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A Biomechanical Analysis of Barefoot versus Shod Distance Running

Kelsey J. Picha, Michelle L. Weber, and Cailee E. Welch

Edited by Michael G. Dolan

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Reliability of Clinician Scoring of the Landing Error Scoring System to Assess Jump-Landing Movement Patterns

Jessica G. Markbreiter, Bronson K. Sagon, Tamara C. Valovich McLeod, and Cailee E. Welch

Clinical Scenario:

An individual’s movement patterns while landing from a jump can predispose him or her to lower-extremity injury, if performed improperly. The Landing Error Scoring System (LESS) is a clinical tool to assess jump-landing biomechanics as an individual jumps forward from a box. Improper movement patterns, which could predispose an individual to lower-extremity injuries, are scored as errors. However, because of the subjective nature of scoring errors during the task, the consistency and reliability of scoring the task are important. Since the LESS is a newer assessment tool, it is important to understand its reliability.

Focused Clinical Question:

Are clinicians reliable at scoring the LESS to assess jump-landing biomechanics of physically active individuals?

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Personal and Environmental Characteristics Associated With Burnout in Athletic Trainers: A Critically Appraised Topic

Amy M. Gibson, Gary W. Cohen, Kelly K. Boyce, Megan N. Houston, and Cailee E. Welch Bacon

Clinical Question: What personal and environmental characteristics are associated with burnout in athletic trainers, as measured by the Maslach Burnout Inventory (MBI) and Athletic Training Burnout Inventory (ATBI)? Clinical Bottom Line: There is strong evidence suggesting that personal and environmental factors are associated with burnout in athletic trainers, as measured by the MBI and ATBI. While it is difficult to identify a single contributing factor that increases the athletic trainer’s perception of burnout, athletic trainers should be aware of the characteristics associated with the condition and take appropriate action to reduce the risk of burnout.

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The Diagnostic Accuracy of Screening Tools to Detect Eating Disorders in Female Athletes

Alyssa J. Wagner, Casey D. Erickson, Dayna K. Tierney, Megan N. Houston, and Cailee E. Welch Bacon

Clinical Scenario:

Eating disorders in female athletes are a commonly underdiagnosed condition. Better screening tools for eating disorders in athletic females could help increase diagnosis and help athletes get the treatment they need.

Focused Clinical Question:

Should screening tools be used to detect eating disorders in female athletes?

Summary of Key Findings:

The literature was searched for studies that included information regarding the sensitivity and specificity of screening tools for eating disorders in female athletes. The search returned 5 possible articles related to the clinical question; 3 studies met the inclusion criteria (2 cross-sectional studies, 1 cohort study) and were included. All 3 studies reported sensitivity and specificity for the Athletic Milieu Direct Questionnaire version 2, the Brief Eating Disorder in Athletes Questionnaire version 2, and the Physiologic Screening Test to Detect Eating Disorders Among Female Athletes. All 3 studies found that the respective screening tool was able to accurately identify female athletes with eating disorders; however, the screening tools varied in sensitivity and specificity values.

Clinical Bottom Line:

There is strong evidence to support the use of screening tools to detect eating disorders in female athletes. Screening tools with higher sensitivity and specificity have demonstrated a successful outcome of determining athletes with eating disorders or at risk for developing an eating disorder.

Strength of Recommendation:

There is grade A evidence available to demonstrate that screening tools accurately detect female athletes at risk for eating disorders.

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The Effect of Cognitive Rest as Part of Postconcussion Management for Adolescent Athletes: A Critically Appraised Topic

Rachel S. Johnson, Mia K. Provenzano, Larynn M. Shumaker, Tamara C. Valovich McLeod, and Cailee E. Welch Bacon

Clinical Scenario:

It is hypothesized that cognitive activity following a concussion may potentially hinder patient recovery. While the recommendation of cognitive rest is often maintained and rationalized, a causal relationship between cognitive activity and symptom duration has yet to be established.

Clinical Question:

Does the implementation of cognitive rest as part of the postconcussion management plan reduce the number of days until the concussed adolescent patient is symptom free compared to a postconcussion management plan that does not incorporate cognitive rest?

Summary of Key Findings:

A thorough literature search returned 7 possible studies; 5 studies met the inclusion criteria and were included. Three studies indicated that increased cognitive activity is associated with longer recovery from a concussion, and, therefore, supported the use of cognitive rest. One study indicated that the recommendation for cognitive rest was not significantly associated with time to concussion symptom resolution. One study indicated that strict rest, defined as 5 days of no school, work, or physical activity; might prolong symptom duration.

Clinical Bottom Line:

There is moderate evidence to support the prescription of moderate cognitive rest for concussed patients. Clinicians who intend on implementing cognitive rest in their concussion protocols should be aware of inconsistencies and be open-minded to alternative treatment progressions while taking into consideration each individual patient and maintaining adequate patient-centered care principles.

Strength of Recommendation:

Grade B evidence exists that prescription of moderate cognitive rest for concussed patients may be beneficial as a supplement to physical rest as treatment for symptom reduction in adolescents.

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Kinesiophobia After Anterior Cruciate Ligament Reconstruction in Physically Active Individuals

Arika L. Cozzi, Kristina L. Dunn, Josie L. Harding, Tamara C. Valovich McLeod, and Cailee E. Welch Bacon

Clinical Scenario:

There are approximately 200,000 anterior cruciate ligament (ACL) tears reported annually in the United States. Patients who undergo ACL reconstruction followed by an aggressive rehabilitation protocol can often structurally and functionally progress to a preinjury level. Despite physical improvements with ACL-rehabilitation protocols, however, there are still a substantial number of individuals who do not return to preinjury level, particularly physically active individuals, of whom only 63% return to their full potential preinjury level. This may be due to continued pain, swelling, stiffness, and weakness in the knee. In addition, research concerning the topic of kinesiophobia (ie, fear of reinjury), which may prevent individuals from returning to their activities, has increased over the past several years. Kinesiophobia is defined as the irrational or debilitating movement of physical activity resulting in the feeling of vulnerability to painful injury or reinjury. Kinesiophobia may have a significant impact on physically active individuals, considering the proportion of patients who do not return to their sport. However, it is unknown whether kinesiophobia is associated with patients’ perceived physical-impairment levels after ACL reconstruction.

Focused Clinical Question:

Is kinesiophobia associated with self-perceived levels of knee function after ACL reconstruction?

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Athletic Trainers’ Perceptions of Their Scope of Practice

Cailee E. Welch Bacon, Nydia L. Cabra, Taryn C. Pennington, Lindsey E. Eberman, and Julie M. Cavallario

All athletic trainers (ATs) must meet regulatory standards as outlined in state practice acts. While state practice acts are similar, some variations can lead to misunderstanding or unfamiliarity with appropriate scopes of practice. We aimed to describe ATs’ perceptions regarding athletic training scope of practice. Only 29.7% of respondents correctly identified state government as the agency that defines athletic training scope of practice and 51.7% agreed their respective state practice act limits the skills they can perform. To advocate for the profession, ATs must have a primary understanding of the laws and regulations that promote ATs to work at their fullest ability.

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The Ability of Baseline and Normative Neurocognitive Testing to Identify Cognitive Impairments Following Concussion: A Critically Appraised Topic

Nicholas M. Hattrup, Rebekah L. Gardiner, Hannah Gray, Cailee E. Welch Bacon, and Tamara C. Valovich McLeod

Focused Clinical Question: In a high school, college, and professional athletic population, does individualized baseline tests increase the diagnostic accuracy (e.g., sensitivity and specificity) of identifying cognitive impairments when utilizing neurocognitive testing compared to normative data? Clinical Bottom Line: There was insufficient evidence to definitively suggest the use of individualized baseline data over the use of normative data during a postinjury assessment.

Open access

Pain Education With Therapeutic Exercise in Chronic Nonspecific Low Back Pain Rehabilitation: A Critically Appraised Topic

Kaitlyn C. Jones, Evelyn C. Tocco, Ashley N. Marshall, Tamara C. Valovich McLeod, and Cailee E. Welch Bacon

Clinical Scenario: Low back pain is widely prevalent in the general population as well as in athletes. Therapeutic exercise is a low-risk and effective treatment option for chronic pain that can be utilized by all rehabilitation clinicians. However, therapeutic exercise alone does not address the psychosocial aspects that are associated with chronic low back pain. Pain education is the umbrella term utilized to encompass any type of education to the patient about their chronic pain. Therapeutic exercise in combination with pain education may allow for more well-rounded and effective treatment for patients with chronic nonspecific low back pain (NS-LBP). Clinical Question: Does pain education combined with therapeutic exercise, compared with therapeutic exercise alone, improve patient pain in adults with chronic NS-LBP over a 2- to 3-month treatment period? Summary of Key Findings: A thorough literature review yielded 8 studies potentially relevant to the clinical question, and 3 studies that met the inclusion criteria were included. The 3 studies included reports that exercise therapy reduced symptoms. Two of the 3 included studies support the claim that exercise therapy reduces the symptoms of chronic NS-LBP when combined with pain education, whereas one study found no difference between pain education with therapeutic exercise. Clinical Bottom Line: There is moderate evidence to support the use of pain education along with therapeutic exercise when attempting to reduce symptoms of pain and disability in patients with chronic NS-LBP. Educational interventions should be created to educate patients about the foundation of pain, and pain education should be implemented as a part of the clinician’s strategy for the rehabilitation of patients with chronic NS-LBP. Strength of Recommendation: Grade B evidence exists to support the use of patient education with therapeutic exercise for decreasing pain in patients with chronic NS-LBP.

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Athletic Trainers’ Perceived Challenges Toward Comprehensive Concussion Management in the Secondary School Setting

Cailee E. Welch Bacon, Gary W. Cohen, Melissa C. Kay, Dayna K. Tierney, and Tamara C. Valovich McLeod

Available financial and personnel resources often dictate the specifics of concussion policies and procedures in the secondary school setting. The purpose of this qualitative study was to explore athletic trainers’ perceived challenges toward comprehensive concussion management in the secondary school setting. The findings indicate several challenges exist toward concussion management in the secondary school, including facility, personnel, and community resources, education levels of various stakeholders, and general perceptions of concussion and athletic trainers. It is important to identify challenges athletic trainers may face in order to develop strategies to align current concussion management procedures with current best practices.