Effects of a soccer-specific vertical jump on lower extremity landing kinematics.

Anterior cruciate ligament (ACL) injury frequently occurs in female soccer athletes during deceleration movements such as landings. In soccer, landings mostly occur following jumping headers. Little research has been done to determine the mechanics that follow and how they compare to standard drop vertical jumps (DVJ). The purpose of this study was to analyze differences in kinematics between the DVJ and the soccer-specific vertical jump (SSVJ) in female soccer athletes to better assess the sport-specific risk for ACL injury. A secondary aim was to compare second landings (L2) to first landings (L1). Eight female recreational soccer athletes performed DVJs and SSVJs initiated from a 31 â€‹cm height. Motion capture was performed during landings and data were analyzed using repeated-measures ANOVA. SSVJs produced less peak hip flexion (p â€‹= â€‹0.03) and less peak knee flexion (p â€‹= â€‹0.002) than DVJs. SSVJs also demonstrated increased ankle plantarflexion at initial contact (IC) than DVJs (p â€‹= â€‹0.005). L2s produced less peak hip (p â€‹= â€‹0.007) and knee flexion (p â€‹= â€‹0.002) than L1s. SSVJs and L2s displayed a more erect landing posture than the DVJs and L1s at the hip and knee, a known ACL risk factor. The significant results between jump styles show that the SSVJ displays mechanics that are different from the DVJ. The SSVJ may be a better sport-specific screening tool for ACL injury mechanisms than the DVJ in soccer athletes as it has a more direct translation to the sport.

Speech-language pathologists' perspectives of interprofessional collaboration.

This study aims to provide insight into speech-language pathologists' experiences of and preparation for interprofessional collaborative practice across various settings and geographical locations in the United States. We disseminated an online survey via Qualtrics© to reach a representative sample of speech-language pathologists. We questioned respondents about the extend to which they engage in interprofessional collaborative practice, professionals with whom they engage in interprofessional collaborative practice, preparation for interprofessional collaborative practice, and barriers to engaging in interprofessional collaborative practice. Responses from 296 participants were analyzed to describe details regarding speech-language pathologists' experiences in interprofessional collaboration. Quantitative data included means, ranges, standard deviations, and frequency counts. Open-ended responses underwent analysis through a consensual qualitative approach. Most speech-language pathologists in this study (59%) reported feeling prepared for interprofessional collaboration. Participants reported that they engage in interprofessional collaborative practice with other professionals from disciplines such as nursing, occupational therapy, teaching, physical therapy, and school psychology. To best prepare students for future speech-language pathology practice, participants recommended that students engage in interprofessional education to learn about collaborating with these disciplines. These results could have implications for future design and implementation of interprofessional education activities for students and practicing clinicians.

Employability in Academe for Athletic Trainers With the Doctor of Athletic Training Degree.

CONTEXT: The doctor of athletic training (DAT) degree has recently been introduced into academe. Limited literature exists regarding how individuals with this degree can become part of an athletic training faculty. OBJECTIVE: To identify department chairs' perceptions of the DAT degree and determine whether they viewed the degree as viable when hiring new faculty within a postbaccalaureate professional athletic training program. DESIGN: Cross-sectional study. SETTING: Online survey instrument. PATIENTS OR OTHER PARTICIPANTS: A total of 376 department chairs who had oversight of Commission on Accreditation of Athletic Training Education athletic training programs were invited to participate. Of these, 190 individuals (50.5%) accessed the survey, and 151 of the 190 department chairs (79.5%) completed all parts of the survey. MAIN OUTCOME MEASURE(S): A web-based survey instrument consisted of several demographic questions and 4-point Likert-scale items related to perceptions of the DAT degree. Independent variables were degree qualifications, advanced degree requirements, institutional control, student enrollment, current faculty with a clinical doctorate, and institutional degree-granting classification. The dependent variables were the department chairs' responses to the survey items. RESULTS: More than 80% of department chairs were moderately or extremely familiar with the concept of an advanced practice doctoral degree, and 64% believed it would be extremely to moderately beneficial to hire someone with this degree in the athletic training program. Furthermore, 67% of department chairs were very likely or likely to hire someone with a DAT degree and expected they would do so in the next 5 years. Characteristics associated with higher perception scores were lower institutional student enrollment, having more current faculty with an advanced practice doctoral degree, and a lower institutional degree-granting classification. CONCLUSIONS: Department chairs recognized the DAT degree as a viable degree qualification for teaching in professional athletic training programs. Future researchers should examine the need for athletic trainers with the DAT degree in clinical practice settings.

Employability of the Doctor of Athletic Training Degree within Academe.

CONTEXT: The Doctor of Athletic Training (DAT) degree has recently been introduced into academe. Limited literature exists regarding how individuals with this degree can be utilized as athletic training faculty. OBJECTIVE: To identify department chairs' perceptions of the DAT degree and determine whether they view the degree as viable when hiring new faculty within a post-baccalaureate professional AT program. DESIGN: Cross-sectional survey design Setting: Online survey instrument Patients or Other Participants: 376 department chairs who had oversight of Commission on Accreditation of Athletic Training Education athletic training programs were invited to participate. 190 individuals (50.5%) accessed the survey and 151 of the 190 department chairs completed (79.5%) all parts of the survey. INTERVENTION(S): A web-based survey instrument, which included several demographic questions and 4-point Likert-scale items related to perceptions of the DAT degree, was completed. MAIN OUTCOME MEASURES: Independent variables included institutional control, student enrollment, degree granting classification, faculty with a clinical doctorate, and advanced degree requirements. The dependent variables were the department chairs' responses to the survey items. RESULTS: More than 80% of department chairs were moderately or extremely familiar with the concept of an advanced practice doctoral degree and 64% reported it would be extremely to moderately beneficial to hire someone with this degree within the AT program. Furthermore, 67% of department chairs reported they were very likely or likely to hire someone with a DAT degree, and believed they would do so in the next 5 years. Characteristics associated with higher perception scores included higher institutional student enrollment, having more current faculty with an advanced practice doctoral degree, and increased level of institutional degree granting classification. CONCLUSION(S): Department chairs recognize the DAT degree as a viable degree qualification to teach within professional AT programs. Future research should examine the need for the DAT degree within clinical practice settings.

Anticipatory effects on lower extremity kinetics during a land and cross step maneuver in female volleyball players.

BACKGROUND: Anticipation has been previously shown to affect lower extremity mechanics during both landing and cutting maneuvers. However, little research has been conducted looking at the effects of anticipation on lower body kinetics and kinematics during a land and cross step maneuver, which due to similar kinematics, may elicit injury. The purpose of this study was to investigate competitive female volleyball players and the effect of anticipation on lower extremity mechanics during a landing and subsequent cross stepping maneuver. METHODS: Twelve female, college-level volleyball players performed right and left cross step maneuvers following a landing under anticipated and unanticipated conditions. Kinetics were measured for the ankle, knee and hip of the dominant limb during the landing phase of the land and cross step anticipatory conditions. RESULTS: An interaction effect (anticipation x direction; P=0.001) was observed for vertical ground reaction force (VGRF), in which greater VGRF was found during unanticipated pivoting maneuvers. Additional interaction effects were determined for ankle (P=0.004) and hip (P=0.037) power absorption, in which greater absorption was found during anticipated, push off conditions. Frontal plant knee kinetics revealed a higher-order interaction, as a larger knee adduction moment was shown during anticipated, push off trials (P=0.001). CONCLUSIONS: High risk cross step maneuvers were found during unanticipated and anticipated conditions, as athletes demonstrated movement mechanics that may increase the risk of knee injury when performing movements away from the dominant limb. Consideration should be given to drills familiarizing volleyball players with unanticipated and anticipated changes of direction, as well as improving strength of the lower extremity muscles required to effectively decelerate the body, as both training modalities may minimize injury risk during cross step maneuvers.

Challenges to and Resources for Participation in Interprofessional Collaborative Practice: Perceptions of Collegiate Athletic Trainers.

CONTEXT: Health care systems are increasing their emphasis on interprofessional collaborative practice (IPCP) as a necessary component to patient care. However, information regarding the challenges athletic trainers (ATs) perceive with respect to participating in IPCP is lacking. OBJECTIVE: To describe collegiate ATs' perceptions of challenges to and resources for participation in IPCP. DESIGN: Qualitative study. SETTING: College and university. PATIENTS OR OTHER PARTICIPANTS: The response rate was 8% (513 ATs [234 men, 278 women, 1 preferred not to disclose sex], years in clinical practice = 10.69 ± 9.33). DATA COLLECTION AND ANALYSIS: Responses to survey-based, open-ended questions were collected through Qualtrics. A general inductive qualitative approach was used to analyze data and establish relevant themes and categories for responses. Multianalyst coding and an external auditor confirmed coding saturation and assisted in triangulation. RESULTS: Challenges were reported in the areas of needing a defined IPCP team structure, respect for all involved health care parties, and concerns when continuity of care was compromised. Communication was reported as both a perceived challenge and a resource. Specific resources seen as beneficial to effective participation in IPCP included communication mechanisms such as shared patient health records and educational opportunities with individuals from other health care professions. CONCLUSIONS: As ATs become more integrated into IPCP, they need to accurately describe and advocate their roles, understand the roles of others, and be open to the dynamic needs of team-based care. Development of continuing interprofessional education opportunities for all relevant members of the health care team can help to delineate roles more effectively and provide more streamlined care with the goal of improving patient outcomes.

Collegiate athletic trainers' perceptions of the benefits and drawbacks of interprofessional collaborative practice.

Interprofessional collaborative practice (IPCP) is a recommended area of emphasis within healthcare. Little is known regarding athletic trainers' perceptions of benefits and drawbacks to participation in IPCP. A cross-sectional survey design with open-ended questions was utilised to survey 513 athletic trainers from across the United States. Data were extracted and analysed following a general inductive qualitative approach to determine categories and subcategories. Triangulation occurred via multi-analyst coding and review of findings by an external auditor. Athletic trainers' perceptions of IPCP align with the Interprofessional Education Collaborative (IPEC) Core Competencies. A team approach to care and improved patient care are perceived as benefits to IPCP. Learning and understanding the roles of other healthcare professionals as well as communication among team members are perceived as both benefits and drawbacks to IPCP. The ability to appreciate and implement the IPEC Core Competencies may help the athletic trainer participate in the growing IPCP culture. Identification and dissemination of strategies to increase IPCP participation among athletic trainers are needed.

Perceptions of Interprofessional and Collaborative Practice in Collegiate Athletic Trainers.

CONTEXT: The ability to engage in interprofessional and collaborative practice (IPCP) has been identified as one of the Institute of Medicine's core competencies required of all health care professionals. OBJECTIVE: To determine the perceptions of athletic trainers (ATs) in the collegiate setting regarding IPCP and current practice patterns. DESIGN: Cross-sectional study. PATIENTS OR OTHER PARTICIPANTS: Of 6313 ATs in the collegiate setting, 739 (340 men, 397 women, 2 preferred not to answer; clinical experience = 10.97 ± 9.62 years) responded (11.7%). MAIN OUTCOME MEASURE(S): The Online Clinician Perspectives of Interprofessional Collaborative Practice survey section 1 assessed ATs' perceptions of working with other professionals (construct 1), ATs engaged in collaborative practice (construct 2), influences of collaborative practice (construct 3), and influences on roles, responsibilities, and autonomy in collaborative practice (construct 4). Section 2 assessed current practice patterns of ATs providing patient care and included the effect of communication on collaborative practice (construct 5) and patient involvement in collaborative practice (construct 6). Between-groups differences were assessed using a Kruskal-Wallis H test and Mann-Whitney U tests ( P < .05). RESULTS: Athletic trainers in the collegiate setting agreed with IPCP constructs 1 through 4 (construct 1 = 3.56 ± 0.30, construct 2 = 3.36 ± 0.467, construct 3 = 3.48 ± 0.39, construct 4 = 3.20 ± 0.35) and indicated that the concepts of constructs 5 and 6 (1.99 ± 0.46, 1.80 ± 0.50, respectively) were sometimes true in their setting. Athletic trainers functioning in a medical model reported lower scores for construct 5 (1.88 ± 0.44) than did those in an athletic model (2.03 ± 0.45, U = 19 522.0, P = .001). A total of 42.09% of the ATs' patient care was performed in collaborative practice. CONCLUSIONS: Athletic trainers in the collegiate setting agreed that IPCP concepts were beneficial to patient care but were not consistently practicing in this manner. Consideration of a medical model structure, wherein more regular interaction with other health care professionals occurs, may be beneficial to increase the frequency of IPCP.

Exploring the Relationship Between Athletic Identity and Beliefs About Rehabilitation Overadherence in College Athletes.

CONTEXT: Athletic identity has been associated with rehabilitation overadherence in college athletes. OBJECTIVES: To explore which constructs of athletic identity predict rehabilitation overadherence, gauge athletes' views of the most salient aspect of their athletic participation, and understand their perceptions of the reasons they adhere to their rehabilitation program. DESIGN: Cross-sectional, mixed methods. SETTING: University athletic training clinics and online. PARTICIPANTS: Currently injured college athletes (N = 80; 51 male, 29 female). MAIN OUTCOME MEASURES: Athletic Identity Measurement Scale (AIMS), Rehabilitation Overadherence Questionnaire (ROAQ), and 2 open-ended questions about athletic participation and rehabilitation adherence. RESULTS: Higher levels of athletic identity were associated with higher levels of rehabilitation overadherence (r = .29, P = .009). Hierarchical multiple regression used on AIMS subscales to predict ROAQ subscales did not reveal a significant model for the subscale "ignore practitioner recommendations." However, a significant model was revealed for the subscale "attempt an expedited rehabilitation," F5,73 = 2.56, P = .04, R2 = .15. Negative affectivity was the only significant contribution to the equation (ß = 0.33, t = 2.64, P = .01). Content analysis revealed that bodily benefits, sport participation, personal achievement, social relationships, and athlete status were perceived to be the most important aspects of being an athlete. The themes of returning to competition, general health, and relationship beliefs were identified as the major factors for adhering to a rehabilitation program. CONCLUSIONS: Negative affectivity accounted for a significant but low amount of variance for rehabilitation overadherence, suggesting that athletic trainers should pay attention to personal variables such as athletic identity that might influence the rehabilitation process. Using the knowledge of why athletes adhere to their rehabilitation and what is most important to them about being an athlete, athletic trainers can use appropriate interventions to facilitate proper rehabilitation adherence.

Graduate-Assistant Athletic Trainers' Perceptions of Professional Socialization in the Collegiate Setting: Part I.

CONTEXT: Many newly credentialed athletic trainers (ATs) pursue graduate assistantships, which allow them to gain experience while being supervised by an experienced AT. The graduate-assistant (GA) ATs' perception of their socialization process into the collegiate setting is unknown. OBJECTIVE: To explore the professional socialization of GAs in the collegiate setting. DESIGN: Qualitative study. SETTING: Phone interviews. PATIENTS OR OTHER PARTICIPANTS: A total of 19 collegiate GAs (15 women, 4 men; average age = 23 ± 0.15 years; National Collegiate Athletic Association Division I = 13, II = 3, III = 2; National Association of Intercollegiate Athletics = 2; postprofessional athletic training program = 6) participated. DATA COLLECTION AND ANALYSIS: Data were collected via phone interviews and transcribed verbatim. Interviews were conducted until data saturation occurred. Data were analyzed through phenomenologic reduction. Trustworthiness was established via member checks and peer review. RESULTS: Four themes emerged: (1) role identity, (2) initial entry into role, (3) maturation, and (4) success. Before beginning their role, participants envisioned the assistantship as a way to gain independent experience while being mentored. They perceived themselves as the primary care providers for their athletic teams. Those who were immediately immersed into clinical practice adapted to their role quickly despite experiencing stress initially. Participants felt that a formal orientation process and a policies and procedures manual would have alleviated some of the initial stress. The GAs matured as they practiced clinically and developed confidence as they gained experience. Personal attributes, experience, and peer and supervisor support contributed to perceived success as GAs. Factors that hindered perceived success were lack of confidence, an unsupportive environment, and long hours. CONCLUSIONS: When looking for graduate assistantships, ATs should seek a position that allows them to practice independently and provides didactic educational opportunities while aligning with their athletic training philosophies.

Graduate-Assistant Athletic Trainers' Perceptions of the Supervisor's Role in Professional Socialization: Part II.

CONTEXT: Many new athletic trainers (ATs) obtain graduate-assistant (GA) positions to gain more experience and professional development while being mentored by a veteran AT; however, GA ATs' perceptions of the supervisor's role in professional development are unknown. OBJECTIVE: To explore the supervisor's role in the professional development of GAs in the collegiate setting. DESIGN: Qualitative study. SETTING: Phone interviews. PATIENTS OR OTHER PARTICIPANTS: A total of 19 collegiate GAs (15 women, 4 men; average age = 23 ± 0.15 years; National Collegiate Athletic Association Division I = 13, II = 3, III = 2; National Association of Intercollegiate Athletics = 2; postprofessional athletic training program = 5). DATA COLLECTION AND ANALYSIS: Data were collected via phone interviews and transcribed verbatim. Interviews were conducted until data saturation occurred. Data were analyzed through phenomenologic reduction. Trustworthiness was established via member checks and peer review. RESULTS: Three themes emerged: (1) GAs' expectations of supervisors, (2) professional development, and (3) mentoring and support. Participants expected their supervisors to provide mentorship, support, and feedback to help them improve their athletic training skills, but they also realized supervisors were busy with patient care responsibilities. Most participants felt their supervisors were available, but others believed their supervisors were too busy to provide support and feedback. Participants felt their supervisors provided professional development by teaching them new skills and socializing them into the profession. Furthermore, they thought their supervisors provided mentorship professionally, personally, and clinically. Supervisors supported the participants by standing behind them in clinical decisions and having open-door policies. CONCLUSIONS: The graduate assistantship allows new ATs to gain experience while pursuing professional development, mentorship, and support from a supervisor. The extent of development is highly dependent on the supervisor, but most supervisors mentor GAs. When looking for graduate assistantships, future GAs should seek positions in which supervisors actively provide mentoring and professional development.

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.

Supervising athletic trainers' perceptions of professional socialization of graduate assistant athletic trainers in the collegiate setting.

CONTEXT: Many newly credentialed athletic trainers gain initial employment as graduate assistants (GAs) in the collegiate setting, yet their socialization into their role is unknown. Exploring the socialization process of GAs in the collegiate setting could provide insight into how that process occurs. OBJECTIVE: To explore the professional socialization of GAs in the collegiate setting to determine how GAs are socialized and developed as athletic trainers. DESIGN: Qualitative study. SETTING: Individual phone interviews. PATIENTS OR OTHER PARTICIPANTS: Athletic trainers (N = 21) who had supervised GAs in the collegiate setting for a minimum of 8 years (16 men [76%], 5 women [24%]; years of supervision experience = 14.6 ± 6.6). DATA COLLECTION AND ANALYSIS: Data were collected via phone interviews, which were recorded and transcribed verbatim. Data were analyzed by a 4-person consensus team with a consensual qualitative-research design. The team independently coded the data and compared ideas until a consensus was reached, and a codebook was created. Trustworthiness was established through member checks and multianalyst triangulation. RESULTS: Four themes emerged: (1) role orientation, (2) professional development and support, (3) role expectations, and (4) success. Role orientation occurred both formally (eg, review of policies and procedures) and informally (eg, immediate role immersion). Professional development and support consisted of the supervisor mentoring and intervening when appropriate. Role expectations included decision-making ability, independent practice, and professionalism; however, supervisors often expected GAs to function as experienced, full-time staff. Success of the GAs depended on their adaptability and on the proper selection of GAs by supervisors. CONCLUSIONS: Supervisors socialize GAs into the collegiate setting by providing orientation, professional development, mentoring, and intervention when necessary. Supervisors are encouraged to use these socialization tactics to enhance the professional development of GAs in the collegiate setting.

Perceived outcomes of web-based modules designed to enhance athletic trainers' knowledge of evidence-based practice.

CONTEXT: The release of evidence-based practice (EBP) Web-based learning modules to the membership of the National Athletic Trainers' Association has provided athletic trainers (ATs) the opportunity to enhance their knowledge of the various EBP concepts. Whereas increasing the knowledge of EBP among ATs is important, assessing whether this newfound knowledge is being translated into clinical practice and didactic education is crucial. OBJECTIVE: To explore the effectiveness of an educational intervention regarding EBP on the didactic instruction patterns of athletic training educators and the clinical practice behaviors of clinicians. DESIGN: Qualitative study. SETTING: Individual telephone interviews. PATIENTS OR OTHER PARTICIPANTS: A total of 25 ATs (12 educators, 13 clinicians; experience as an AT = 16.00 ± 9.41 years) were interviewed. DATA COLLECTION AND ANALYSIS: We conducted 1 individual telephone interview with each participant. After transcription, the data were analyzed and coded into common themes and categories. Triangulation of the data occurred via the use of multiple researchers and member checking to confirm the accuracy of the data. RESULTS: Participants perceived the EBP Web-based modules to produce numerous outcomes regarding education and clinical practice. These outcomes included perceived knowledge gain among participants, an increase in the importance and scope of EBP, a positive effect on educators' didactic instruction patterns and on instilling value and practice of EBP among students, and an enhanced ability among clinicians to implement EBP within clinical practice. However, some clinicians reported the Web-based modules had no current effect on clinical practice. CONCLUSIONS: Although the EBP Web-based modules were successful at enhancing knowledge among ATs, translation of knowledge into the classroom and clinical practice remains limited. Researchers should aim to identify effective strategies to help ATs implement EBP concepts into didactic education and clinical practice.

An evidence-based practice educational intervention for athletic trainers: a randomized controlled trial.

CONTEXT: As evidence-based practice (EBP) becomes a necessity in athletic training, Web-based modules have been developed and made available to the National Athletic Trainers' Association membership as a mechanism to educate athletic trainers (ATs) on concepts of EBP. OBJECTIVE: To assess the effect of an educational intervention on enhancing knowledge of EBP among ATs. DESIGN: Randomized controlled trial. SETTING: Web-based modules and knowledge assessment. PATIENTS OR OTHER PARTICIPANTS: A total of 164 of 473 ATs (34.7% response rate), including professional athletic training students, graduate students, clinical preceptors, educators, and clinicians, were randomized into a control group (40 men, 42 women) or experimental group (33 men, 49 women). INTERVENTION(S): Ten Web-based modules were developed that covered concepts involved in the EBP process. Both groups completed the Evidence-Based Practice Knowledge Assessment before and after the intervention phase. During the intervention phase, the experimental group had access to the Web-based modules for 4 weeks, whereas the control group had no direct responsibilities for the investigation. The knowledge assessment consisted of 60 multiple choice questions pertaining to concepts presented in the 10 modules. Test-retest reliability was determined to be good (intraclass correlation coefficient [2,1] = 0.726, 95% confidence interval = 0.605, 0.814). MAIN OUTCOME MEASURE(S): Independent variables consisted of group (control, experimental) and time (preassessment, postassessment). Knowledge scores were tabulated by awarding 1 point for each correct answer (maximum = 60). Between-group and within-group differences were calculated using a 2 × 2 repeated-measures analysis of variance (P ≤ .05), post hoc t tests, and Hedges g effect size with 95% confidence intervals. RESULTS: We found a group × time interaction (F1,162 = 26.29, P < .001). No differences were identified between the control (30.12 ± 5.73) and experimental (30.65 ± 5.93) groups during the preassessment (t162 = 0.58, P = .84). The experimental group (36.35 ± 8.58) obtained higher scores on the postassessment than the control group (30.99 ± 6.33; t162 = 4.55, P = .01). No differences were identified among time instances within the control group (t81 = 1.77, P = .08); however, the experimental group obtained higher scores on the postassessment than the preassessment (t81 = 7.07, P < .001). CONCLUSIONS: An educational intervention consisting of 10 Web-based modules was an effective mechanism to increase knowledge of foundational EBP concepts among ATs. However, it is not known whether ATs are integrating EBP into daily clinical practice. Researchers should determine whether increased knowledge of EBP affects the daily clinical decision making of ATs.

Future directions of evidence-based practice in athletic training: perceived strategies to enhance the use of evidence-based practice.

CONTEXT: The shift to a culture of evidence-based practice (EBP) in athletic training is a necessary step in both the optimization of patient care and the advancement of athletic trainers (ATs) as health care professionals. Whereas individuals have gained knowledge in this area, most ATs still are not practicing in an evidence-based manner. Exploring perceived strategies to enhance the use of EBP will help to determine the best approaches to assist ATs in applying EBP concepts to practice to improve patient care. OBJECTIVE: To explore beneficial strategies and techniques ATs perceived would promote successful implementation of EBP within athletic training education and clinical practice. DESIGN: Qualitative study. SETTING: Individual telephone interviews. PATIENTS OR OTHER PARTICIPANTS: Twenty-five ATs (12 educators, 13 clinicians; athletic training experience = 16.00 ± 9.41 years) were interviewed. DATA COLLECTION AND ANALYSIS: One phone interview was conducted with each participant. After the interview was transcribed, the data were analyzed and coded into common themes and categories. Triangulation of the data occurred via the use of multiple researchers and member checking to confirm the accuracy of the data. RESULTS: Participants identified several components they perceived as essential for enhancing the use of EBP within the athletic training profession. These components included the need for more EBP resources, more processed information, focused workshops, peer discussion and mentorship, and continual repetition and exposure. Participants also indicated that ATs need to accept their professional responsibilities to foster EBP in their daily practices. CONCLUSIONS: The proper shift to a culture of EBP in athletic training will take both time and a persistent commitment by ATs to create strategies that will enhance the implementation of EBP across the profession. Researchers should focus on continuing to identify effective educational interventions for ATs and to determine successful strategies to implement EBP into didactic curricula and clinical practice. Additional focus should be given to which strategies most effectively produce changes in clinical practice.

Perceptions of approved clinical instructors: barriers in the implementation of evidence-based practice.

CONTEXT: As evidence-based practice (EBP) becomes prevalent in athletic training education, the barriers that Approved Clinical Instructors (ACIs) experience in implementing it with students need to be understood. OBJECTIVE: To investigate barriers ACIs face when implementing EBP concepts in clinical practice and in teaching EBP to professional athletic training students and to investigate the educational emphases to improve the barriers. DESIGN: Qualitative study. SETTING: Telephone interviews. PATIENTS OR OTHER PARTICIPANTS: Sixteen ACIs (11 men, 5 women; experience as an athletic trainer = 10 ± 4.7 years, experience as an ACI = 6.81 ± 3.9 years) were interviewed. DATA COLLECTION AND ANALYSIS: We interviewed each participant by telephone. Interview data were analyzed and coded for common themes and subthemes regarding barriers and educational emphases. Themes were triangulated through multiple-analyst triangulation and interpretive verification. RESULTS: Barriers to EBP incorporation and educational emphasis placed on EBP were the main themes reported. Resources, personnel, and student characteristics were subthemes identified as barriers. Resource barriers included time, equipment, access to current literature, and knowledge. Coworkers, clinicians, and coaches who were unwilling to accept evidence regarding advancements in treatment were identified as personnel barriers. Programmatic improvement and communication improvement were subthemes of the educational emphasis placed on EBP theme. The ACIs reported the need for better integration between the clinical setting and the classroom and expressed the need for EBP to be integrated throughout the athletic training education program. CONCLUSIONS: Integration of the classroom and clinical experience is important in advancing ACIs' use of EBP with their students. Collaborative efforts within the clinical and academic program could help address the barriers ACIs face when implementing EBP. This collaboration could positively affect the ability of ACIs to implement EBP within their clinical practices.

Use of evidence-based practice among athletic training educators, clinicians, and students, part 1: perceived importance, knowledge, and confidence.

CONTEXT: Although evidence-based practice (EBP) has become more prevalent, athletic trainers' perceptions of importance and knowledge of these concepts and their confidence in EBP are largely unknown. OBJECTIVE: To assess perceived importance and knowledge of and confidence in EBP concepts in athletic trainers in various roles and with different degree levels. DESIGN: Cross-sectional study. SETTING: Online survey instrument. PATIENTS OR OTHER PARTICIPANTS: The survey was sent to 6702 athletic training educators, clinicians, and postprofessional students. A total of 1209 completed the survey, for a response rate of 18.04%. MAIN OUTCOME MEASURE(S): Demographic information and perceived importance and knowledge of and confidence in the steps of EBP were obtained. One-way analysis of variance, a Kruskal-Wallis test, and an independent-samples t test were used to determine differences in scores among the demographic variables. RESULTS: Athletic trainers demonstrated low knowledge scores (64.2% ± 1.29%) and mild to moderate confidence (2.71 ± 0.55 out of 4.0). They valued EBP as moderately to extremely important (3.49 ± 0.41 out of 4.0). Perceived importance scores differed among roles (clinicians unaffiliated with an education program scored lower than postprofessional educators, P = .001) and highest educational degree attained (athletic trainers with terminal degrees scored higher than those with bachelor's or master's degrees, P < .001). Postprofessional athletic training students demonstrated the highest total EBP knowledge scores (4.65 ± 0.91), whereas clinicians demonstrated the lowest scores (3.62 ± 1.35). Individuals with terminal degrees had higher (P < .001) total knowledge scores (4.31 ± 1.24) than those with bachelor's (3.78 ± 1.2) or master's degrees (3.76 ± 1.35). Postprofessional educators demonstrated greater confidence in knowledge scores (3.36 ± 0.40 out of 4.0) than did those in all other athletic training roles (P < .001). CONCLUSIONS: Overall knowledge of the basic EBP steps remained low across the various athletic trainers' roles. The higher level of importance indicated that athletic trainers valued EBP, but this value was not reflected in the knowledge of EBP concepts. Individuals with a terminal degree possessed higher knowledge scores than those with other educational preparations; however, EBP knowledge needs to increase across all demographics of the profession.

Use of evidence-based practice among athletic training educators, clinicians, and students, part 2: attitudes, beliefs, accessibility, and barriers.

CONTEXT: Successful implementation of evidence-based practice (EBP) within athletic training is contingent upon understanding the attitudes and beliefs and perceived barriers toward EBP as well as the accessibility to EBP resources of athletic training educators, clinicians, and students. OBJECTIVE: To assess the attitudes, beliefs, and perceived barriers toward EBP and accessibility to EBP resources among athletic training educators, clinicians, and students. DESIGN: Cross-sectional study. SETTING: Online survey instrument. PATIENTS OR OTHER PARTICIPANTS: A total of 1209 athletic trainers participated: professional athletic training education program directors (n = 132), clinical preceptors (n = 266), clinicians (n = 716), postprofessional athletic training educators (n = 24) and postprofessional students (n = 71). MAIN OUTCOME MEASURE(S): Likert-scale items (1 = strongly disagree, 4 = strongly agree) assessed attitudes and beliefs and perceived barriers, whereas multipart questions assessed accessibility to resources. Kruskal-Wallis H tests (P ≤ .05) and Mann-Whitney U tests with a Bonferroni adjustment (P ≤ .01) were used to determine differences among groups. RESULTS: Athletic trainers agreed (3.27 ± 0.39 out of 4.0) that EBP has various benefits to clinical practice and disagreed (2.23 ± 0.42 out of 4.0) that negative perceptions are associated with EBP. Benefits to practice scores (P = .002) and negative perception scores (P < .001) differed among groups. With respect to perceived barriers, athletic trainers disagreed that personal skills and attributes (2.29 ± 0.52 out of 4.0) as well as support and accessibility to resources (2.40 ± 0.40 out of 4.0) were barriers to EBP implementation. Differences were found among groups for personal skills and attributes scores (P < .001) and support and accessibility to resources scores (P < .001). Time (76.6%) and availability of EBP mentors (69.6%) were the 2 most prevalent barriers reported. Of the resources assessed, participants were most unfamiliar with clinical prediction rules (37.6%) and Cochrane databases (52.5%); direct access to these 2 resources varied among participants. CONCLUSIONS: Athletic trainers had positive attitudes toward the implementation of EBP within didactic education and clinical practice. However, accessibility and resource use remained low for some EBP-related resources. Although the perceived barriers to implementation are minimal, effective integration of EBP within athletic training will present challenges until these barriers dissolve.

Approved clinical instructors' perspectives on implementation strategies in evidence-based practice for athletic training students.

CONTEXT: Understanding implementation strategies of Approved Clinical Instructors (ACIs) who use evidence-based practice (EBP) in clinical instruction will help promote the use of EBP in clinical practice. OBJECTIVE: To examine the perspectives and experiences of ACIs using EBP concepts in undergraduate athletic training education programs to determine the importance of using these concepts in clinical practice, clinical EBP implementation strategies for students, and challenges of implementing EBP into clinical practice while mentoring and teaching their students. DESIGN: Qualitative study. SETTING: Telephone interviews. PATIENTS OR OTHER PARTICIPANTS: Sixteen ACIs (11 men, 5 women; experience as a certified athletic trainer = 10 ± 4.7 years, experience as an ACI = 6.8 ± 3.9 years) were interviewed. DATA COLLECTION AND ANALYSIS: We interviewed each participant by telephone. Interview transcripts were analyzed and coded for common themes and subthemes regarding implementation strategies. Established themes were triangulated through peer review and member checking to verify the data. RESULTS: The ACIs identified EBP implementation as important for validation of the profession, changing paradigm shift, improving patient care, and improving student educational experiences. They promoted 3 methods of implementing EBP concepts with their students: self-discovery, promoting critical thinking, and sharing information. They assisted students with the steps of EBP and often faced challenges in implementation of the first 3 steps of EBP: defining a clinical question, literature searching, and literature appraisal. Finally, ACIs indicated that modeling the behavior of making clinical decisions based on evidence was the best way to encourage students to continue using EBP. CONCLUSIONS: Athletic training education program directors should encourage and recommend specific techniques for EBP implementation in the clinical setting. The ACIs believed that role modeling is a strategy that can be used to promote the use of EBP with students. Training of ACIs should include methods by which to address the steps of the EBP process while still promoting critical thinking.