic Ankle Instability on Physical Activity: A Critically Appraised Topic
Priya Patel, Luke Donovan, Tricia Hubbard-Turner, and Abbey C. Thomas
Lateral ankle sprains are the most common injury sustained by physically active individuals. The overwhelming majority of people who sprain their ankle go on to develop chronic ankle instability (CAI). CAI may cause affected individuals to limit their physical activity, leading to health issues such as obesity and cardiovascular disease. The growing body of literature suggests that functional limitations reported by individuals with CAI may lead a the decrease in physical activity. This critically appraised topic sought to determine if adolescent and college-aged individuals with CAI have lower physical activity levels than their healthy peers. A literature search was conducted in between August 2021–February 2022 using the terms “chronic ankle instability” and “physical activity.” Studies were included if the participants were adolescent or college-aged and had CAI. Three studies meeting the inclusion criteria were identified. The first study reported that college students with CAI walk fewer steps per week than their healthy peers, while the second study observed higher physical activity levels among adolescents with CAI. The third study incorporated details on how there is a high prevalence of ankle injury in adolescents, so methods to prevent the injury should be followed to avoid injury earlier on. Despite the conflicting evidence on how CAI impacts physical activity levels, physical activity remains important for long-term health. Thus, it is necessary to emphasize that individuals with CAI should seek treatment to mitigate recurrent ankle sprains in order to safely continue with physical activity.
Clinical Evaluation Findings in Patients Diagnosed With Deltoid Ligament Ankle Sprains: A Report From the Athletic Training Practice-Based Research Network
Alison R. Snyder Valier, Haley Toohill, Kenneth C. Lam, and Kellie C. Huxel Bliven
Objective: To describe clinical presentation and initial management of patients with deltoid ligament ankle sprains. Design: Retrospective. Setting: Practice-based research network. Participants: Athletic trainers (n = 133) from 52 clinics in 19 states. Independent Variable: Deltoid sprains (October 2009–April 2020). Main Outcome Measurements: Clinical findings (e.g., sport, mechanism of injury, severity, range of motion, tests) and initial management. Results: Deltoid sprains (n = 105) were diagnosed within 3.2 ± 4.1 days of injury, mostly in male secondary school athletes (n = 62/105, 59.0%). Common sports were football (n = 29/94, 30.9%) and basketball (n = 28/94, 29.8%). Common mechanism of injuries were twisting (n = 35/94, 37.2%) and contact (n = 28/94, 29.8%). Sprains were mostly mild (n = 59/94, 62.7%) with mild or no edema (n = 85/96, 85.5%) and effusion (n = 90/96, 93.4%). Active (n = 49/96, 51.0%) and passive range of motion (n = 54/96, 56.3%) were mostly normal, and a median of four (interquartile range = 2–5) tests were used, mostly anterior drawer (n = 74/105, 70.5%) and talar tilt-eversion (n = 74/105, 70.5%). Management involved removal from participation (n = 48/94, 51.1%), treatment by athletic trainers (n = 22/40, 55.0%), and referral to physicians (n = 16/40, 40.0%). Conclusions: Deltoid sprains mostly occurred in males playing football or basketball and were caused by twisting with minimal effusion, edema, and range of motion loss. Given the infrequency of deltoid sprains and difficulty diagnosing them, thorough clinical evaluation is necessary for treatment decisions.
Case in Point: Skating Into Sports Medicine
Emily Kirillov, Mara Smith, and Jeffrey B. Driban
Patients deserve an opportunity to tell clinicians and researchers their views about how sports medicine could better address their needs. In our “Case in Point” article, we provide an internationally competitive figure skater with a chance to identify her community’s needs and suggest solutions. We then have a clinician who works with skaters provide their perspective on the skater’s call to action. Finally, a researcher shares suggestions based on the views of the skater and clinician. We hope this “Case in Point” article highlights how novel clinical and research ideas can be sparked by creating a forum for athletes/patients, providers, and researchers to share ideas.
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.
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.
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.
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.
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.
Postoperative Psychological Factors Are Associated With Perceived Improvement Following Hip Arthroscopy
Kate N. Jochimsen, James D. Doorley, Ana-Maria Vranceanu, Brian Noehren, Stephen T. Duncan, and Cale A. Jacobs
Psychological factors are receiving increased attention for their role in musculoskeletal health, surgical outcomes, and patient-reported outcome measures. This study examined if preoperative and 3-month postoperative pain catastrophizing, kinesiophobia, and self-efficacy differ between patients who report greater versus less than 75% overall improvement from baseline to 3 months after hip arthroscopy for femoroacetabular impingement syndrome. Of 43 patients, 13 (30.2%) reported <75% improvement 3 months after surgery. Patients who reported <75% improvement had higher pain catastrophizing (p = .04), higher kinesiophobia (p = .02), and lower self-efficacy (p = .007) 3 months after surgery. None of the preoperative psychological factors differed between groups (p ≥ .67). Findings suggest that patients with maladaptive psychological responses 3 months following surgery may also perceive suboptimal surgical improvement.