Self-Reflection as a Support to Evidence-Based Practice: A Grounded Theory Exploration.

The purpose of this study was to explore how reflective practice is experienced by occupational therapists. Thirty participants were purposefully sampled to explore reflective practice experiences using a critical reflection inquiry model as a theoretical framework. Grounded theory using a constant comparative analysis method was used to analyze interview data. Three categories emerged: triggers to reflection, depth of reflection, and actions taken. The frequency of statements compared across survey groups showed that participants with high reflection behaviors made more critical reflections, used steps of the EBP cycle, and took actions to correct practice. Results inform practice in three ways: (1) practitioner experiences were analyzed through the complete reflective practice construct, (2) findings indicated that greater depth of reflective thinking promotes EBP use and actions taken to correct practice, and (3) narrative content analysis was found to be a credible method of assessing reflection within practice narratives, suggesting it as useful for education and promoting continuing competency.

Occupational Therapists' Implementation of Evidence-Based Practice: A Cross Sectional Survey.

Evidence-based practice (EBP) implementation has been associated with quality health care outcomes, yet only a small proportion of occupational therapists implement EBP. We conducted a cross-sectional survey measuring EBP implementation, skill and knowledge, self-reflection behavior, and practice demographics to clarify implementation of EBP and factors acting as supports. A random sample of occupational therapists practicing in the U.S. was invited to participate; 578 surveys were included in the final analysis. Participants implemented EBP less than 1 time over the previous 8 weeks; EBP use was highest in those with a doctorate (p = .002) and high self-reflection behavior (p = .001); EBP use was marginally higher in those with organizational support (p = .008; p = .009), time for EBP (p = .009), and access to full text articles (p = .006). Further investigation of how reflective practice and levels of doctoral education support EBP use are recommended.

How traditional undergraduate college students define and perceive wellness: A qualitative phenomenological study.

OBJECTIVE: To understand college students' perceptions and understanding of wellness. PARTICIPANTS: A convenience sample of 20 undergraduate students (age 20.6 ± 2.2 years) at a private liberal arts university in Southern California who recently completed a general education health and wellness course. METHOD: Five focus group sessions were conducted to explore perceptions of wellness among undergraduate college students. Data was analyzed, themed, and coded. RESULTS: A thematic analysis of the descriptions of wellness revealed 2 higher-ordered themes as whole-person and wellbeing, and 3 lower-ordered themes of balance, interconnectedness, and personalized in relation to participants' understanding of wellness. CONCLUSIONS: The importance of balance between wellness dimensions and the acknowledgment of the interconnectedness of wellness dimensions are related to quality of life and life satisfaction. A deeper insight is needed to better understand the perceptions of wellness in this population to provide more effective interventions. This can be achieved through the development of enhanced pedagogy, which may improve student health.

Motivation and Behaviors Related to Sport Specialization in College Baseball Players.

CONTEXT: Early sport specialization is a growing concern among youth sports athletes, particularly in baseball. Motivation to participate in sports is an important factor in determining which sports youth athletes participate in and why. OBJECTIVE: The purpose of this study was to qualitatively investigate youth sport participation behaviors and motivations of college baseball players. DESIGN: Qualitative Study. SETTING: Online Teleconference. PATIENTS OR OTHER PARTICIPANTS: We conducted 25 semi-structured interviews with college baseball athletes who were classified as either high-level (n=8), moderate-level (n=9), or low-level specialists (n=8) prior to college. DATA COLLECTION AND ANALYSIS: Participants completed an individual semi-structured interview to develop an understanding of the participants' youth and high school sports experiences and associated motivations to participate in those experiences. A framework analysis approach was used to analyze transcript data to identify themes among the three specialization groups. RESULTS: From our interview analysis, six overall themes emerged among the groups: (1) Motivation, (2) Stress, (3) Quitting, (4) Barriers, (5) Facilitators of Success, and (6) Future Directions. Moderate and high-level specialists described higher levels of passion, participating in deliberate practice, higher levels of performance-related stress, and a desire to quit sports more than low-level specialists. None of the groups described parents as an overbearing external motivator to participate in sports at an early age. CONCLUSIONS: Participants who were classified as low-, moderate-, and high-level specialists described different experiences related to their motivation, stress levels, desire to quit, barriers to participating in baseball, facilitators of success, and their overall future career goals after completing baseball. This information may be useful for parents, coaches, and health care professionals to better communicate the benefits and risks associated with sport specialization to youth athletes. Future research is needed to determine if differences in motivation levels exist in younger populations.

Early Sport Specialization and Long-term Throwing Arm Health in College Baseball Players.

BACKGROUND: Early sport specialization is associated with increased risk of overuse injuries in several sports, including baseball. However, limited evidence exists evaluating how early sport specialization affects patient-reported outcome measures as they age. The purpose of this study was to determine differences in Kerlan-Jobe Orthopedic Clinic (KJOC) Shoulder and Elbow Scores among collegiate baseball players based on the grade when a participant first reported high specialization behaviors. HYPOTHESIS: Baseball players who were highly specialized at a younger age will have worse throwing arm health while participating in college. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 752 college baseball players was contacted through their institution's athletic trainer. We measured baseball specialization and KJOC scores using the validated Baseball and Sport Experience survey. Data were summarized using means and SDs, medians and interquartile ranges (IQRs), and frequencies and percentages. A Kruskal-Wallis test was used to determine differences in mean KJOC scale scores based on the earliest time the participant reported high-level specialization. RESULTS: A total of 294 baseball players completed the survey (response rate: 39.1%). Of the 294 participants, 280 completed the KJOC scale questions to generate a total KJOC score (median: 90.5; IQR: 76.6-97.2). No significant differences in KJOC total scores (P = 0.78) existed based on the grade period in which the athlete was first highly specialized. CONCLUSION: Early baseball specialization as a youth baseball player may not impact throwing arm health in college baseball athletes. CLINICAL RELEVANCE: Early specialization has been linked to increased risk for overuse injuries in certain sports, but may not lead to poorer throwing arm health in college baseball players. Sports medicine clinicians and researchers may use this information to educate various stakeholders about the benefits and risks associated with early sport specialization.

Athletic Trainers' Beliefs About and Implementation of Evidence-Based Practice.

CONTEXT: Understanding the beliefs about and use of evidence-based practice (EBP) among athletic trainers (ATs) will help to determine appropriate strategies to improve implementation. OBJECTIVE: To examine the ATs' beliefs about and use of EBP. DESIGN: Cross-sectional study. SETTING: Online survey instrument. PATIENTS OR OTHER PARTICIPANTS: A total of 467 ATs responded to the survey request, a response rate of 11.67%. A total of 385 (9.6%) completed the EBP Beliefs Scale and 342 (8.5%) completed the EBP Implementation Scale. MAIN OUTCOME MEASURE(S): The EBP Beliefs Scale and EBP Implementation Scale were administered. The surveys collected demographic information in addition to information about participants' beliefs regarding EBP and implementation of EBP in clinical practice. RESULTS: The ATs demonstrated a level of neither agree nor disagree (56.00 ± 7.86) on the EBP Beliefs Scale. Belief scores were higher among those ATs required to document for third-party reimbursement (P = .001), those with access to current research through professional journals other than the Journal of Athletic Training (P = .02), and those with a doctoral degree (P = .01). A low level of implementation (9.00 ± 11.38), representing the implementation of EBP approximately 0 times in the previous 8 weeks, was found on the EBP Implementation Scale. Implementation scores were higher among preceptors (P = .01), those required to document for third-party reimbursement (P < .001), those with access to current research through professional journals (P = .002), and those with a doctoral degree (P = .01). CONCLUSIONS: Participants had a positive attitude toward EBP; however, they were not implementing EBP concepts when providing patient care. This suggests that additional information and EBP resources are needed so ATs can better implement EBP in practice. To provide the best patient care and to promote EBP within the profession, clinicians should make EBP a priority and advocate for EBP implementation.

Epidemiology of musculoskeletal injuries among sedentary and physically active adults.

PURPOSE: This study describes the types and frequencies of musculoskeletal injuries among a cohort of adults with above average activity levels who were enrolled in the Aerobics Center Longitudinal Study (Dallas, TX). METHODS: Participants were adults aged 20-85 yr who completed a baseline clinical examination (1970-1982) and returned a mailed follow-up survey in 1986. Participants (5,028 men, 1,285 women) were measured for aerobic fitness, height, and body weight during the baseline examination. They reported detailed information about their physical activity levels and injury experiences on the follow-up survey (1986). An injury was defined as any self-reported soft tissue or bone injury that occurred within the previous 12 months. Activity-related injuries were those injuries participants attributed to participation in a formal exercise program. RESULTS: A quarter of all participants reported a musculoskeletal injury. Of these, 83% were activity-related. More than 66% of activity-related injuries occurred in the lower extremity; the knee was listed as the joint most often affected. There were no significant sex differences in the prevalence of injury, regardless of cause. Sport participants had the highest proportion of all-cause and activity-related musculoskeletal injuries among both men and women. Self-perceived severe injuries had a significant negative impact on physical activity levels since almost 1/3 of subjects reported permanently stopping their exercise program after injury. CONCLUSION: These results suggest the need for developing and implementing injury prevention programs targeted toward moderately active adults.

Experiences with workplace bullying among athletic trainers in the collegiate setting.

CONTEXT: Workplace bullying (WPB) is a series of persistent negative interactions that affect a clinician's ability to perform his or her role. Although WPB has been studied in other health professions, to date, no information exists pertaining to WPB in athletic training. OBJECTIVE: To determine the prevalence of WPB in the collegiate setting and examine factors that influence its occurrence. DESIGN: Cross-sectional study. SETTING: Collegiate setting. PATIENTS OR OTHER PARTICIPANTS: There were 723 (329 female, 394 male) athletic trainers (ATs) aged 37.5 ± 10.4 years. MAIN OUTCOME MEASURE(S): We collected data via the validated and reliable online Athletic Training Environment Survey. Descriptive statistics were obtained to determine a bullying score for each AT and examine the prevalence of WPB. Chi-square analyses were performed to examine the differences between (1) sex, (2) academic degree level, (3) employment title, and (4) National Athletic Trainers' Association district. RESULTS: A total of 106 participants (14.7%) had a score of 2 or higher, indicating they were bullied in the athletic training setting. Of those bullied, 47 (44.3%) were women and 59 (55.7%) were men. There was no difference between women and men with respect to having experienced bullying (χ(2)1 = 0.068, P = .794). Moreover, no difference existed in the prevalence of bullying among ATs holding various degrees (χ(2)3 = 6.73, P = .081) or among ATs holding various titles within an organization (χ(2)5 = 3.55, P = .616). More (χ(2)1 = 23.77, P = < .001) perpetrators were male (74.2%, n = 75) than female (25.8%, n = 26); of these, 38.2% (n = 39) were coaches, 17.6% (n = 18) were supervisory ATs, and 8.8% (n = 9) were coworker ATs. CONCLUSIONS: Bullying was experienced by both male and female ATs in the collegiate setting, and a higher number of bullies were male. More research is necessary to explore WPB in other work settings.

Perceptions of workplace bullying among athletic trainers in the collegiate setting.

CONTEXT: Bullying has received a vast amount of attention in the recent past. One form of bullying, workplace bullying (WPB), has been a substantial concern explored in many health professions that can negatively influence a health care provider's role in an organization. To date, however, WPB has not been investigated in athletic training contexts. OBJECTIVE: To examine the perceptions of certified athletic trainers who experienced or witnessed WPB during employment in the collegiate setting. DESIGN: Qualitative study. SETTING: College or university. PATIENTS OR OTHER PARTICIPANTS: Fifteen athletic trainers (7 women, 8 men) with an average age of 42 ± 12 years. DATA COLLECTION AND ANALYSIS: Data were collected via semistructured, in-depth phone interviews or asynchronous online interviews. Data were analyzed using an inductive content analysis. Trustworthiness was established with member checks and peer debriefing. RESULTS: Four themes emerged from the analysis: (1) antecedents of WPB, (2) consequences of WPB, (3) coping with WPB, and (4) lack of workplace environment training. The antecedents of WPB involved the bully's personality and perceptions of the athletic training profession as well as environmental factors including the pressure to win and a lack of administrative support. The consequences of WPB included increased stress, feelings of inadequacy, and increased distrust. Individuals coped with WPB by relying on emotional resilience and avoidance. A final theme, lack of workplace environment training, revealed that little attention was given to interpersonal issues and WPB in the workplace. CONCLUSIONS: Workplace bullying incidents occur when administrators tolerate bullying behaviors from controlling and manipulative individuals who lack respect for the athletic training professional. Several negative outcomes result from bullying interactions, including stress and anxiety; WPB is dealt with by learning to be more emotionally resilient and avoiding confrontations. Workplace training is needed to prepare athletic trainers for such negative experiences.

Longitudinal evaluation of Journal of Athletic Training author credentials: implications for future research engagement in athletic training.

PURPOSE: To employ retrospective trend analysis in an attempt to provide a layered description of the relative contribution (per credential) of clinical athletic trainers (those without terminal degrees) to authoring scientific literature in the Journal of Athletic Training (JAT). From these data, our secondary purpose was to evaluate trends relative to changes in journal policy and increased educational rigor or professional limitations over the past decade, discussing how they may affect the potential for clinical athletic trainers to contribute to JAT. DESIGN: Exploratory study design with trend analysis. PARTICIPANTS: Data collection and analysis included a trend evaluation of the credentials of clinical athletic trainer authors in JAT and the teams (by credential) of authorship to determine the credentials of authors who published in JAT. MEASUREMENTS: Longitudinal tabulation of JAT author credentials from 1995 through 2007. RESULTS: We noted increases in the absolute number of research articles per volume and the number of authors per article and a decrease in the relative percentage of authors who were athletic trainers. The results also suggested that the bachelor of science degree (BS-ATC, representative of clinical athletic trainers without advanced degrees) and Doctor of Medicine (MD) credential may be underrepresented in JAT authorship. CONCLUSIONS: Postgraduate research training may facilitate scientific article contribution by athletic trainers. Continued evolution in the athletic training evidence-based medicine movement should foster research-based mentorship during education. Cultivating collaborations between clinical athletic trainers and research teams may also promote outcomes assessment trials, which will benefit athletic training practices.

Critical-Thinking Predisposition Among Undergraduate Athletic Training Students.

OBJECTIVE: To investigate the tendency of undergraduate athletic training students to think critically, to assess their likelihood of using specific components of critical thinking, and to study the effect of selected demographic and educational variables on critical-thinking tendencies in this sample of students. DESIGN AND SETTING: Data were collected before regularly scheduled athletic training classes at the beginning of the spring semester. SUBJECTS: Ninety-one students enrolled in 3 Commission on Accreditation of Allied Health Education Programs-accredited undergraduate athletic training education programs in the southeast. The subjects ranged in age from 19 to 29 years (mean age = 22.33 +/- 1.94). Forty-six (50.5%) of the subjects were men and 45 (49.5%) were women. MEASUREMENTS: The California Critical Thinking Disposition Inventory contains 75 Likert-type items assessing 7 components of critical thinking: truth seeking, open mindedness, analyticity, systematicity, inquisitiveness, cognitive maturity, and critical-thinking self-confidence. RESULTS: The overall mean indicated a general but mild trend toward critical thinking, with weak scores on the truth-seeking subscale. One-way analysis of variance reflected significant differences among the schools for truth seeking, open mindedness, and maturity subscales and for the overall mean score for the entire inventory. Only the open-mindedness difference persisted between 2 of the schools after post hoc testing. Correlation analyses indicated no significant relationship between total score and age, sex, ethnicity, year in athletic training program, cumulative grade point average, completed semester hours, or clinical-experience hours. CONCLUSIONS: Athletic training students are inclined toward critical thinking, but this tendency is relatively weak. Classroom and clinical instructors should use teaching methods and techniques that facilitate the components of critical thinking. The promotion of critical thinking and critical-thinking skills has implications for athletic training education and the advancement of certified athletic trainers and the profession of athletic training.

Predictors of lower extremity injury among recreationally active adults.

OBJECTIVE: To identify gender-specific predictors of lower extremity injury among a sample of adults engaging in running, walking, or jogging (RWJ) for exercise. DESIGN: Prospective cohort study. SETTING: Cooper Clinic Preventive Medicine Center, Dallas, Texas. PARTICIPANTS: Participants were 2,481 men and 609 women who underwent a physical examination between 1970 and 1981 and returned a follow-up survey in 1986. Predictor variables measured at baseline included height, weight, and cardiorespiratory fitness. At follow-up, participants recalled information about musculoskeletal injuries, physical activity levels, and other predictors for lower extremity injury over two time periods, 5 years and 12 months. MAIN OUTCOME MEASURES: An injury was defined as any self-reported lower extremity injury that required a consultation with a physician. Cox proportional hazards regression (HR) was used to predict the probability of lower extremity injury for the 5-year recall period, and unconditional logistic regression was used for the 12-month recall period. RESULTS: Among men, previous lower extremity injury was the strongest predictor of lower extremity injury (HR = 1.93-2.09), regardless of recall period. Among women, RWJ mileage >20 miles/wk was the strongest predictor for the 5-year period (HR = 2.08), and previous lower extremity injury was the strongest predictor for the 12-month period (HR = 2.81). CONCLUSIONS: For healthy adults, walking at a brisk pace for 10-20 miles per week accumulates adequate moderate-intensity physical activity to meet national recommendations while minimizing the risk for musculoskeletal lower extremity injury. Clinicians may use this information to provide appropriate injury prevention counseling to their active patients.