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Ten Years Gone

Patrick O. McKeon and Jennifer M. Medina McKeon

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Overuse Injury Definitions and Rates of Overuse Injury in Epidemiology Studies Concerning High School-Aged Athletes: A Critically Appraised Topic

Tricia Cich and Kevin M. Biese

Context: The definition of an “overuse injury” had some ambiguity until recent publications. It is unknown whether the improved definition of “overuse injury” has been applied to epidemiology studies that examine high school-aged athletes. This population may be predisposed to overuse injuries due to several factors. Clinical Question: Is there more consistency in how the term “overuse injury” is being used, and has the rate of overuse injuries in high school-aged athletes’ epidemiology studies changed since Roos and Marshall’s 2014 systematic review on overuse injury definitions? Clinical Bottom Line: Since Roos and Marshall’s systematic review, more studies are recognizing “overuse injuries” as needing a specific mechanism of injury; however, several studies failed to differentiate “overuse injuries” from “noncontact injuries.” The rate of overuse injuries does not appear to have changed significantly.

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The Perceptions and Experiences Among Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Agender Patients of Quality of Care With Health Care Services

Lauren G. Ford, Connor Lewis, and Jennifer Lynn Volberding

Clinical Scenario: The lesbian, gay, bisexual, transgender, queer/questioning, intersex, agender (LGBTQIA+) community has a unique set of health care needs and experience barriers to services. Many providers assume these needs are similar to heterosexual counterparts. Investigating experiences and perceptions with health care and recommendations on how to improve care can provide insight for professionals. Clinical Question: What are the perceptions of quality of health care and experiences among the LGBTQIA+ patients? Summary of Key Findings: A search was performed for articles exploring perceptions and experiences of LGBTQIA+ patients with health care. Four articles were included. All were Level VI qualitative studies. All demonstrated a lack of cultural competency leading to poor experiences with providers. Common themes included: misgendering, stigmatization, and negative provider attitude leading to poor experiences. Experiences improved if providers used inclusive language, created welcoming environments, and had knowledge/experience about needs of LGBTQIA+ patients. Clinical Bottom Line: LGBTQIA+ patients felt providers lacked adequate knowledge to understand and care for their needs. Future research should include facts contributing to accessing health care services, solutions to these barriers, and increasing geographic areas. Strength of Recommendation: According to the Strength of Recommendation Taxonomy (SORT) scale, there is Level C evidence that LGBTQIA+ patients experience providers who are not adequately prepared to properly care for their unique needs.

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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

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.

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Professional Conflict in Athletic Training and Nursing Environments: A Commentary on Comparisons and Solutions

Alicia M. Pike Lacy, Thomas G. Bowman, Craig R. Denegar, and Stephanie M. Singe

The athletic training and nursing professions have similar characteristics regarding workplace environment and challenges with interdependence. Professionals in both fields often face conflict with stakeholders while fulfilling their job responsibilities. Although sources and antecedents of conflict differ somewhat between the professions, the consequences of conflict are nearly identical. Job-related stress, depression and burnout, and interpersonal conflict can take a toll on clinicians’ mental and physical health. Greater efforts must be made to better prepare clinicians to diffuse and resolve conflict. Compared with athletic training, nursing has placed a greater emphasis on developing students’ conflict resolution skills in the professional curriculum. Therefore, athletic training educators and preceptors can learn from nursing education and adopt similar educational experiences for athletic training students. Providing students with tools early on can give them confidence to address conflict promptly and constructively, which may mitigate negative impacts of the conflict on patient care.

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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.

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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.

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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.

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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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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.