Organizational Expectations Regarding Documentation Practices in Athletic Training.

CONTEXT: Although guidance is available, no nationally recognized standard exists for medical documentation in athletic training, leaving individual organizations responsible for setting expectations and enforcing policies. Previous research has examined clinician documentation behaviors; however, the supervisor's role in creating policy and procedures, communicating expectations, and ensuring accountability has not been investigated. OBJECTIVE: To investigate supervisor practices regarding support, hindrance, and enforcement of medical documentation standards at an individual organization level. DESIGN: Mixed-methods study. SETTING: Online surveys and follow-up interviews. PATIENTS OR OTHER PARTICIPANTS: We criterion sampled supervising athletic trainers (n = 1107) in National Collegiate Athletic Association member schools. The survey collected responses from 64 participants (age = 43 ± 11 years; years of experience as a supervisor = 12 ± 10; access rate = 9.6%; completion rate = 66.7%), and 12 (age = 35 ± 6 years; years of experience as a supervisor = 8 ± 5) participated in a follow-up interview. DATA COLLECTION AND ANALYSIS: We used measures of central tendency to summarize survey data and the consensual qualitative research approach with a 3-person data analysis team and multiphase process to create a consensus codebook. We established trustworthiness using multiple-analyst triangulation, member checking, and internal and external auditing. RESULTS: Fewer than half of supervisors reported having formal written organization-level documentation policies (n = 45/93, 48%) and procedures (n = 32/93, 34%) and an expected timeline for completing documentation (n = 24/84, 29%). Participants described a framework relative to orienting new and existing employees, communicating policies and procedures, strategies for holding employees accountable, and identifying purpose. Limitations included lack of time, prioritization of other roles and responsibilities, and assumptions of prior training and record quality. CONCLUSION: Despite a lack of clear policies, procedures, expectations, prioritization, and accountability strategies, supervisors still felt confident in their employees' abilities to create complete and accurate records. This highlights a gap between supervisor and employee perceptions, as practicing athletic trainers have reported uncertainty regarding documentation practices in previous studies. Although supervisors perceive high confidence in their employees, clear organization standards, employer prioritization, and mechanisms for accountability surrounding documentation will result in improved patient care delivery, system outcomes, and legal compliance.

Higher Levels of Income and Education are Associated with More Specialized Sport Participation Behaviors: Results from a Representative Sample of Youth Sport Parents from the United States.

Background: While previous studies have examined the impact of family socioeconomic characteristics on a child's sport specialization behaviors, this research has been limited to affluent communities with limited sociodemographic diversity. Hypothesis/Purpose: The purpose of this study was to examine associations of parent income and education with child sport specialization behaviors among a nationally representative sample of youth sport parents in the United States. Study Design: Cross-sectional. Methods: Parents of youth athletes in the United States (n=236, age: 39.2±8.1 years, 57.2% female) were recruited to complete an online questionnaire by Qualtrics Online Samples (Qualtrics, Provo, UT) using a combination of actively managed, double-opt-in market research panels. The questionnaire used for this study consisted of: 1) parent demographics (including parent age, race/ethnicity, biological sex, gender identity, household income, and educational status), and 2) child sport participation characteristics and sport specialization behaviors. Results: Parents who reported an annual household income of $75,001 or more were more likely than parents making less than $75,000 to report that their child participated on an organized club team (OR [95%CI]: 1.94 [1.15-3.27]), participated on multiple organized teams at the same time (OR [95%CI]: 1.85 [1.10-3.11]), or specialized in a single sport (OR [95%CI]: 2.45 [1.45-4.14]). Parents who reported receiving a Bachelor's degree or higher were more likely than parents who did not to report that their child participated on an organized club team (OR [95%CI]: 3.04 [1.78-5.18]), participated on multiple organized teams at the same time (OR [95%CI]: 2.42 [1.43-4.10]), or specialized in a single sport (OR [95%CI]: 1.94 [1.15-3.26]). Conclusions: Thes results suggest that in the modern youth sport culture, family resources may serve as a major determining factor in the type of experiences available for a youth athlete. Level of Evidence: III.

The Impact of the Social Determinants of Health on Athletic Trainer Availability in Indiana Secondary Schools.

CONTEXT: The Social Determinants of Health (SDOH) are circumstances individuals are born, work, and live, that influence health outcomes. Previous research has examined one determinant of economic stability and found disparities in socioeconomic status and athletic trainer availability (AT availability). OBJECTIVE: Examine SDOH characteristics of Indiana secondary schools and AT availability. DESIGN: Cross-sectional study. SETTING: Database secondary analysis. PARTICIPANTS: 426 secondary schools. MAIN OUTCOME MEASURES: All data was collected from publically available databases. The independent variable was AT availability, schools were classified as having a full-time AT (full-time AT), a part-time AT only (part-time AT), or no AT (no AT). The SDOH variables were gathered for each school (school and county-level). Data were summarized using measures of central tendencies, one-way ANOVAs, and Kruskal-Wallis tests. RESULTS: School enrollment was larger in schools with greater AT availability (p<.001). The proportion of non-white students was greater in schools with more AT availability (p=0.002). There was greater AT availability in counties with higher graduation rates (p=0.03). Post-hoc comparisons revealed significant differences in graduation rate between part-time AT and no AT schools (p=0.04). Schools with less AT availability were located in counties with a slightly higher percentage of the population uninsured (p=0.02). Schools with greater AT availability were located in counties with a higher ratio of population to primary care physicians (p=0.03). Schools with less AT availability were located in counties with higher population experiencing severe housing problems (p=0.02). There were no significant differences in AT availability based on the three social and community context variables (p>0.05). CONCLUSIONS: We found differences in AT availability and a different SDOH characteristics at the secondary school-level. There was less AT availability where high school graduation rates and population of primary care providers are lower. Strategies should be implemented to improve access to athletic health care in under-resourced communities.

WORKPLACE CLIMATE FOR SEXUAL AND GENDER MINORITIES IN ATHLETIC TRAINING.

CONTEXT: Sexual and gender minorities (SGM) are individuals with sexual orientations, gender identities and/or expressions that differ from cultural norms. SGMs often face workplace discrimination and report decreased physical and emotional well-being from discrimination. OBJECTIVE: To explore the workplace climate of SGM athletic trainers (AT). DESIGN: Sequential mixed-methods study. SETTING: Web-based survey and interviews. PATIENTS OR OTHER PARTICIPANTS: Criterion sampling of SGM ATs (117 survey participants and 12 interview participants). DATA COLLECTION AND ANALYSIS: We modified the LGBTQ Inclusion Assessment and the Organizational Self-Assessment for the survey and developed a semi-structured interview script (scale-level content validity index=0.94). We used means, standard deviations, frequencies and the consensual qualitative research tradition to characterize participant responses. Trustworthiness was established through reflexivity (researchers checking bias throughout the research process), member-checking, multi-analyst triangulation, internal and external auditing. RESULTS: Participants indicated their workplace was inclusive (24, 20.5%), somewhat inclusive (29, 24.8%), not inclusive (14, 12.0%), or did not indicate at all (50, 42.7%). Respondents most often indicated they were unsure of the stage of change their organizations and organizational units were in addressing LGBTQPIA+ issues in the workplace as well as specific actions taken for inclusion. Two domains emerged from the interview data: safety and inclusion. The safety domain represents aspects of the workplace climate that make the participants feel safe including organizational initiatives (12/12), patient-centered policies (7/12), local and federal regulations (7/12), and signaling (12/12). The inclusion domain represents how the participants felt a sense of belonging to the organization through their own experience (12/12), through the experiences of their patients (9/12), and through an infrastructure designed for inclusion (12/12). Participants expressed both the affirmative and the negative feelings of safety and inclusion throughout their responses. CONCLUSIONS: Organizations must take both structural and cultural actions to address the issues of exclusion and lack of safety.

Youth Sport Participation Experiences From the Perspective of Hispanic/Latinx Parents and Their Children.

Hispanic/Latinx communities remain an underserved population in terms of health and physical activity opportunities. The rise of sport specialization can jeopardize these opportunities. Understanding the appeal and welcomeness that minoritized populations feel toward sport and sport specialization culture can play an important role in health promotion and breaking down barriers that widen the gap on physical activity levels in Hispanic/Latinx communities. To date, these studies have not qualitatively investigated Hispanic/Latinx youth sport dyads (parent and child) and how sport specialization perceptions have affected their sport participation experiences. We used a qualitative interpretative phenomenological analysis to explore experiences of Hispanic/Latinx high school athletes. We engaged in semistructured interviews with 12 parent-child dyads. The following 3 interrelated themes emerged: (a) expectations of youth sport participation, (b) meeting expectations of youth sport participation, (c) and (mis)alignment of cultures. Dyads describe a negative youth sport experience when both cultures do not align because of the rise in sport specialization and pay-to-play culture. Findings indicate that dyads understand what is necessary to participate in organized sport and do this by methods that are rooted in their Hispanic/Latinx culture.

The Knowledge and Use of the International Classification of Functioning, Disability and Health (ICF) Framework in Athletic Training.

In 2015, the Strategic Alliance adopted the International Classification of Functioning, Disability, and Health (ICF) as the disablement model framework for delivery of and communication about patient care in athletic training. The purpose of this study was to examine athletic trainers' familiarity, knowledge, application, and implementation of the ICF framework. We used a cross-sectional online survey with 185 athletic trainers (age = 35 ± 9 y), which included 32 items focused on familiarity, knowledge, application, and implementation of the ICF framework. Most participants (n = 96, 51.9%) reported never learning about the ICF framework. During the knowledge assessment, participants scored 4.3 ± 2.7 out of 8, which is equivalent to 53.7%. For the sorting assessment, participants scored 10.9 ± 3.9 out of 18, which is equivalent to 60.5%. On the implementation matrix, the most frequently reported ICF tasks elicited by the athletic trainers included neuromusculoskeletal and movement, structure related to movement, and mobility. The most common 'never elicited' ICF tasks included voice and speech, sexual orientation, and structures related to genitourinary and reproductive system. Deficits related to the ICF framework exist. Athletic trainers reported low implementation across all ICF categories. The decision to not elicit information on these areas of health may reduce the ability to provide patient-centered healthcare.

Interprofessional Team Collaboration for Routine and Emergent Mental Health Concerns Among Collegiate Student-Athletes: A Case Series from the Association for Athletic Training Education Research Network.

Collegiate student-athletes experience an increasing number of mental health concerns. To help address these concerns and provide high-quality health care for student-athletes, institutions of higher education are being encouraged to create interprofessional health care teams that are specifically dedicated to managing mental health. We interviewed 3 interprofessional health care teams who collaborate to manage routine and emergency mental health conditions in collegiate student-athletes. Teams represented all 3 National Collegiate Athletics Association (NCAA) divisions and included athletic trainers, clinical psychologists, psychiatrists, dietitians and nutritionists, social workers, nurses, and physician assistants (associates). The interprofessional teams indicated that the existing NCAA recommendations helped to solidify members and roles of the mental health care team; however, they all believed their teams would benefit from more counselors and psychiatrists. Teams had different mechanisms for referral and accessing mental health resources on their campuses, which may make on-the-job training for new members of the team an organizational necessity.

The Integration of Patient-Centered Care and the Biopsychosocial Model by Athletic Trainers in the Secondary School Setting.

Our purpose was to explore the degree to which secondary school athletic trainers (SSATs) perceive they are integrating the principles of patient-centered care (PCC) and the biopsychosocial (BPS) model in their practice. We used a cross-sectional design to explore the primary research question. We used the Global Perceptions of Athletic Trainer Patient-Centered Care (GPATPCC) tool and the Biopsychosocial Model of Health (BPSMH) tool, both measured on a 4-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = agree, 4 = strongly agree, with an unscored "unsure" option). We sent the survey to 5665 SSATs through the National Athletic Trainers' Association. Results indicate participants expressed strong agreement (mode = 4) with 7 of the 14 statements and agreement (mode = 3) with the remaining 7 statements of the GPATPCC tool (grand mean = 3.4 ± 0.8). Overall, participants rated their level of agreement on the BPSMH as agreeing (mode = 3) for each item (grand mean = 3.0 ± 1.0). SSATs perceive they are integrating the principles of PCC and the BPS model in clinical practice. These findings align with two previous studies concluding that patients, parents, and providers believe athletic trainers provide care that is focused on whole-person healthcare.

Athletic Trainer's Varying Levels of Awareness and Use of Disablement Model Frameworks: A Qualitative Study.

In healthcare, disablement model frameworks aim to improve the delivery of patient-centered care through the recognition of patient factors beyond impairments, restrictions, and limitations, which include personal, environmental, and societal factors. Such benefits translate directly to athletic healthcare providing a mechanism for athletic trainers (ATs), as well as other healthcare professionals, to ensure that all aspects of the patient are managed prior to returning to work or sport. The purpose of this study was to investigate ATs recognition and use of disablement frameworks in current clinical practice. We used criterion sampling to identify ATs who were currently practicing from a random sample of ATs that participated in a related cross-sectional survey. A total of 13 participants engaged in an online, audio-only, semi-structured interview that was audio-recorded and transcribed verbatim. A consensual qualitative research (CQR) approach was used to analyze the data. A coding team of three individuals used a multi-phase process to construct a consensus codebook that identified common domains and categories among the participants' responses. Four domains emerged regarding ATs' experiences and recognition of disablement model frameworks. The first three domains were related to the application of disablement model frameworks: (1) patient-centered care, (2) limitations and impairments, and (3) environment and support. Participants described varying degrees of competence and consciousness regarding these domains. The fourth domain related to participants' exposure to disablement model frameworks through formal or informal experiences. Findings suggest that ATs largely demonstrate unconscious incompetence regarding the use of disablement frameworks in clinical practice.

Content Validation of the Athletic Training Milestones: A Report from the Association for Athletic Training Education Research Network.

The Athletic Training Milestones were developed as a comprehensive framework to assess athletic trainers' knowledge, skill, and behavior acquisition across the continuum of athletic training practice. However, without established content validity, it is unclear whether the Athletic Training Milestones can be used effectively as a clinical evaluation and research tool to evaluate competence and performance across multiple users and sites. We conducted a highly conservative content validity index (CVI) with data from 12 content experts. Our findings revealed an extremely high overall scale CVI of 0.99, and CVI scores of the 28 individual subcompetency items assessed ranged from 0.83 to 1.00. For the athletic training profession to truly embrace competency-based evaluation and performance assessments, we need a highly valid and comprehensive instrument, such as the Athletic Training Milestones.

Experiences of Current National Collegiate Athletic Association Division I Collegiate Student-Athletes With Mental Health Resources.

CONTEXT: Collegiate student-athletes (SAs) experience psychological stressors due to rigid schedules, team conflict, and injury. These factors can result in symptoms of mental health conditions, decreased daily functioning, and suicidality. OBJECTIVE: To explore National Collegiate Athletic Association Division I SAs' experiences with mental health and access to and experiences with mental health resources at their university. DESIGN: Consensual qualitative research study. SETTING: One-on-one interviews. PATIENTS OR OTHER PARTICIPANTS: Twenty-three Division I SAs (18 women, 5 men; mean age = 20 ± 2 years). MAIN OUTCOME MEASURE(S): Participants completed a semistructured interview that focused on their experiences with mental health. The interviews were audio recorded and transcribed verbatim via Zoom. Credibility and trustworthiness were established via member checking, triangulation, and peer discussion among a 3-person coding team. RESULTS: Two domains, increased expectations and resources and management, were identified. The participants shared how they balanced life as a college student, academic stressors, performance expectations, and a sport-first mindset they perceived from coaches and support staff. They discussed their experience with the internal support network of coaches, the athletic department, and sport psychology. Participants remarked on their external support network, which included their family, friends, and psychological services. The resources available at their institutions and their accessibility were perceived both positively and negatively. Some collegiate SAs described resources as helpful, whereas others portrayed a lack of timeliness for appointments, lack of advertisement, incomprehension by counselors of athlete demands, and no sport-specific counseling as barriers. CONCLUSIONS: Collegiate SAs expressed mental health concerns due to stress and the demands of sport participation. Self-regulated coping strategies and support networks continue to be powerful and helpful resources for mental health, with or without a diagnosed condition. Barriers to mental health service use were a lack of sport specificity and lack of access. Institutions need to focus on creating athlete-centered mental health resources with annual advertisements to increase use.

Differences in Access to Athletic Trainers in Public Secondary Schools Based on Socioeconomic Status.

CONTEXT: Significant health care disparities exist in the United States based on socioeconomic status (SES), but the role SES has in secondary school athletes' access to athletic training services has not been examined on a national scale. OBJECTIVE: To identify differences in access to athletic training services in public secondary schools based on school SES. DESIGN: Cross-sectional study. SETTING: Database secondary analysis. PATIENTS OR OTHER PARTICIPANTS: Data for 3482 public high schools. MAIN OUTCOME MEASURE(S): Data were gathered from the Athletic Training Locations and Services (ATLAS) database, US Census Bureau, and National Center for Education Statistics. We included schools from 5 states with the highest, middle, and lowest poverty percentages (15 states total) and collected county median household income, percentage of students eligible for free or reduced-price lunch, race and ethnicity demographics, and access to athletic training services (full-time athletic trainer [AT], part-time AT only, no AT) for each school. Data were summarized in means, SDs, medians, interquartile ranges (IQRs), frequencies and proportions, 1-way analyses of variance, and Kruskal-Wallis tests. RESULTS: Differences were present in school SES between schools with full-time, part-time-only, and no athletic training services. Schools with greater access to athletic training services had fewer students eligible for free or reduced-price lunch (full time: 41.1% ± 22.3%, part time only: 45.8% ± 24.3%, no AT: 52.9% ± 24.9; P < .001). Similarly, county median household income was higher in schools with increased access to athletic training services (full time median [IQR]: $56 026 [$49 085-$64 557], part time only: $52 719 [$45 355-$62 105], and no AT: $49 584 [$41 094-$57 688]; P < .001). CONCLUSIONS: Disparities in SES were seen in access to athletic training services among a national sample of public secondary schools. Access to ATs positively influences student-athletes' health care across several measures. Pilot programs or government funds have been used previously to fund athletic training services and should be considered to ensure equitable access, regardless of school SES.

Board of Certification Examination Achievement Gaps as a Barrier to Diversifying the Athletic Training Profession.

CONTEXT: Achievement gaps have been well documented in the medical and health professions. Previous researchers have indicated that individuals from underrepresented minority groups consistently fall short of White candidates in performance on standardized credentialing examinations. OBJECTIVE: To determine the relative risk of failure by ethnicity and first-time and retake pass rates on the Board of Certification (BOC) examination. DESIGN: Descriptive study. SETTING: Professional master's degree athletic training programs. PATIENTS OR OTHER PARTICIPANTS: A total of 3742 unique candidates with 4425 attempts between examination windows 1 of 2011-2012 (April) and 5 of the 2019-2020 (February) cycle of the BOC examination. MAIN OUTCOME MEASURE(S): Ethnicity as self-selected by the candidates, attempt number, result of each attempt, year, and testing window. RESULTS: Examination candidates self-identified as White (60.4%, n = 2261/3742), unknown (ie, withheld an ethnicity selection; 10.6%, n = 395/3742), Hispanic (8.6%, n = 320/3742), or African American (8.4%, n = 313/3742). On the first attempt, White candidates passed at a rate of 93.2% (2107/2261), African American candidates at 74.8% (234/313), and Hispanic candidates at 86.9% (278/320; overall first-time pass rate for this subsample = 90.5%, 2619/2894). The relative risk of first-attempt failure was higher for African Americans than for both White (relative risk = 3.706, 95% CI = 2.903, 4.730; P < .001) and Hispanic (relative risk = 1.923, 95% CI = 1.368, 2.703; P > .001) candidates. For Hispanic candidates, the relative risk of first-attempt failure was about 50% lower than for White candidates (relative risk = 0.519, 95% CI = 0.377, 0.715; P < .001). CONCLUSIONS: Achievement gaps existed between White candidates and those from ethnic minority groups in athletic training. Diversification of the athletic training workforce will require ensuring equity in preparation for and success on the BOC examination.

Sports Medicine Physicians Comfort and Competence in Caring for Transgender and Gender Nonconforming Patients and Athletes.

OBJECTIVE: The purpose of this study was to explore primary care sports medicine physicians' comfort, competence, education, and scope of training in caring for transgender and gender nonconforming (TGNC) patients/athletes. DESIGN: Mixed-methods, cross-sectional survey. SETTING: Online. PATIENTS OR PARTICIPANTS: In total, 4300 e-mails were successfully sent with 252 eligible responses received from the American Medical Society for Sports Medicine members. INDEPENDENT VARIABLES: Previous relationships with TGNC persons; previous relationships with TGNC patients/athletes; frequency of care for TGNC patients/athletes. MAIN OUTCOME MEASURES: The participants completed a 38-item tool used to assess perceived comfort and competence treating TGNC patients/athletes. Physicians defined "transgender" and described their thoughts on unfair competitive advantage of transgender athletes. RESULTS: Most participants had worked with a TGNC patient (70.2%, n = 177), but far fewer worked with a TGNC athlete (n = 26.6%, n = 67). Among the participants who provided a definition of transgender (n = 183), only 28.4% (n = 52) of participants were able to correctly define the term, whereas most were able to partially (57.9%, n = 106) characterize the term. The most common mechanisms identified for learning about TGNC patients were reading peer-reviewed journal articles (44.8%, n = 113) and CME (41.3%, n = 104). Those with previous TGNC friend/family, patient, and athlete relationships had a significantly different level of comfort and competence treating TGNC patients/athletes. CONCLUSIONS: Previous care relationships with TGNC strongly influences comfort and perceived competence of primary care sports medicine physicians. Training, from unbiased peer-reviewed sources of data, is critical to improve care for TGNC patients/athletes.

Secondary School Athletic Trainers' Navigation of Patient Socioeconomic Status Challenges in Care: A Qualitative Study.

Secondary school ATs (SSATs) are uniquely positioned healthcare providers at an optimal public health intersection where they can provide equitable healthcare to low socioeconomic status (SES) adolescents. SSATs face similar challenges to physicians in treating low SES patients, but their strategies may be different compared to other medical professions. However, the consequences of low SES population healthcare delivery by SSATs have not been explored. SSATs were asked to share what challenges, if any, they encounter with providing care for their low SES patients and what strategies they find most effective to overcome these challenges. Data were collected via semi-structured interviews and reflective field notes and analyzed using a four-step, interpretative phenomenological analysis (IPA) guided theme development. Data saturation was met, and the sample size aligned with other IPA studies. Trustworthiness was established with research triangulation and Yardley's four principles. Three interrelated themes emerged: (a) mechanisms for identifying SES, (b) the impact of SES on care, and (c) navigating SES challenges. SSATs described many strategies that were gained through their clinical experiences to overcome healthcare barriers. SSATs have the potential to decrease health disparities through their role as a liaison and advocates for their low SES patients.

Validation of a Script to Facilitate Social Determinant of Health Conversations with Adolescent Patients.

Current social determinants of health (SDOH) tools exist to assess patient exposure; however, healthcare providers for the adolescent population are unsure of how to integrate SDOH knowledge into clinical practice. The purpose of this study was to validate a focused history script designed to facilitate SDOH conversations between clinicians and adolescents through the use of the Delphi method. Six individuals (1 clinician, 5 educators/researchers) participated as expert panelists. Panelists provided critical feedback on the script for rounds 1 and 2. For rounds 3-7, panelists received an electronic questionnaire asking them to indicate agreement on a 6-point Likert scale (1 = strongly disagree, 6 = strongly agree). We defined consensus as mean item agreement ≥ 5.0 and percent agreement ≥ 80%. In round 7, panelists rated overall script level of agreement. After seven rounds of feedback, the focused history script achieved content validity with 100% of panelists agreeing on the final 40-item script. A focused history script for the SDOH was content validated to aid conversations between healthcare providers and adolescent patients on factors that affect their life, school, and play. Addressing social determinants of health with adolescent patients will improve cultural proficiency and family-centered care delivered by school healthcare professionals.

Athletic trainers' viewpoints of patient-centered care: Preliminary findings.

The core competency of patient-centered care (PCC) states that for positive patient outcomes, the provider must respect the patient's views and recognize their experiences. The Athletic Training Strategic Alliance Research Agenda Task Force identified a profession-wide belief that examining the extent to which athletic trainers (ATs) provide PCC in their clinical practice would benefit the profession. To first address this line of inquiry, we must study the subjectivity of how ATs view PCC. This study used Q methodology which is a research design that collects data from participants from a quantitative and qualitative perspective. A total of 115 (males = 62, females = 53, age = 37±10 y, experience = 13±10 y) ATs dispersed between 11 job settings volunteered for this study. Participants were asked to pre-sort (agree, disagree, neutral) 36 validated statements representing the 8 dimensions of PCC, then completed a Q-sort where they dragged-and-dropped the pre-sorted statements based on perceived importance in providing PCC. The Q-sorts were analyzed using QMethod software. A principal component analysis was used to identify statement rankings and factors. Factors were determined by an Eigenvalue > 1 and analyzed using a scree plot. The 6 highest selected statements per factor were assessed to create the distinguishing viewpoints. Two distinguishing viewpoints emerged from the factor analysis of the Q-sorts: 1) the interpersonal connection that valued teamwork, open communication, and respectful care with varied populations; 2) the holistic gatekeeper that valued personal promotion for activities of daily living, self-care, and quality of life. Overall, ATs value patient's preferences and respect. However, a lack of importance was identified for incorporating the disablement model which is a core competency and adopted framework by the athletic training profession.

Parent decision-making regarding youth sport participation during the COVID-19 pandemic.

PURPOSE: To describe youth sport participation behaviors during the COVID-19 pandemic as reported by parents of youth sport athletes, to examine the association of family demographics with the likelihood of children resuming sports, and to qualitatively report the factors influencing parental decision-making regarding youth sport participation during the COVID-19 pandemic. METHODS: A national sample of parents of youth athletes from across the United States (n=236, age: 39.2±8.1 years, 57.2% female) were recruited to complete an online questionnaire by Qualtrics Online Samples (Qualtrics, Provo, UT) using a combination of actively managed, double-opt-in market research panels. The questionnaire focused on changes in child sport participation and family finances as a result of COVID-19 and included both close-ended and open-ended questions. RESULTS: Most parents (63.1%) reported the time their children spent participating in organized youth sports had decreased because of the COVID-19 pandemic. Three-quarters of parents (75.5%) reported that it was likely that their children would fully resume participating in organized youth sports within the next year. Parents whose financial situation was worsened by COVID-19 were less likely to report that their children would resume sports in the upcoming year. Three domains related to parental decision-making emerged from the open-ended responses: safety, fear, and normalcy. CONCLUSIONS: Understanding the factors influencing changes in youth sport participation during the pandemic can allow systems to implement strategies for safe participation in youth sport and physical activity among children. Encouraging participation in outdoor sports with appropriate safety precautions such as masking, social distancing, and hygiene may reduce fear of participation among parents.

Patient Outcomes After Treatment by Athletic Therapy Students.

CONTEXT: Patient-reported outcome measures (PROMs) should be used in athletic training and athletic therapy but are rarely incorporated in internships. Student-run clinics are common in other health professions and provide effective treatment and valuable learning environments. To our knowledge, no one has evaluated rehabilitation outcomes in patients treated by athletic therapy students (ATSs). OBJECTIVE: To measure the improvement in function in injured patients seeking treatment at an ATS clinic. DESIGN: Cohort study. SETTING: An ATS clinic. PATIENTS OR OTHER PARTICIPANTS: A total of 59 patients (32 women, age = 33.9 ± 14.7 years; 27 men, age = 38 ± 14.4 years) from the community with a variety of low back, lower extremity, and upper extremity injuries participated. MAIN OUTCOME MEASURE(S): At baseline and 6-week follow-up, all patients completed 1 of 3 scales (depending on their injury location) to assess their injured level of function. Scales were the Oswestry Disability Index for low back injuries; Lower Extremity Functional Scale for lower extremity injuries; and Disabilities of the Arm, Shoulder and Hand for upper extremity injuries. RESULTS: On average, patients received 4.7 ± 1.8 treatments across 48.8 ± 16.1 days. They experienced an increase in function between baseline and follow-up assessments (18.8% ± 20.3%; P < .001, Cohen d = 1.06). Moreover, the amount of functional improvement was clinically meaningful, as it was greater than the minimal clinically important difference for each scale. The efficacy of treatments did not differ according to the internship experiences of the ATSs. CONCLUSIONS: Function improved in patients after treatment delivered by an ATS. Patient-reported outcome measures were useful for the students in monitoring patient improvement, but more research is needed regarding effective treatments for patients with chronic pain. Our results suggested that ATS clinics provide effective treatments for patients, service to the community, and a learning opportunity for students.

Psychological Ownership in Athletic Training.

CONTEXT: Psychological ownership (PO) is a state in which an individual feels possession over an object, organization, or entity (eg, PO over the organization where one works, PO over the profession one serves). Understanding PO could provide insight into the "vitality of the profession" as defined in the Prioritized Research Agenda for the Athletic Training Profession. OBJECTIVE: To explore athletic trainers' (ATs') PO over their employing organizations and the athletic training profession. DESIGN: Cross-sectional study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: Clinically practicing ATs who were active members of the National Athletic Trainers' Association. MAIN OUTCOME MEASURE(S): Demographic variables, Psychological Ownership Questionnaire (POQ) scores, and Psychological Ownership Questionnaire for athletic training (POQ-AT) scores were the primary outcomes measured. Descriptive statistics were calculated for the demographic variables, POQ and POQ-AT overall scores, form scores, and dimension scores. Nonparametric tests were used to investigate differences between the POQ and POQ-AT by demographic characteristics. RESULTS: The ATs indicated greater PO over the athletic training profession (Z = -3.45, P = .001) than over their employing organizations. They displayed greater belongingness (Z = -9.51, P < .001) and self-identity (Z = -8.71, P < .001) and less territoriality (Z = -5.52, P < .001) and accountability (Z = -5.33, P < .001) over their profession than their organization. Those ATs who supervised others had higher overall POQ (Mann-Whitney U test = 34 372, P < .001) and overall POQ-AT (U = 36 624, P = .014) scores than ATs who did not supervise others. A difference was evident in overall POQ (Kruskal-Wallis statistical analysis H4 = 20.47, P < .001) and overall POQ-AT (H4 = 21.34, P < .001) scores by years of experience. CONCLUSIONS: Respondents indicated greater PO over their profession than their employing organizations. They demonstrated greater self-identity and belongingness and less territoriality and accountability over the athletic training profession than over their employing organization, suggesting that they were connecting aspirations and accomplishments with the profession but connecting duty and responsibility with their organizations. Years of experience and supervisor status may play roles in the level of organizational PO.