Athletic Trainers' Perceptions of Implementing Psychological Strategies for Patient Management: A Systematic Review.

OBJECTIVE: To synthesize the best available evidence regarding the perceptions and current clinical practices of athletic trainers (ATs) in integrating psychological skills into patient management. DATA SOURCES: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) (via EBSCOhost), PsycInfo (via EBSCOhost), SPORTDiscus (via EBSCOhost), Scopus (via Elsevier). STUDY SELECTION: Studies had to investigate the current clinical practices and perceptions of certified ATs in integrating psychologically informed practice for patient management. Studies that were Level 4 evidence or higher were included. Studies were excluded if they were published before 1999, the primary language was not English, they involved athletic training students or other rehabilitation specialists, or if the studies explored the athlete and/or patient's perception of psychosocial techniques or strategies. DATA EXTRACTION: This systematic review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Statement in Exercise, Rehabilitation, Sport medicine and SporTs science (PERSiST) guidance. DATA SYNTHESIS: A total of 1,857 articles were reviewed, and 8 met inclusion criteria. Two studies had level 2a evidence, four studies had level 4a evidence, and two studies had level 4b evidence. Six studies were rated as good quality, and two studies were rated as lesser quality. The included studies demonstrated a high-quality body of evidence with consistent results which strengthens the review findings. CONCLUSIONS: Ats have the knowledge to identify when athletes are psychologically affected by injury and can identify common psychological responses. Although Ats acknowledge the value of implementing psychosocial strategies, lack of confidence in implementing basic or advanced techniques, feeling underprepared by their educational program, and lack of clinical training appear to impact the use of psychosocial techniques in clinical practice and the rate of mental health recognition and referral amongst ATs.

No Association Between Injury-Related Fear and Isokinetic Quadriceps Strength in Individuals With a History of Anterior Cruciate Ligament Reconstruction.

CONTEXT: Injury-related fear and quadriceps strength are independently associated with secondary anterior cruciate ligament (ACL) injury risk. It is not known whether injury-related fear and quadriceps strength are associated, despite their individual predictive capabilities of secondary ACL injury. The purpose of this study was to examine the association between injury-related fear and quadriceps strength in individuals at least 1 year after ACL reconstruction (ACLR). DESIGN: Cross-sectional study. METHODS: Forty participants between the ages of 18 and 35 years at least 1 year post unilateral primary ACLR. Participants completed the Tampa Scale of Kinesiophobia-11 (TSK-11) and a standard isokinetic quadriceps strength assessment using the Biodex Isokinetic Dynamometer. Pearson Product-Moment correlations were used to examine the linear association between the TSK-11 scores and peak torque (in nanometers per kilogram) for each limb and between the TSK-11 scores and limb symmetry indices for each limb. Pearson Product-Moment correlation coefficients (r) were interpreted as very high (.90-1.00), high (.70-.90), moderate (.50-.70), low (.30-.50), and no correlation (.00-.30). RESULTS: The average TSK-11 score was 18.2 (5.3), average ACLR peak quadriceps torque was 1.9 (0.50) N·m/kg, average contralateral peak quadriceps torque was 2.3 (0.48) N·m/kg, and average limb symmetry index was 85.3% (12.6%). There was no statistically significant correlation between the TSK-11 and peak quadriceps torque on the ACLR limb (r = .12, P = .46), the TSK-11 and contralateral limb (r = .29, P = .07), or the TSK-11 and limb symmetry index (r = -.18, P = .27). CONCLUSIONS: There was no association between kinesiophobia and peak isokinetic quadriceps strength in individuals at least 1 year post-ACLR. Both factors, independently, have been shown to influence risk of secondary injury in patients after ACLR.

Persistent Early Knee Osteoarthritis Symptoms in the First Two Years After ACL Reconstruction.

CONTEXT: Early identification of knee osteoarthritis (OA) symptoms after anterior cruciate ligament reconstruction (ACLR) could enable timely interventions to improve long-term outcomes. However, little is known about the change in early OA symptoms from 6 to 12 months following ACLR. OBJECTIVE: To evaluate the change over time in meeting classification criteria for early knee OA symptoms from 6 to 12 months following ACLR. DESIGN: Prospective Cohort Study. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: 82 participants aged 13-35 years who underwent unilateral primary ACLR. On average, participants' 1st and 2nd visits were 6.2 and 12.1 months post-ACLR. MAIN OUTCOME MEASURES: Early OA symptoms were classified using generic (Luyten Original) and patient population-specific (Luyten PASS) thresholds on Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales. Changes in meeting early OA criteria were compared between an initial and follow-up visit at an average of 6 and 12 months post-ACLR, respectively. RESULTS: Twenty-two percent of participants exhibited persistent early OA symptoms across both visits using both the Luyten Original and PASS criteria. From initial to follow-up visit, 18-27% had resolution of early OA symptoms while 4-9% developed incident symptoms. In total, 48-51% had no early OA symptoms at either visit. There were no differences between change in early OA status between adults and adolescents. CONCLUSIONS: Nearly one quarter of participants exhibited persistent early knee OA symptoms based on KOOS thresholds from 6 to 12 months post-ACLR. Determining if this symptom persistence predicts worse long-term outcomes could inform the need for timely interventions after ACLR. Future research should examine if resolving persistent symptoms in this critical window improves later outcomes. Tracking early OA symptoms over time may identify high-risk patients who could benefit from early treatment.

Lower Extremity Reaction Time in Individuals With Contact Versus Noncontact Anterior Cruciate Ligament Injuries After Reconstruction.

CONTEXT: Deficits in perceptual-motor function, like visuomotor reaction time (VMRT), are risk factors for primary and secondary anterior cruciate ligament (ACL) injury. Noncontact ACL injuries have been associated with slower reaction time, but whether this association exists for patients with contact ACL injuries is unknown. Exploring differences in VMRT among individuals with contact versus noncontact ACL injuries may provide a more comprehensive understanding of modifiable risk factors. OBJECTIVE: To compare lower extremity VMRT (LEVMRT) in individuals with contact or noncontact ACL injuries after ACL reconstruction (ACLR). DESIGN: Cross-sectional study. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 36 participants with primary, unilateral ACLR completed an LEVMRT assessment (contact ACL injury = 20 [56%], noncontact ACL injury = 16 [44%]). MAIN OUTCOME MEASURE(S): The LEVMRT was assessed bilaterally and collected using a series of wireless light discs deactivated by individuals with their feet. The ACLR-active LEVMRT (ie, ACLR limb is deactivating lights) and ACLR-stable LEVMRT were compared using separate analyses of covariance to determine the association with contact or noncontact injury using time since surgery as a covariate. RESULTS: After controlling for time since surgery, a difference and large effect size between groups was found for the ACLR-stable LEVMRT (P = .010; η2 = 0.250) but not for the ACLR-active (P = .340; η2 = 0.065) condition. The contact group exhibited slower ACLR-stable LEVMRT (521.7 ± 59.3 milliseconds) than the noncontact group (483.4 ± 83.9 milliseconds). CONCLUSIONS: Individuals with contact ACL injury demonstrated a slower LEVMRT while their ACLR limb was stabilizing. The group differences during the ACLR-stable LEVMRT task might indicate deficits in perceptual-motor function when the surgical limb maintains postural control during a reaction time task. After ACLR, individuals with contact injuries may need additional motor learning interventions to enhance perceptual-motor functioning.

A Systematic Review of the Effectiveness of Concussion Education Programs for Coaches and Parents of Youth Athletes.

Coach and parent concussion education programs are essential for the prevention, diagnosis, management, and return to play of youth athletes. This systematic review examined the content and efficacy (changes in knowledge, impact on concussion incidence) of concussion education programs for coaches and parents of youth and high school athletes. Six databases were searched: SPORTDiscus, Academic Search Premiere, CINAHL, PsycINFO, PubMed, and Google Scholar. Studies evaluated the use and/or efficacy of concussion education programs among coaches or parents of youth athletes. A total of 13 articles (out of 1553 articles) met selection criteria. Although different concussion education programs exist, only three have been evaluated in the literature: ACTive Athletic Concussion Training™, USA Football's Heads Up Football, and the Center for Disease Control and Prevention's HEADS UP. These programs are well liked among coaches and parents and the suggested practices are easily implemented by coaches. These programs increased concussion knowledge among coaches and parents and promoted behavioral changes among coaches to reduce the concussion risk in high school sports. Few studies have assessed the efficacy of concussion education programs on youth athlete health outcomes. No studies included a longitudinal follow up to determine the degree of knowledge retention following the intervention. While online educational programs are sufficient to improve coach knowledge, in-person training may be a more effective educational tool for reducing the incidence of youth sport concussion. Future studies addressing the efficacy of concussion education programs should include a longitudinal follow up to assess knowledge retention and fidelity.

A Systematic Review and Meta-Analysis of School-Based Stress, Anxiety, and Depression Prevention Programs for Adolescents.

Given the recent rise in adolescent mental health issues, many researchers have turned to school-based mental health programs as a way to reduce stress, anxiety, and depressive symptoms among large groups of adolescents. The purpose of the current systematic review and meta-analysis is to identify and evaluate the efficacy of school-based programming aimed at reducing internalizing mental health problems of adolescents. A total of 42 articles, including a total of 7310 adolescents, ages 11-18, met inclusion for the meta-analyses. Meta-analyses were completed for each of the three mental health outcomes (stress, depression, and anxiety) and meta-regression was used to determine the influence of type of program, program dose, sex, race, and age on program effectiveness. Overall, stress interventions did not reduce stress symptoms, although targeted interventions showed greater reductions in stress than universal programs. Overall, anxiety interventions significantly reduced anxiety symptoms, however higher doses may be necessary for universal programs. Lastly, depression interventions significantly reduced depressive symptoms, but this reduction was moderated by a combination of program type, dose, race, and age group. Although, school-based programs aimed at decreasing anxiety and depression were effective, these effects are not long-lasting. Interventions aimed at reducing stress were not effective, however very few programs targeted or included stress as an outcome variable. Implications for practice, policy and research are discussed.