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Workplace Bullying in Healthcare: A Critically Appraised Topic

Jonathan I. Hochstetler, Anne C. Russ, Ryan Tierney, and Jamie L. Mansell

Focused Clinical Question: In athletic training, what is the percentage of workplace bullying compared to the percentage in nursing? Clinical Bottom Line: There is evidence that workplace bullying is prevalent in the athletic training and nursing professions.

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The Impact of Concussion Education on Injury Disclosure in High School Athletes: A Critically Appraised Topic

Alyson Hansbarger, Ryan Thomson, Jamie L. Mansell, and Ryan T. Tierney

Clinical Scenario: Sport-related concussions are common injuries during sport-related activities. Evaluations of these injuries involve symptom reporting. Unfortunately, concussion symptoms are widely underreported by athletes, and can lead to longer recovery times. Concussion education programs were created to encourage reporting of symptoms by athletes. Clinical Question: Does concussion education impact injury disclosure in high school athletes? Summary of Key Findings: Three studies were included in this appraisal. Two studies utilized an educational lecture, and one study utilized an informational video providing the concussion education. All three studies found significant increases in injury history disclosure from pre-education to immediate post-education. Clinical Bottom Line: There is moderate evidence to support the idea that education has a positive impact on concussion reporting behaviors. These studies found positive results immediately following concussion education therefore it may be beneficial to provide concussion education several times a year. Strength of Recommendation: There is Level B evidence to support the idea that implementing concussion education will impact concussion reporting behaviors as it pertains to injury history disclosure.

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The Efficacy of Cryotherapy on Decreasing Swelling: A Critically Appraised Topic

Rachel A. Ziner, Jamie L. Mansell, Anne C. Russ, and Ryan T. Tierney

Context: Swelling is a major consequence of musculoskeletal conditions and can be a barrier to healing. Cryotherapy has been reported to decrease swelling. How effective is cryotherapy in reducing swelling during rehabilitation? Methods: PubMed was searched in June 2022 using the Boolean phrases: Swelling OR edema AND cryotherapy OR ice, Swelling AND injury AND cryotherapy. Included articles were published during or after 2017, consisted of one or more cryotherapy interventions, and listed swelling as an outcome measure. The PEDro scale was used to assess study validity. Swelling was measured by the figure-of-eight method (in centimeters). Means, SDs, and 95% confidence interval (CI) were calculated. Results: Three articles were screened. Stasinopoulos et al. received a score of 9/10; Sari et al. and Tittley et al. received a score of 10/10. Tittley et al. reported a decrease in swelling from 52.7 (SD = 0.8; 95% CI [52.35, 53.05]) to 52.0 (SD = 0.8; 95% CI [51.65, 52.35]). Stasinopoulos et al. reported decreases from 62.62 (SD = 0.34; 95% CI [62.51, 62.80]) to 61.10 (SD = 0.30; 95% CI [60.98, 61.24]). Sari et al. also found minimal change in swelling from pre- to posttreatment, 38.7 (SD = 2.6; 95% CI [37.83, 39.57]) to 38.2 (SD = 2.4; 95% CI [37.40, 39.00]). Conclusion: There is consistent evidence indicating that cryotherapy applied during rehabilitation does not decrease swelling in a patient with a musculoskeletal condition.

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The Effect of the Closed-Loop Control System on Blood Glucose Control With Exercise: A Critically Appraised Topic

Melanie A. Mason, Anne C. Russ, Ryan T. Tierney, and Jamie L. Mansell

Context: Exercise can cause fluctuations in blood glucose control in type 1 diabetics. For athletes with type 1 diabetes, maintenance of blood glucose within an ideal range may be difficult. Objective: To determine, in individuals with type 1 diabetes, the effectiveness of the closed loop control system versus the open loop control system in keeping blood glucose levels in the ideal range with exercise. Data Sources: A search of PubMed was conducted in June of 2020 using the Boolean phrases: (closed loop control system OR artificial pancreas) AND type 1 diabetes AND exercise AND ideal range AND adolescents, artificial pancreas AND glucose prediction AND exercise. Study Selection : Titles were reviewed for relevance, the abstract was then assessed for applicability, and finally the full text was examined. Articles were included that examined the percent of time in the ideal blood glucose range when exercise occurred during that day. Articles were excluded that didn’t compare the closed loop and open loop control systems and articles that did not involve exercise. Data Extraction : The PEDro scale was used to determine the methodological quality of the included studies. The measure addressed was the percent of time in the ideal blood glucose range of 70-180 mg/dL. 95% Confidence Intervals and Cohen’s D were calculated for each article. Data Synthesis : The search yielded 268 articles and 3 were selected for inclusion. The two randomized controlled trials scored 9/10 on the PEDro scale and the randomized two-arm crossover clinical trial scored 9/10 on the PEDro scale. Percent time spent in the ideal blood glucose range when exercise was performed was significantly higher in the closed loop group versus the open loop group in each of the three studies. In one randomized control trial, mean time in the ideal range was 71.3% (SD = 17.6, 95% CI = 62.5, 80.10) in the closed loop group versus 64.7% (SD = 13.3, 95% CI = 58.1–71.4) in the open loop group. Cohen’s D was 0.4. In the second randomized control trial, mean time in the ideal range was 73.5% (SD = 8.4, 95% CI = 70.1, 76.9) for the closed loop group versus 50% (SD = 26.8, 95% CI = 39.1, 60.9). Cohen’s D was 1.2. The two-arm crossover clinical trial resulted in a mean time in target range of 84.1% (SD = 11.5, 95% CI = 79.0, 89.2) in the closed loop group versus 68.7% (SD = 13.9, 95% CI = 62.5, 74.9) in the open loop group. Cohen’s D was 1.2. Conclusions : For adolescents with type 1 diabetes who exercise, the closed loop control system maintains blood glucose levels in the ideal range for a longer percent of time versus an open loop system. Each patient should be evaluated on a case-by-case basis with his/her healthcare team. Future research should examine the closed loop control system on specific energy systems.