scholarly journals Exploring Athletic Trainers' Self-Confidence for Interpreting Results from Concussion Assessments

2019 ◽  
Vol 34 (5) ◽  
pp. 756-756
Author(s):  
N R D’Amico ◽  
T Covassin ◽  
N Murray ◽  
P Schatz ◽  
R J Elbin

Abstract Purpose To explore athletic trainers' self-confidence for interpreting results from concussion assessments. Methods An online survey was administered via the National Athletic Trainers’ Association (NATA) membership listserv to a cross-sectional sample of 10,000 certified athletic trainers (ATCs) employed in high school and collegiate settings. The survey included: 1) ATC demographics (i.e., age, sex, years of experience); 2) ATC concussion management practices (i.e., previous concussion training, continuing education received on concussion, concussion assessments administered); and 3) a 4-point Likert scale (1=no confidence, 4=high confidence) assessing ATC self-confidence for interpreting results from concussion assessments. A total of 725 ATCs completed the survey yielding a response rate of 7.25%; 114 were excluded for missing data and 611 ATCs were included in final analyses. Sample demographics, ATC concussion management practices, and ATC self-confidence scores were examined with demographic statistics (i.e., means, standard deviations, frequencies, percentages) for 16 commonly used concussion assessments. Results The sample of ATCs (mean age 38.97±14.89 years) was predominately female (59.2%) and reported an average of 10.08±7.58 years of clinical experience. Clinical examinations (63.2%) and symptom scales (61.4%) were among the most frequent assessments with high ATC self-confidence for interpretation. Vestibular/oculomotor measures (27.2%) and computerized neurocognitive testing (26.2%) were among the most frequent assessments with low ATC self-confidence for interpretation. Conclusion Low ATC self-confidence scores for interpreting results from vestibular/oculomotor measures and computerized neurocognitive testing highlight the importance of incorporating a multi-disciplinary team approach and including sport neuropsychologists for the proper management of concussion.

2018 ◽  
Vol 53 (10) ◽  
pp. 990-1003 ◽  
Author(s):  
Chelsea L. Williamson ◽  
Grant E. Norte ◽  
Donna K. Broshek ◽  
Joseph M. Hart ◽  
Jacob E. Resch

Context Recent recommendations have emphasized return-to-learn (RTL) protocols to aid athletes in recovery from sport-related concussion (SRC) but have been based primarily on anecdotal evidence. Objective To investigate the RTL practices of certified athletic trainers (ATs) after an SRC. Design Cross-sectional study. Setting Online survey. Patients or Other Participants A total of 1083 individuals (27%) from a random sample of 4000 ATs in the National Athletic Trainers' Association membership database completed an electronic survey. Participants consisted of 729 self-identified secondary school ATs (SSATs; 67.3%; experience = 14.0 ± 9.7 years) and 354 self-identified collegiate ATs (CATs; 32.7%; experience = 13.4 ± 9.7 years). Main Outcome Measure(s) We used χ2 analyses to assess respondent differences related to current knowledge, current practices, and available resources. Independent t tests were used to compare SSATs and CATs on years of certification and annual number of SRCs evaluated. Results Of our total respondents, 41.2% (n = 446) correctly indicated the absence of evidence-based RTL guidelines. Whereas most (73.9%, n = 800) respondents had an established RTL policy, only 38.1% (n = 413) used such guidelines in their clinical practice. Most (97.1%, n = 708) SSATs and 82.2% (n = 291) of CATs had access to (a) mental health professional(s); however, minorities of SSATs (21.4%, n = 156) and CATs (37.0%, n = 131) never accessed these resources to care for concussed student-athletes. Conclusions Our results suggested that, despite the absence of empirical evidence, most surveyed ATs incorporated some form of RTL protocol in their SRC management policy. The varying AT knowledge, clinical practices, and resources highlighted by our results should be considered when creating or refining an RTL protocol.


2011 ◽  
Vol 46 (4) ◽  
pp. 415-423 ◽  
Author(s):  
Leamor Kahanov ◽  
Elizabeth J. Gilmore ◽  
Lindsey E. Eberman ◽  
Jeffrey Roberts ◽  
Tamar Semerjian ◽  
...  

Context: Methicillin-resistant Staphylococcus aureus (MRSA) infections are increasingly common in athletic settings. The MRSA knowledge and infection-control practices of certified athletic trainers (ATs) and the cleanliness of the athletic training room are important factors in preventing MRSA infections. Objective: To assess knowledge of MRSA and the use of common disinfectants among ATs and to explore their infection-control practices. Design: Cross-sectional study. Setting: High school and collegiate athletic training rooms. Patients or Other Participants: A total of 163 ATs from National Collegiate Athletic Association Divisions I, II, and III and high schools, representing all 10 National Athletic Trainers' Association districts. Main Outcome Measure(s): Frequencies, analyses of variance, and χ2 tests were used to assess current practices and opinions and relationships between factors. Results: Methicillin-resistant Staphylococcus aureus was perceived as a national problem by 92% of respondents; 57% perceived MRSA as a problem in their practice setting. Most respondents had treated general infections (88%), staphylococcal infections (75%), and MRSA infections (57%). Male sex was associated with treating all 3 types of infections (χ2 test, P < .05). Noncurriculum education was associated with a lack of recognition of environmental issues as risk factors and with the use of isopropyl alcohol for disinfection (χ2 test, P < .05). For example, 10% of respondents did not recognize that contaminated whirlpools can be a source of MRSA infection. Respondents also incorrectly identified effective cleaning solutions. Thirty percent of respondents cleaned their hands frequently or sometimes before treating each athlete and 35% cleaned their hands sometimes, occasionally, or never after seeing each athlete. Conclusions: The majority of ATs were informed about MRSA and made correct disinfection choices. However, improvements are still needed, and not all ATs were using proper disinfection practices.


2018 ◽  
Vol 53 (10) ◽  
pp. 983-989 ◽  
Author(s):  
Jennifer L. Savage ◽  
Tracey Covassin

Context:  Diagnostic and return-to-play assessments of athletes with sport-related concussions (SRCs) have changed dramatically over the past decade. Currently, SRC assessment and management has taken a multifaceted approach, with new SRC measures being developed yearly. However, to date, no researchers have examined certified athletic trainers' (ATs') self-efficacy in assessing and managing a patient with an SRC. Objective:  To examine the self-efficacy of ATs in assessing and managing athletes with SRCs, with a secondary purpose of examining job setting (high school and college). Design:  Cross-sectional study. Setting:  Web-based questionnaire. Patients or Other Participants:  A total of 94 ATs (high school setting = 54.3%, n = 51; collegiate setting = 45.7%, n = 43) completed an online survey, for a response rate of 9.2%. Main Outcome Measure(s):  The survey contained 3 primary subsections: demographics, self-efficacy in assessing SRCs, and self-efficacy in managing SRCs. Possible self-efficacy ratings for SRC assessment and management in the survey ranged from 0 to 100. Multivariate analyses of variance were performed to identify differences in the self-efficacy of high school and collegiate ATs in assessing and managing athletes with SRCs. Results:  The self-efficacy of all 94 participants in their assessment of SRCs was 60.34 ± 14.5 and in their management of SRCs was 55.30 ± 14.1. Collegiate ATs reported higher self-efficacy in the assessment of SRCs using balance (P < .001) and the King-Devick test (P = .04), and their responses approached significance for vestibular-ocular motor screening (P = .05). Additionally, their self-efficacy in the management of SRCs was greater using balance (P < .001) and vestibular-ocular therapy (P = .01) compared with high school ATs. Conclusions:  Athletic trainers had moderate self-efficacy regarding their assessment and management of SRCs. Collegiate ATs had higher self-efficacy in newer SRC assessment and management tools than high school ATs.


2010 ◽  
Vol 45 (5) ◽  
pp. 459-466 ◽  
Author(s):  
Leamor Kahanov ◽  
Alice R. Loebsack ◽  
Matthew A. Masucci ◽  
Jeff Roberts

Abstract Context: Female athletic trainers (ATs) are currently underrepresented in the collegiate setting. Parenting and family obligations may play a role in this underrepresentation. Objective: To examine female ATs' perspectives on parenting and working in the secondary school and collegiate employment settings. Design: Cross-sectional study. Setting: Online survey. Patients or Other Participants: A total of 1000 nonstudent, female certified ATs who were currently members of the National Athletic Trainers' Association. Main Outcome Measure(s): An original survey was developed to assess perceptions related to motherhood and work responsibilities. Descriptive statistics were used to assess age, years of experience as a certified AT, employment position, and parent or nonparent status. A correlation matrix was conducted to determine factors among parent and nonparent status, perceptions of motherhood, and employment-setting decisions. Results: Of the 1000 surveys sent via e-mail, 411 (41.1%) female ATs responded. Responses indicated that a majority of the female ATs worked in the secondary school setting. Sixty-one percent of the respondents did not have children. Past female ATs' experiences indicated a perception that motherhood created more challenges or struggles (or both) in the work and family settings. Whether parents considered children a factor in employment-setting changes produced conflicting results: no significant correlations or differences were found among responses. Conclusions: Parenting considerations had influences on both the home and employment settings. Although parents and nonparents had different views on the implications of parenting in the workplace, both groups agreed that parenting could affect the work environment and the choice to change employment settings and careers. Administrative decisions need to be considered in relation to parenting concerns. Mentoring that includes employment-setting choices relative to life goals should be provided to ATs, regardless of sex.


2013 ◽  
Vol 48 (5) ◽  
pp. 636-644 ◽  
Author(s):  
Justin Rigby ◽  
Luzita Vela ◽  
Jeff Housman

Context: Practice guidelines recommend a multifaceted approach for managing concussions, but a relatively small percentage of athletic trainers (ATs) follow these recommendations. Understanding ATs' beliefs toward the recommended concussion practice guidelines is the first step in identifying interventions that could increase compliance. The theory of planned behavior (TPB) allows us to measure ATs' beliefs toward the recommended concussion practice guidelines. Objective: To examine the influence of ATs' beliefs toward the current recommended concussion guidelines on concussion-management practice through an application of the TPB. Design: Cross-sectional study. Setting: A Web link with a survey was e-mailed to 1000 randomly selected members of the National Athletic Trainers' Association (NATA). Patients or Other Participants: A total of 221 certified ATs working in secondary school/clinic, high school, and college/university settings. Main Outcome Measure(s): A 66-item survey reflecting the current recommended concussion guidelines of the NATA and International Conference on Concussion in Sport was created to measure beliefs using the TPB constructs attitude toward the behavior (BA), subjective norms (SN), perceived behavioral control (PBC), and behavioral intention (BI) of ATs. We used a linear multiple regression to determine if the TPB constructs BA, SN, and PBC predicted BI and if PBC and BI predicted behavior according to the TPB model. Results: We found that BA, SN, and PBC predicted BI (R = 0.683, R2 = 0.466, F3,202 = 58.78, P < .001). The BA (t202 = 5.53, P < .001) and PBC (t202 = 9.64, P < .001) contributed to the model, whereas SN (t202 = −0.84, P = .402) did not. The PBC and BI predicted behavior (R = 0.661, R2 = 0.437, F2,203 = 78.902, P < .001). Conclusions: In this sample, the TPB constructs predicted BI and behavior of ATs' compliance with recommended concussion-management guidelines. The BA and PBC were the most influential constructs, indicating that those with positive attitudes toward concussion-management recommendations are more likely to implement them, and ATs are less likely to implement them when they do not believe they have the power to do so. We theorize that interventions targeting ATs' attitudes and control perceptions will lead to improved compliance.


2018 ◽  
Vol 53 (11) ◽  
pp. 1098-1102
Author(s):  
Patricia Estock ◽  
Janet E. Simon

Context Little is known about the prevalence of exposure to catastrophic events or how caring for athletes exposed to catastrophic events can influence burnout in athletic trainers (ATs). Objective To assess (1) the prevalence of exposure to catastrophic events, (2) the levels of burnout among ATs who have been exposed to catastrophic events, and (3) the coping strategies they used. Design Cross-sectional study. Setting Online survey. Patients or Other Participants We invited 9881 certified members of the National Athletic Trainers' Association to participate in this study; 1007 surveys were completed, for a response rate of 10.2% (433 men, 572 women, and 2 who preferred not to answer the question). Main Outcome Measure(s) Participants completed an online survey to assess demographic information, exposure to a catastrophic event, and scores on the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and the Coping Inventory for Stressful Situations (CISS). Scores on the MBI-HSS (personal accomplishment, depersonalization, and emotional exhaustion subscales) and CISS (avoidance, task, and emotion-oriented subscales) were determined. Two multivariate analyses of variance (one for MBI-HSS and one for CISS) were conducted using the independent variable of group (catastrophic event and no catastrophic event). The α level was set at P < .05 for all analyses. Results A total of 518 ATs (51.4%) reported providing care to athletes exposed to a catastrophic event and 489 (48.6%) did not. The group that reported providing care for athletes exposed to a catastrophic event had a significantly worse personal accomplishment score (46.1 ± 6.7) than the group that had never provided such care (44.6 ± 7.7; P < .05). The emotion-oriented score for those who had provided care for athletes exposed to a catastrophic event was 14.3 ± 4.8 versus 14.9 ± 4.2 for those who had not (P < .05), indicating less use of emotion-oriented coping strategies. Conclusions The ATs who provided care to athletes exposed to a catastrophic event could be more likely to suffer from a lack of personal accomplishment and exhibit task and emotion-oriented coping behaviors.


2013 ◽  
Vol 48 (6) ◽  
pp. 844-850 ◽  
Author(s):  
Robert C. Lynall ◽  
Kevin G. Laudner ◽  
Jason P. Mihalik ◽  
Justin M. Stanek

Context: Understanding concussion-assessmment and -management practices that athletic trainers (ATs) currently use will allow clinicians to identify potential strategies for enhancing the quality of care provided to patients. Objective: To assess current clinical concussion diagnostic and return-to-participation practices among ATs. Design: Cross-sectional study. Setting: Web-based survey. Patients or Other Participants: A link to the survey was sent randomly to a convenience sample of 3222 members of the National Athletic Trainers' Association. A total of 1053 (32.7%) certified ATs (experience as an AT = 11.2 ± 9.1 years) responded to the survey. Intervention(s): Prospective participants received electronic correspondence informing them of the purpose of the study and providing a link to the Web-based survey instrument. A reminder e-mail was sent approximately 6 weeks later, and the survey remained online for a total of 8 weeks. Main Outcome Measure(s): We collected information on the annual number of concussions assessed and tools employed to diagnose, manage, and safely return an athlete to participation. Descriptive statistics were computed for each variable. Results: Participants reported observing 10.7 ± 11.0 concussions per year. Clinical examination (n = 743, 70.6%) was the most commonly reported means for evaluating and diagnosing concussion. Less than half of our respondents employed the Standardized Assessment of Concussion (n = 467, 44.3%), any variation of the Romberg test (n = 461, 43.8%), and computerized neuropsychological testing (n = 459, 43.6%). Clinical examination (n = 773, 73.4%), return-to-participation guidelines (n = 713, 67.7%), physician recommendation (n = 660, 62.7%), or player self-report (n = 447, 42.5%) contributed to the return-to-participation decisions of ATs. Only 20.8% (n = 219) of ATs reported using all 3 recommended domains of the concussion battery. Conclusions: Our study demonstrated a growth in the number of ATs incorporating objective clinical measures of concussion as a part of their concussion management. Conversely, fewer ATs reported using a standard clinical examination in their concussion assessment. These findings suggest ATs must continue to increase their use of both objective concussion assessment tools and the standard clinical examination.


2021 ◽  
pp. 1-8
Author(s):  
Reid Skeel ◽  
Anissa Maffett ◽  
Abigail Feder ◽  
Cayla Mitzkovitz ◽  
Sofia Lesica

Context: Recovery protocols for treatment of sports concussion have received widespread adoption across the country. While stages of recovery and treatment are relatively clearly defined, there remains variability in implementation of specific recommendations, particularly regarding activities that constitute rest during stages calling for limitations on activity participation. Specific recommendations being employed by practitioners have not been previously assessed. In an aim to document current concussion management practices in the field, athletic trainers were surveyed regarding how activities that may constitute rest are utilized and defined. Design: The study was based on a cross-sectional vignette-based survey. Methods: The sample used was a geographically representative convenience sample of United States-based high school athletic trainers. E-mails were sent to 2146 potential survey respondents yielding a final sample of 226 athletic trainers. Data were gathered for questions concerning recommendations for follow-up care and rest based on provided vignettes, factors considered when developing recommendations, and differences in recommendations associated with varying symptom presentations. The percentage of practitioners that would utilize each potential recommendation was used to characterize results. Results: Participants demonstrated consensus on the importance of physical and cognitive rest as well as school accommodations (all greater than 97% endorsement). Greater variability was present for recommendations regarding pain medication for headache, repeating baseline cognitive testing, and engaging in subsymptom threshold activities. Recommendations for attending but not participating in games and practice yielded conflicting information. Conclusions: Responses indicated general consensus regarding factors considered when making recommendations. There was also consensus regarding general recommendations for activity limitation following recovery with almost all participants strongly recommending cognitive and physical rest, in accordance with consensus guidelines. However, substantial differences were found for specific activities that should be limited or encouraged following youth concussion. Further research concerning the relationship between community and social interaction and clinical outcomes after concussion is warranted.


Author(s):  
Jeremy M. Eith ◽  
Clint R. Haggard ◽  
Dawn M. Emerson ◽  
Susan W. Yeargin

Context Determining an athlete's hydration status allows hydration-related concerns to be identified before significant medical or performance concerns arise. Weight charts are an accurate measure of hydration status changes, yet their clinical use by athletic trainers (ATs) is unknown. Objective To investigate ATs' use of weight charts in athletic settings and describe their subsequent clinical decisions. Design Cross-sectional survey. Setting High schools and National Collegiate Athletic Association Divisions I, II, III and National Association Intercollegiate Athletics colleges. Patients or Other Participants A total of 354 ATs (men = 162, women = 17; 17 respondents did not answer the demographic questions) responded across athletic settings (Division I [45.7%]; Division II, Division III, National Association Intercollegiate Athletics combined [n = 19.9%]; and high school [34.4%]). Main Outcome Measure(s) The 26-question online survey was developed by content experts and pilot tested before data collection. Participants answered questions focused on weight-chart use (implementation, timing, and calculations) and clinical decision processes (policies, interventions, and referral). Frequency statistics were calculated. Results The majority of ATs (57.2%) did not use weight charts. Of those who did, most (76.0%) used charts with football, soccer (28%), and wrestling (6%) athletes. They calculated changes as either an absolute (42.2%) or percentage (36.7%) change from prepractice to postpractice; only 11.7% used a baseline weight for calculations. Of those who used the percentage change in body mass, 66.0% selected a threshold of −3% to −4% for an intervention. Most ATs (97.0%) intervened with oral education, whereas only one-third (37.0%) provided specific fluid amounts based on body mass changes. Conclusions Typically, ATs in athletic settings did not use weight charts. They considered a body mass change of –3% the indication for intervention but did not specify rehydration amounts for hypohydrated athletes. Educational workshops or technology applications could be developed to encourage ATs to use weight charts and calculate appropriate individual fluid interventions for their athletes.


2018 ◽  
Vol 53 (6) ◽  
pp. 606-618
Author(s):  
Kristen L. Kucera ◽  
Hester J. Lipscomb ◽  
Karen G. Roos ◽  
John M. Dement ◽  
Jennifer M. Hootman

Context:  Health care workers have high rates of musculoskeletal injuries, but many of these injuries go unreported to workers' compensation and national surveillance systems. Little is known regarding the work-related injuries of certified athletic trainers (ATs). Objective:  To determine the 12-month incidence and prevalence of work-related injuries and describe injury-reporting and -management strategies. Design:  Cross-sectional study. Setting:  Population-based online survey. Patients or Other Participants:  Of the 29 051 ATs currently certified by the Board of Certification, Inc, who “opted in” to research studies, we randomly selected 10 000. Of these, 1826 (18.3%) ATs currently working in the clinical setting were eligible and participated in the baseline survey. Main Outcome Measure(s):  An online survey was e-mailed in May of 2012. We assessed self-reported work-related injuries in the previous 12 months and management strategies including medical care, work limitations or modifications, and time off work. Statistics (frequencies and percentages) were calculated to describe injury rates per 200 000 work hours, injury prevalence, injury characteristics, and injury-reporting and -management strategies. Results:  A total of 247 ATs reported 419 work-related injuries during the previous 12 months, for an incidence rate of 21.6 per 200 000 hours (95% confidence interval = 19.6, 23.7) and injury prevalence of 13.5% (95% confidence interval = 12.0%, 15.1%). The low back (26%), hand/fingers (9%), and knee (9%) were frequently affected body sites. Injuries were most often caused by bodily motion/overexertion/repetition (52%), contact with objects/equipment/persons (24%), or slips/trips/falls (15%). More than half of injured ATs (55.5%) sought medical care, 25% missed work, and most (77%) did not file a workers' compensation claim for their injury. Half of injured ATs were limited at work (n = 125), and 89% modified or changed their athletic training work as a result of the injury. Conclusions:  More than half of AT work-related injuries required medical care or work limitations and were not reported for workers' compensation. Understanding how ATs care for and manage their work-related injuries is important given that few take time off work.


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