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Megan D. Granquist, Leslie Podlog, Joanna R. Engel and Aubrey Newland

Context:

Adherence to sport-injury rehabilitation protocols may be pivotal in ensuring successful rehabilitation and return-to-play outcomes.

Objectives:

To investigate athletic trainers' perspectives related to the degree to which rehabilitation adherence is an issue in collegiate athletic training settings, gain insight from certified athletic trainers regarding the factors contributing to rehabilitation nonadherence (underadherence and overadherence), and ascertain views on the most effective means for promoting adherence.

Design:

Crosssectional, mixed methods.

Setting:

Collegiate athletic training in the United States.

Participants:

Certified athletic trainers (n = 479; 234 male, 245 female).

Main Outcome Measures:

Online survey consisting of 3 questions regarding rehabilitation adherence, each followed by an open-ended comments section. Descriptive statistics were calculated for quantitative items; hierarchical content analyses were conducted for qualitative items.

Results:

Most (98.3%) participants reported poor rehabilitation adherence to be a problem (1.7% = no problem, 29.2% = minor problem, 49.7% = problem, 19.4% = major problem), while most (98.96%) participants reported that they had athletes who exhibited poor rehabilitation adherence (1% = never, 71.4% = occasionally, 22.5% = often, 5% = always). In addition, the majority (97.91%) of participants reported that overadherence (eg, doing too much, failing to comply with activity restrictions, etc) was at least an occasional occurrence (2.1% = never, 69.3% = occasionally, 26.3% = often, 1.9% = always). Hierarchical content analyses regarding the constructs of poor adherence and overadherence revealed 4 major themes: the motivation to adhere, the development of good athletic trainer–athlete rapport and effective communication, athletic trainers' perception of the coaches' role in fostering adherence, and the influence of injury- or individual- (eg, injury severity, sport type, gender) specific characteristics on rehabilitation adherence.

Conclusions:

These results suggest that participants believe that underadherence (and to a lesser extent overadherence) is a frequent occurrence in collegiate athletic training settings. Strategies for enhancing rehabilitation adherence rates and preventing overadherence may therefore be important for optimizing rehabilitation outcomes.

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Aubrey Newland, Maria Newton, E. Whitney G. Moore and W. Eric Legg

Given the key role coaches play in the experience of athletes, understanding the relationship between coach leadership styles and positive youth development (PYD) is crucial. This study examined the relationship of coach transformational leadership (TFL) to PYD. Athletes (n = 203) nested within 28 competitive youth basketball teams completed questionnaires about their coaches’ TFL, and two measures related to their own PYD – Youth Experiences for Sport, measuring PYD specific to the sport context, and a measure to assess the 5Cs (Competence, Confidence, Connection, Character, and Caring). Due to the nested nature of athletes within team and significant intraclass correlations, the predictive contribution of team and individual level perceptions of TFL was assessed with multilevel modeling. Individual and team perceptions of coach TFL significantly predicted 59% of the YES-S variance. In addition to team and individual main effects, a significant cross-level interaction predicted 20% of a player’s development of the 5Cs. Thus, athletes reporting above average coach TFL on teams reporting above average coach TFL reported the greatest 5C development. These results provide additional support for TFL as an avenue to foster PYD. Findings elucidate transformational coach behaviors that are related to positive experiences in youth sport and the 5Cs.