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OBJECTIVE: The aim of this study was to investigate the association between academic adjustments and recovery from sport-related concussions (SRCs) in collegiate athletes. MATERIALS AND METHODS: A retrospective medical chart review was performed between the 2015-2016 and 2019-2020 sport seasons at 11 Long-term Impact of Military-relevant Brain Injury Consortium Military and Tactical Athlete Research Study (LIMBIC MATARS) sites. Days between injury and symptom resolution, and injury and return to sport (dependent variables) for collegiate athletes who did or did not receive academic adjustments (independent variable) were analyzed using Mann-Whitney U tests. RESULTS: The number of days between date of injury and symptom-resolution between those who did (median = 9 [interquartile range = 5,16]) and did not have (7[3,12]) academic adjustments were statistically different (z=-2.76, p < 0.01, r=-0.17). However, no differences were observed between days to return to sport among those who did (14[10,22]) and did not (13[8,20]) receive assigned academic adjustments (z= -1.66, p = 0.10, r= -.10). CONCLUSIONS: Recovery trajectories were similar between athletes diagnosed with a SRC who did or did not receive academic adjustments.. Our findings suggest academic adjustments supported recovery for those who needed academic adjustments. Clinicians and healthcare professionals should assist and support collegiate athletes after SRCs on an individual basis, including academic adjustments when appropriate based on patient presentation.
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Traumatismos em Atletas , Concussão Encefálica , Humanos , Traumatismos em Atletas/diagnóstico , Estudos Retrospectivos , Concussão Encefálica/diagnóstico , Estudantes , AtletasRESUMO
OBJECTIVE: While recovery from concussion is variable, women are more likely to report symptoms, experience worse outcomes, and have longer recovery trajectories following concussion than men. Preliminary data suggest that hormonal fluctuations, specifically progesterone, may be associated with this variability. This study aimed to understand the effect of contraceptive medication on concussion recovery. METHODS: A retrospective chart review using consensus-based common data elements was conducted at 11 NCAA institutions as part of the LIMBIC MATARS consortium. Participants included female collegiate athletes diagnosed with a concussion who did (n = 117) or did not report (n = 339) contraceptive medication use. Number of days between diagnosis and symptom resolution were compared using Mann-Whitney U tests. Self-reported diagnosis of attention deficit hyperactivity disorder, concussion history, anxiety, and depression was compared using Chi-squared tests. RESULTS: The proportions of participants who did or did not take contraceptive medication were similar across covariates. Female athletes regardless of contraceptive medication use recovered similarly following a concussion. CONCLUSIONS: Our findings suggest that contraceptive medication use did not significantly impact concussion recovery. Future prospective investigations should examine documentation practices and operationalize terminology for hormonal contraceptive medication to better understand their role on recovery from sport-related concussion in female collegiate athletes.
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OBJECTIVE: Investigate whether an athlete's biological sex and exposure to a dedicated athletic trainer (AT) were related to clinical milestones after a sports-related concussion (SRC). DESIGN: Retrospective chart review. METHODS: Medical charts of collegiate athletes (n = 196 [70.9% female]) diagnosed with SRC were reviewed to extract: biological sex, dedicated AT exposure for their sport (yes/no), and time (days) to reaching clinical milestones (diagnosis, symptom resolution, unrestricted return to sport [RTS]). Mann-Whitney U tests were used to determine whether time to clinical milestones differed by sex, AT exposure, or their interaction. Proportions of same-day diagnoses and times to diagnosis, symptom resolution, and unrestricted RTS were evaluated with chi-squared and spearman's rank correlations, respectively. RESULTS: There were no significant differences in times to reaching any clinical milestone by sex, AT exposure, or their interaction (ps > 0.05). Forty-three percent of participants were diagnosed on the day of their SRC. This did not differ by sex or AT exposure (ps > 0.29). Longer times to SRC diagnosis were associated with more days to symptom resolution (ρ = 0.236, p = 0.001) and unrestricted RTS (ρ = 0.223, p < 0.001). CONCLUSIONS: Athlete sex and AT exposure were not associated with times to reach any clinical milestone; however, delayed diagnosis was associated with longer times to reach clinical recovery.
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PURPOSE: We investigated time to reach concussion diagnosis and recovery milestones in collegiate athletes relative to their schools' National Collegiate Athletic Association (NCAA) classification. METHODS: We retrospectively examined 849 (43.1% female) concussion cases from 11 NCAA institutions (Division I Power 5 [n = 4], Division I Non-Power 5 [n = 4], and Division II/III [n = 3]) from the 2015-16 to 2019-20 athletic seasons. Our primary outcome measures were days to reach specific clinical milestones following concussion. RESULTS: Median (IQR) time from injury to diagnosis was significantly longer at Division II/III institutions (1 [0-4] days) compared to Division I Power 5 (0 [0-1] days) and Division I Non-Power 5 (0 [0-1] days) institutions (p < 0.001). Likewise, Division II/III athletes (15 [11-22] days) took significantly longer to return to sport after concussion than Division I Power 5 (10 [7-16] days) and Division I Non-Power 5 (11 [7-18.5] days) athletes (p < 0.001). CONCLUSION: Division II/III athletes had delayed concussion diagnoses and return to sport timelines compared to Division I athletes. Our results suggest that differences in sports medicine resources across NCAA divisions may influence injury recognition and recovery in collegiate athletes with concussion.
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OBJECTIVE: To investigate the association between sport type (collision, contact, non-contact) and subsequent injury risk following concussion in collegiate athletes. MATERIALS AND METHODS: This retrospective chart review of 248 collegiate athletes with diagnosed concussions (age: 20.0 ± 1.4 years; height: 179.6 ± 10.9 cm; mass: 79.0 ± 13.6 kg, 63% male) from NCAA athletic programs (n = 11) occurred between the 2015-2020 athletic seasons. Acute injuries that occurred within six months following concussion were evaluated. Subsequent injuries were grouped by lower extremity, upper extremity, trunk, or concussion. The independent variable was sport type: collision, contact, non-contact. A Cox proportional hazard model was used to assess the risk of subsequent injury between sport types. RESULTS: Approximately 28% (70/248) of athletes sustained a subsequent acute injury within six months post-concussion. Collision sport athletes had a significantly higher risk of sustaining any injury (HR: 0.41, p < 0.001, 95% CI: 0.28, 0.62), lower extremity (HR: 0.55, p = 0.04, 95% CI: 0.32, 0.97), and upper extremity (HR: 0.41, p = 0.01, 95% CI: 0.20, 0.81) injuries following concussion. No differences between sport types were observed for other injuries. CONCLUSION: Collision sport athletes had a higher rate of any subsequent injury, lower, and upper extremity injuries following concussion. Future research should focus on sport-specific secondary injury prevention efforts.
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OBJECTIVE: To investigate whether routine daily activities (RDA), non-prescribed exercise (Non-ERx), or prescribed exercise (ERx) were associated with recovery from sport-related concussion (SRC) in collegiate athletes. MATERIALS AND METHODS: Data for this cross-sectional, retrospective chart review of collegiate athletes diagnosed with SRC (n = 285[39.6% female], age = 19.5 ± 1.4 years) were collected during the 2015-16 to 2019-20 athletic seasons. The independent variable was group (RDA, Non-ERx, ERx). Dependent variables included days from date of diagnosis to symptom resolution (Dx-SR) and SR to return to sport (SR-RTS). RESULTS: Those in the Non-ERx group took nearly 1.3 times longer to achieve SR (IRR = 1.28, 95% CI: 1.11, 1.46) and, 1.8 times longer for RTS (IRR = 1.82, 95% CI: 1.11, 2.71) when compared to those in the RDA group. No other comparisons were significant. CONCLUSION: Collegiate athletes in the Non-ERx group took approximately 1 week longer to achieve SR as compared to the RDA and ERx groups. Our findings suggest that if exercise is recommended following SRC, it must be clearly and specifically prescribed. If exercise parameters cannot be prescribed, or monitored, RDA appear to be similarly beneficial during recovery for collegiate athletes with concussion.
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ABSTRACT: Nobari, H, Alves, AR, Abbasi, H, Khezri, D, Zamorano, AD, and Bowman, TG. Are metabolic power distribution and accelerometer-based GPS variables associated with odds ratios of noncontact injuries in professional soccer players? J Strength Cond Res 37(9): 1809-1814, 2023-The present study was intended to i) investigate the relationship between metabolic power average (MPA), acceleration (AcZ) and deceleration (DcZ) zones, and their differences (Δ) on 3 load levels with noncontact injuries in professional players throughout a full soccer season and ii) to analyze the injury risk associated between high-load versus low-load levels for each of the aforementioned parameters with odds ratios (OR) and relative risk (RR), respectively. Twenty-one professional soccer players (age = 28.3 ± 3.9 years) were monitored during a full season (48 weeks) through global positioning system (GPS). A relationship between MPA and accelerometer-based GPS, mainly in explosive actions (i.e., AcZs and DcZs), was found. A higher incidence of injuries in the high-load weeks compared with the low-load weeks were reported (mainly in MPA, AcZ1, AcZ2, and DcZ3 variables). Moreover, significant means of OR (mean = 4.3) and RR (mean = 2.6) of noncontact injuries were established in intense periods with higher metabolic load (i.e., power accelerations, AcZ1, x2 = 0.022). Our results may be useful for coaches, sports scientists, and researchers regarding the optimization of the athletes' performance, as well as providing insights about the impact of intense exercise.
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Desempenho Atlético , Futebol , Humanos , Adulto Jovem , Adulto , Futebol/lesões , Sistemas de Informação Geográfica , Razão de Chances , Aceleração , AcelerometriaRESUMO
Controversy exists among collegiate lacrosse about the use of headgear and whether its use will facilitate greater risk compensation by players and thus contribute to unsafe gameplay. We aimed to characterize the attitudes of headgear among women's collegiate lacrosse stakeholders. A total of 190 women's lacrosse stakeholders (players: n = 87; coaches: n = 71; officials: n = 32) participated in this study. Participants completed a survey surrounding attitudes of headgear in women's lacrosse. Descriptives, multiple regressions, and Kruskal-Wallis analyses compared attitudes surrounding headgear among stakeholder groups. Scales of Headgear Affects Play (ß = -0.38, p < 0.001) and Sports Development and Safety Practices (ß = 0.26, p < 0.05) significantly predicted endorsement on Headgear Safety Attitudes Scale. Among players, Aesthetics (ß = 0.51, p < 0.001) and Intention to Wear Headgear (ß = 0.31, p < 0.05) predicted endorsement on Headgear Safety Attitudes Scale. Stakeholders did not agree if headgear should be worn in women's lacrosse. Items related to sports development, safety and potential changes in gameplay predicted attitudes to headgear safety among all participants.
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ABSTRACT: Austin, AB, Collins, SM, Huggins, RA, Smith, BA, and Bowman, TG. The impact of environmental conditions on player loads during preseason training sessions in women's soccer athletes. J Strength Cond Res 35(10): 2775-2782, 2021-Our objective was to determine the impact of environmental conditions on player loads during preseason training sessions in women's soccer athletes. Eleven women's NCAA Division III soccer players (age = 20 ± 1 year, height = 167.28 ± 8.65 cm, body mass = 60.18 ± 5.42 kg, VÌo2max = 43.70 ± 3.95 ml·kg-1·min-1) volunteered to wear Global Positioning System (GPS) devices (Sports Performance Tracking, Melbourne, Australia) that provided measures of training session external intensity throughout all preseason practices (n = 15). We recorded wet-bulb globe temperature (WBGT), session Rating of Perceived Exertion-Training Load (sRPE-TL), and ΔBM during each preseason training session and set α ≤ 0.05. The combination of WBGT, sRPE-TL, and ΔBM explained 34% of the variance in GPS-based intensity score (proprietary measure) (F3,153 = 26.25, p < 0.001). Wet-bulb globe temperature (t156 = -2.58, p = 0.01), sRPE (t156 = 8.24, p < 0.001), and ΔBM (t156 = 2.39, p = 0.02) were significantly associated with intensity. The ΔBM from prepractice (60.00 ± 5.21 kg) to postpractice (59.61 ± 5.10 kg) was statistically significant (p < 0.001); however, ΔBM from the beginning of preseason (59.87 ± 5.31 kg) to the end of preseason (59.91 ± 5.58 kg) was not significant (p = 0.89). Despite relatively low to moderate environmental conditions, increases in WBGT were associated with reductions in GPS intensity and elevated internal load via sRPE-TL. Our findings support the association between exercise intensity and WBGT, internal load, and hydration status; thus, coaches and exercise scientists should take these factors into account when monitoring or interpreting intensity metrics. Furthermore, these findings support the continued use of environmental monitoring and hydration best-practice policies to limit exercise intensity in the heat so as to mitigate excessive heat stress.
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Desempenho Atlético , Condicionamento Físico Humano , Futebol , Adulto , Atletas , Feminino , Humanos , Esforço Físico , Adulto JovemRESUMO
Quantifying head impacts is a vital component to understanding and preventing head trauma in sport. Our objective was to establish the frequency and magnitude of head impact mechanisms in men's lacrosse athletes. Eleven male lacrosse athletes wore xPatch sensors during activity. Video footage of practices and games was analyzed to verify impacts and code them with impact mechanisms. The authors calculated incidence rates (IRs) per 1000 exposures with corresponding 95% confidence intervals (CIs) and used multivariate analysis of variances to compare the linear (g) and rotational (rad/s2) accelerations between mechanisms. A total of 167 head impacts were successfully verified and coded with a mechanism using video footage during 542 total exposures. The highest IR was head to body (IR = 118.08; 95% CI, 89.15-147.01), and the lowest was head to ball (IR = 3.69; 95% CI, 0-8.80) (incidence rate ratio = 32.00; 95% CI, 67.83-130.73). Analysis indicated that impact mechanism failed to significantly alter the combined dependent variables (multivariate F10,306 = 1.79, P = .06, η2 = .06, 1-ß = 0.83). While head to head, body to head, and stick to head mechanisms are penalty-inducing offenses in men's lacrosse, head to ground, head to ball, and combination impacts have similar head accelerations. If penalties and rules are created to protect players from traumatic head injury, the authors recommend stricter enforcement.
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Traumatismos em Atletas/prevenção & controle , Traumatismos em Atletas/fisiopatologia , Concussão Encefálica/prevenção & controle , Concussão Encefálica/fisiopatologia , Dispositivos de Proteção da Cabeça , Esportes com Raquete/lesões , Aceleração , Fenômenos Biomecânicos , Humanos , Masculino , Monitorização Ambulatorial , Equipamentos Esportivos , Estados Unidos , Gravação em Vídeo , Adulto JovemRESUMO
OBJECTIVE: Determine how positive BPPV findings in adolescents and young adults following concussion impacted the total number of treatments required and time until discharge. SETTING: Outpatient physical therapy clinic. PARTICIPANTS: 167 individuals who were diagnosed with concussion or brain injury. DESIGN: Retrospective chart review. MAIN MEASURES: Total number of treatments and days until discharge were compared for various BPPV diagnoses (anterior canal, posterior canal, horizontal canal, and combination) and for individuals with and without BPPV. RESULTS: Fifty-one out of 167 cases (30.54%) were diagnosed with BPPV. The total number of treatments provided was statistically different across BPPV diagnoses (P = .004). However, days until discharge were not statistically different between BPPV diagnoses (P = .28). There was no significant difference between time to discharge between those with BPPV (median = 21 days, range = 7-126) and those without (median = 28 days, range = 7-84 days; P = .23, r = 0.09). CONCLUSION: To optimize outcomes, including symptom resolution and return to sport and/or work, early identification of BPPV and subsequent intervention should be prioritized for individuals who have concussion symptoms that suggest vestibular dysfunction.
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Vertigem Posicional Paroxística Benigna , Concussão Encefálica , Humanos , Adolescente , Adulto Jovem , Vertigem Posicional Paroxística Benigna/diagnóstico , Vertigem Posicional Paroxística Benigna/terapia , Estudos Retrospectivos , Canais Semicirculares , Concussão Encefálica/diagnósticoRESUMO
Background/Purpose: No studies have observed the effects of a collegiate lacrosse season on movement pattern quality, dynamic postural control, or the accuracy of athletes' perceived movement pattern quality. The purpose was to examine the effects of a nontraditional fall season on movement pattern quality, perceived movement pattern quality, and dynamic postural control in collegiate lacrosse athletes. Design: Cross-sectional laboratory study. Methods: Fifty men's (age=19.38±1.24 years, height=182.63±6.16 cm, mass=82.37±8.46 kg) and 22 women's (age=19.68±1.17 years, height=165.10±6.88 cm, mass=64.09±8.72 kg) lacrosse players were recruited. Outcome measures included individual Functional Movement Screen™ (FMS™) scores, self-reported perceived movement pattern quality scores, lower and upper extremity Y-Balance Test (YBT) measurements, and active dorsiflexion range of motion (ROM) before the start and again at the end of the fall lacrosse season. Pre- and post-season measurements were assessed using paired t-tests and chi-squared analyses. Results: FMS™ composite scores did not significantly change from preseason to postseason for males (p=0.74) or females (p=0.07). Male perceived movement pattern quality was significantly higher than measured for 10 of 12 movements (p<0.05). Female perceived movement pattern quality was significantly higher than measured for four of 12 movements (p<0.05). Asymmetry frequency significantly increased in males in the hurdle step from two individuals to nine (χ21=25.52, p<0.01), inline lunge from 10 to 20 (χ21=12.50, p<0.01), and shoulder mobility from 4 to 21 (χ21=78.53, p<0.01). Asymmetries in male athletes significantly decreased in the active straight leg raise from 26 to 8 (χ21=25.96, p<0.01). YBT composite scores increased in males for the right leg (p=0.001) and left leg (p<0.03). Right dorsiflexion ROM (p<0.001) and left dorsiflexion ROM (p<0.001) significantly decreased in males from preseason to postseason. YBT scores for the right leg significantly increased in females from preseason to postseason (p=0.01). YBT scores for females for the right arm significantly increased from preseason to postseason (p=0.045). Conclusions: A 5-week season may not change overall movement pattern quality of men's or women's lacrosse players, but some individual movement scores diminished. Athletes may overestimate self-reported movement pattern quality and are therefore unlikely to individually address movement deficits. Male dynamic postural control may change throughout a season, resulting in a potential increased risk of injury later in the season due to compensatory patterns or changes in mobility, proprioception, or balance. Level of Evidence: 3b.
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CONTEXT: Athletic trainers (ATs) face organizational-professional conflict (OPC), often surrounding return-to-sport decisions. To prioritize patient safety and establish a healthy work environment, OPC must be mitigated, yet little research has determined how ATs manage conflicts with stakeholders. OBJECTIVE: To explore ATs' experiences with OPC in the secondary school setting. DESIGN: Qualitative study. SETTING: Telephone interviews. PATIENTS OR OTHER PARTICIPANTS: 16 ATs (9 females, 7 males; age = 43±11 years; years certified = 17±9; years in their current positions = 9±6). DATA COLLECTION AND ANALYSIS: We digitally recorded telephone interviews and had them professionally transcribed. Data saturation guided recruitment efforts, and was met. To ensure rigor and trustworthiness of the data, we completed basic member checks along with multiple analyst triangulation. We analyzed the qualitative data using an interpretive phenomenological approach. RESULTS: Four themes emerged: effective communication, professional relationships, stakeholder education and professional experience. Participants used effective communication described as frequent, open, and direct, during interactions with stakeholders to manage OPC. OPC was reduced when ATs built professional relationships with stakeholders centered on trust and respect. Participants used stakeholder education as a primary strategy for managing OPC by educating stakeholders about prognosis and return-to-sport timelines post-injury and providing rationale for decisions made. Additionally, years of experience served as a mitigating factor of conflict, in that as ATs gained experience and confidence, they perceived less OPC. CONCLUSIONS: Participants suggested various interpersonal relationship development strategies that can be implemented to manage OPC, especially when starting a new position or building rapport with stakeholders. Specifically, educating various stakeholders on reasons for clinical decisions via effective communication and developing strong professional relationships built on mutual respect assisted in avoiding OPC. Since professional experience appears to alleviate conflict, OPC management strategies should be taught during professional preparation and used early during transition to autonomous practice.
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CONTEXT: There is strong evidence that racial and ethnic disparities exist in multiple arenas of health and wellness. The causes of racial and ethnic differences in health care are multidimensional; one factor that may affect injury/illness communication, interactions, and outcomes is patient-provider racial and ethnic concordance. At present, it is unclear what role patient-provider racial and ethnic concordance and discordance plays in facilitating concussion care for collegiate athletes. OBJECTIVE: To investigate the presence of athlete-athletic trainer (AT) racial and ethnic concordance and discordance among diagnosed concussion cases and examine if racial and ethnic concordance and discordance influences time (in days) until diagnosis, symptom resolution, or return-to-sport clinical milestones in collegiate athletes. DESIGN: Retrospective cohort study. SETTING: Collegiate athletics. PATIENTS OR OTHER PARTICIPANTS: A total of 694 concussion cases (38.6% [n = 268] sustained by women, 61.4% [n = 426] sustained by men) that occurred within the 2015-2016 through 2019-2020 sport seasons at 9 institutions. MAIN OUTCOME MEASURE(S): The number of days from the date of injury to diagnosis, symptom resolution, and return to sport and from the date of diagnosis to symptom resolution and return to sport. RESULTS: Overall, 68.4% (n = 475) of concussion cases had patient-provider racial and ethnic concordance, and 31.6% (n = 219) were discordant. All concordant pairs included a White athlete and White AT. Time to diagnosis differed between the concordant and discordant groups (median [interquartile range] = 1 [0-2] versus 0 [0-1], respectively) only in the model adjusted for sex, sport type, and availability of an AT (odds ratio [95% CI] = 1.46 [1.07-1.85]). There were no other group differences. CONCLUSIONS: One-third of concussion cases had athlete-AT racial and ethnic discordance. Although this group was diagnosed with a concussion 1 day sooner than the concordant group, no differences were observed for any concussion recovery milestones. These findings suggest that patient-provider racial and ethnic concordance may play a minor role in concussion recognition or reporting but not necessarily in the management and recovery thereafter.
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Traumatismos em Atletas , Concussão Encefálica , Volta ao Esporte , Humanos , Concussão Encefálica/terapia , Concussão Encefálica/diagnóstico , Masculino , Feminino , Estudos Retrospectivos , Traumatismos em Atletas/terapia , Traumatismos em Atletas/etnologia , Universidades , Atletas , Etnicidade , Adulto Jovem , Disparidades em Assistência à Saúde/etnologia , Grupos RaciaisRESUMO
CONTEXT: Few studies utilize randomized clinical trials (RCT) to quantify clinical intervention safety of rehabilitation after sport-related concussion across sport levels. OBJECTIVE: Describe symptom exacerbation and adverse events (AEs) associated with two concussion rehabilitation interventions. DESIGN: Cluster Randomized Controlled Trial (XXX). SETTING: Sports medicine clinic and field settings. PARTICIPANTS: The RCT enrolled 251 concussed athletes (median age=20 years; female n=48) across 28 sites from New Zealand professional rugby (n=31), Canadian professional football (n=52), United States (U.S.)/Canadian colleges (n=128) and U.S. high schools (n=40). INTERVENTIONS: Two medically supervised interventions: 1) Enhanced Graded Exertion (EGE): international return to sport strategy and sport specific activities only (EGE-only n=119) and 2) Multidimensional Rehabilitation (MDR) followed by EGE: early symptom-directed exercises once symptoms were stable, followed by EGE after symptoms resolved (MDR+EGE n=132). MAIN OUTCOME MEASURES: Primary outcomes were intrasession total symptom severity score exacerbation and significant intersession (increase 10+ severity points) sustained total symptom severity exacerbation, each measured with a Postconcussion Symptom Scale (132 total severity points on scale). Reported AEs were also described. Activity-based rehabilitation sessions (n=1437) were the primary analysis unit. Frequencies, proportions, medians, and Interquartile Ranges (IQRs) were calculated for outcomes by treatment group. RESULTS: The 251 post-injury participants completed 1437 (MDR+EGE=819, EGE-only=618) activity-based intervention sessions. A total of 110 and 105 participants contributed data (those missing had no documented session data) to at least 1 activity-based session in the MDR+EGE and EGE-only arms respectively. Intrasession symptom exacerbations were equivilantly low in MDR+EGE and EGE-only arms (MDR+EGE: 16.7%, 95% CI:14.1%,19.1%; EGE-only: 15.7%, 95% CI: 12.8%,18.6%). In total, 9/819 MDR+EGE sessions (0.9%) and 1/618 EGE-only sessions (0.2%) resulted in a pre- to post-session symptom exacerbation beyond a 10+ severity point increase; 8/9 resolved to <10 points by the next session. Two study-related AEs (1 in each arm) were reported. CONCLUSIONS: Participants in MDR+EGE and EGE-only activities reported equivalently low rates of symptom exacerbation.
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CONTEXT: Early professional (EP) Athletic Trainers (ATs) may encounter adjustments and develop individual identities to master a new role, which can be difficult while transitioning from student to autonomous professional. Previous literature lacks content about the transition to practice of credentialed ATs who identify as Black, Indigenous, or People of Color (BIPOC). OBJECTIVE: Identify challenges during professional education and transition to practice of EP ATs identifying as BIPOC. DESIGN: Qualitative study. SETTING: Virtual interview. PATIENTS OR OTHER PARTICIPANTS: 15 recently credentialed athletic trainers (13 female, 2 male, age=26.73±1.41 years, experience=13.80±4.03 months) who self-identified as BIPOC. DATA COLLECTION AND ANALYSIS: We used an interview guide, validated by peer (n=1) and expert (n=3) review, to structure data collection sessions. Data saturation guided recruitment and we obtained theoretical redundancy after the final interview. We analyzed data with a phenomenological approach and used multianalyst triangulation (n=2) and peer review (n=2) as credibility strategies. RESULTS: Every participant mentioned they were victims of microaggressions during either their professional preparation and/or work environment because of their race. Those who chose to report the incidents felt a lack of support from work supervisors, faculty, peers, and preceptors. Participants noted a preference for racially concordant mentoring to facilitate talking to someone who could better understand BIPOC EPs' experiences. Participants also relied on outside support from friends and family as coping mechanisms. Finally, participants experienced perceived incompetency from supervisors due to their limited work experience as early professionals and felt their professional preparation was stunted by the COVID-19 pandemic. CONCLUSIONS: Participants perceived that their transition to practice was stressful due to microaggressions encountered, a lack of support, and a lack of racially concordant mentoring. Diversity, equity, and inclusion training should be included in athletic training education and workspaces to assist in providing more welcoming environments for BIPOC EP ATs and students.
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CONTEXT: Perceived stress and burnout are significant concerns among athletic trainers (ATs) due to growing professional demands. The global COVID-19 pandemic brought additional stressors, especially for health care providers, including the need to learn and integrate new skill sets in order to continue providing safe and effective patient care. OBJECTIVE: To explore the influence of COVID-19 stressors on ATs engaged in patient care. DESIGN: Cross-sectional study. SETTING: Internet survey. PATIENTS OR OTHER PARTICIPANTS: A total of 429 ATs (age = 33 ± 9 years; experience = 11 ± 9 years; 74 men, 355 women) currently providing patient care. MAIN OUTCOME MEASURE(S): We recruited participants from social media sites to complete a questionnaire with the Coronavirus Anxiety Scale (CAS), Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS MP), and qualitative questions related to the effects of COVID-19. We calculated correlations between CAS and MBI-HSS MP composite scores (emotional exhaustion, personal accomplishment, and depersonalization) and used regression analysis to explore if CAS scores could be predicted by vaccination status (vaccinated or unvaccinated), sex, and MBI-HSS MP composite scores. We analyzed the qualitative data using a phenomenological, inductive approach with multianalyst triangulation and peer review as trustworthiness strategies. RESULTS: Significant correlations existed between CAS and MBI-HSS MP composite scores (P < .001). Emotional exhaustion (P < .001) and depersonalization (P = .008) explained 28% of the variance in CAS scores (F2,405 = 81.29, P < .001). Three major areas of focus emerged: effects on wellness, emphasis on the value of athletic training, and the lessons learned and future innovation to inform potential long-term changes in the athletic training profession. CONCLUSIONS: Key factors of emotional exhaustion and depersonalization during the pandemic may have exacerbated the potential for burnout among ATs. The pandemic affected ATs' wellness, changed perceptions of ATs, and altered operating procedures. Healthy coping strategies and organizational support are suggested for those who are struggling.
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Esgotamento Profissional , COVID-19 , Esportes , Masculino , Humanos , Feminino , Adulto Jovem , Adulto , Pandemias , Estudos Transversais , COVID-19/epidemiologia , Esportes/psicologia , Adaptação Psicológica , Inquéritos e Questionários , Esgotamento Profissional/psicologiaRESUMO
OBJECTIVE: To explore diverse stakeholders' perceptions of headgear use in collegiate women's lacrosse. PARTICIPANTS: 189 collegiate women's lacrosse stakeholders (players: n = 87; coaches: n = 71; officials: n = 32). METHODS: Participants completed online open-ended qualitative questions surrounding headgear use in the sport. Responses were coded by the research team via inductive reasoning. RESULTS: Stakeholders felt that incorporating headgear use into women's lacrosse would increase aggression and change the nature of the sport. Some felt that headgear was important for injury risk mitigation and invoked a need for research and development. Stakeholders raised the need for coaching and officiating improvement as primary injury prevention measures. Players were concerned about esthetics and performance limitations. Finally, many felt that it should be left to player choice to wear headgear or not. CONCLUSION: Most stakeholders invoke concerns of risk compensation and changing the nature of the sport of women's lacrosse, and are in favor of headgear remaining optional.
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CONTEXT: The transition to autonomous clinical practice for early professionals (EPs) has been found to be a stressful time but no studies with multiple stakeholder groups have been completed. OBJECTIVE: Examine the perceptions of EPs' integration during role transition from multiple stakeholder groups. DESIGN: Qualitative study. SETTING: Online interviews. PARTICIPANTS: 17 EPs in the first 2 years of their first job post-certification (9 females, 8 males, age=26±5 years, experience=9.5±5 months), 16 supervisors and mentors of EPs (6 females, 10 males, age=52±11 years), and 10 faculty members and 8 preceptors (11 females, 7 males, age=43±10 years). DATA COLLECTION AND ANALYSIS: Participants completed semistructured interviews using a validated interview guide based on the current literature. We analyzed data using consensual qualitative research principles. Multiple analyst triangulation (n=3), member checking, and peer review served as trustworthiness strategies. RESULTS: We identified 4 themes that defined the integration of EPs during role transition. Integration of EPs was facilitated through role inductance and mentoring. EPs struggle finding balance to avoid burnout as they are new to the profession and feel obligated to exceed expectations from a coverage standpoint rather than focusing on the quality of care delivered. Finally, stakeholders suggested a timeline by which EPs become fully integrated into autonomous professional practice and understand all aspects of their role that typically takes anywhere from 1 to 3 years. CONCLUSIONS: EPs benefited from appropriate graded autonomy during clinical education to develop their clinical reasoning skills, confidence, and mentoring network with past preceptors. Ongoing personal and professional support is needed during the initial few years to ease EPs' role inductance while gaining more experience and establishing their clinician identity. Expectations for EPs should be reasonable to allow for the provision of quality care, adequate work-life balance, and integration into the profession without guilt.
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Background: Cervical (neck) strengthening has been proposed as an important factor in concussion prevention. The purpose of the study was to determine if a six-week cervical strengthening program affected neurocognition and purposeful soccer heading biomechanics. The hypothesis was that the neck strengthening program would improve strength, maintain neurocognition, and alter purposeful soccer heading biomechanics. Study Design: Randomized controlled trial. Methods: Twenty collegiate soccer athletes (8 males, 12 females, age=20.15±1.35 years, height=171.67±9.01 cm, mass=70.56±11.03 kg) volunteered to participate. Time (pre, post) and group (experimental, control) served as the independent variables. Four composite scores from the CNS Vital Signs computer based neurocognitive test (CNSVS; verbal memory, visual memory, executive function, reaction time) and aspects of heading biomechanics from inertial measurement units (xPatch; peak linear acceleration, peak rotational acceleration, duration, Gadd Severity Index [GSI]) served as the dependent variables. Each athlete completed a baseline measure of neck strength (anterior neck flexors, bilateral anterolateral neck flexors, bilateral cervical rotators) and CNSVS after heading 10 soccer balls at two speeds (11.18 and 17.88 m/s) while wearing the xPatch. The experimental group completed specific cervical neck strengthening exercises twice a week for six weeks using a Shingo Imara™ cervical neck resistance apparatus while the control group did not. After six weeks, the participants completed the same heading protocol followed by measurement of the same outcome variables. The alpha value was set to p<0.05 a priori. Results: The interaction between time and group was significant for visual memory (F1,17=5.16, p=0.04, η2=0.23). Interestingly, post hoc results revealed visual memory decreased for the control group from pretest (46.90±4.46) compared to posttest (43.00±4.03; mean difference=3.90, 95% CI=0.77-7.03, p=0.02). Interactions for all other dependent variables were not statistically significant (p>0.05). Conclusions: The cervical neck strengthening protocol allowed maintenance of visual memory scores but did not alter other neurocognitive measures or heading biomechanics. The link between cervical neck strengthening and concussion predisposition should continue to be explored. Level of Evidence: Level 1b.