Athletic Trainers' Effect on Population Health: Improving Access to and Quality of Care

Context The scope of athletic training practice combined with the magnitude of scholastic athletic injuries means that the scholastic athletic trainer (AT) is uniquely positioned to positively affect the overall health care of this population. The AT is equipped to serve in the prevention and primary management of injuries and return to activity of scholastic athletes. However, to optimize the musculoskeletal health of all athletes within a given setting, the gaps in clinical care must be continuously evaluated. Quality improvement (QI) approaches are often used to establish a framework for delivering care that promotes the best health status of the targeted population. Objective To describe the creation, implementation, and early results of a QI initiative aimed at advancing the health of the scholastic athletes served in the Greenville County, South Carolina, school district. Design Cohort study. Patients or Other Participants A total of 49 793 athletes. Main Outcome Measure(s) The QI framework consisted of a process that documented the magnitude of athletic injuries, established risk factors for injury, defined intervention steps for at-risk athletes, and evaluated the QI process before and after implementation. The results were regularly reported to participating stakeholders, including ATs, athletic directors, coaches, parents, and athletes. Results After the QI process, injury rates decreased (absolute risk difference between the 2011–2012 and 2016–2017 academic years = 22%) and resources were more strategically allocated, which resulted in a decrease in health care costs of more than 50%. Conclusions Collectively, the QI framework as described provides a systematic process for empowering the AT as the foundation of the scholastic sports medicine team.

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Key Factors for Providing Appropriate Medical Care in Secondary School Athletics: Athletic Training Services and Budget

Journal of Athletic Training ◽

10.4085/1062-6050-45.1.75 ◽

2010 ◽

Vol 45 (1) ◽

pp. 75-86 ◽

Cited By ~ 16

Author(s):

George S. Wham ◽

Ruth Saunders ◽

James Mensch

Keyword(s):

South Carolina ◽

Secondary School ◽

Medical Care ◽

Athletic Training ◽

Sports Medicine ◽

Interscholastic Athletics ◽

Care Assessment ◽

Interscholastic Athletes ◽

Training Services ◽

Medicine Supply

Abstract Context: Research suggests that appropriate medical care for interscholastic athletes is frequently lacking. However, few investigators have examined factors related to care. Objective: To examine medical care provided by interscholastic athletics programs and to identify factors associated with variations in provision of care. Design: Cross-sectional study. Setting: Mailed and e-mailed survey. Patients or Other Participants: One hundred sixty-six South Carolina high schools. Intervention(s): The 132-item Appropriate Medical Care Assessment Tool (AMCAT) was developed and pilot tested. It included 119 items assessing medical care based on the Appropriate Medical Care for Secondary School-Age Athletes (AMCSSAA) Consensus Statement and Monograph (test-retest reliability: r = 0.89). Also included were items assessing potential influences on medical care. Presence, source, and number of athletic trainers; school size; distance to nearest medical center; public or private status; sports medicine supply budget; and varsity football regional championships served as explanatory variables, whereas the school setting, region of state, and rate of free or reduced lunch qualifiers served as control variables. Main Outcome Measure(s): The Appropriate Care Index (ACI) score from the AMCAT provided a quantitative measure of medical care and served as the response variable. The ACI score was determined based on a school's response to items relating to AMCSSAA guidelines. Results: Regression analysis revealed associations with ACI score for athletic training services and sports medicine supply budget (both P < .001) when controlling for the setting, region, and rate of free or reduced lunch qualifiers. These 2 variables accounted for 30% of the variance in ACI score (R2 = 0.302). Post hoc analysis showed differences between ACI score based on the source of the athletic trainer and the size of the sports medicine supply budget. Conclusions: The AMCAT offers an evaluation of medical care provided by interscholastic athletics programs. In South Carolina schools, athletic training services and the sports medicine supply budget were associated with higher levels of medical care. These results offer guidance for improving the medical care provided for interscholastic athletes.

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Psychological Aspects of Athletic Injuries as Perceived by Athletic Trainers

The Sport Psychologist ◽

10.1123/tsp.10.1.37 ◽

1996 ◽

Vol 10 (1) ◽

pp. 37-47 ◽

Cited By ~ 51

Author(s):

Gerald A. Larson ◽

Chad Starkey ◽

Leonard D. Zaichkowsky

Keyword(s):

Athletic Training ◽

Sport Psychology ◽

Sports Medicine ◽

Athletic Trainers ◽

Psychological Trauma ◽

Athletic Injuries ◽

Psychological Aspects ◽

Certified Athletic Trainers ◽

Sport Psychologist ◽

National Athletic Trainers Association

This study investigated the perceptions of certified athletic trainers concerning their attitudes, beliefs, and application of a variety of psychological strategies and techniques used in the treatment and rehabilitation of athletic injuries. The Athletic Training and Sport Psychology Questionnaire (ATSPQ) was adapted from instruments developed by Wiese, Weiss, and Yukelson (1991) and Brewer, Van Raalte, and Linder (1991). The ATSPQ, a letter of introduction, and a self-addressed stamped envelope were distributed to 1,000 certified athletic trainers randomly selected from the membership database maintained by the National Athletic Trainers’ Association (NATA). Only 482 (48.2%) of these questionnaires returned were usable. 47% of athletic trainers who responded believe that every injured athlete suffers psychological trauma. 24% reported that they have referred an athlete for counseling for situations related to their injury, and 25% reported that they have a sport psychologist as a member of their sports medicine team. This study concludes that future education of athletic trainers should address the psychological aspects of injury treatment as well as the development of a sport psychology referral network.

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PARENTS AND ATHLETES PERCEIVE PAIN AND PEER RELATIONSHIPS DIFFERENTLY: EARLY RESULTS OF A PROMIS DYAD STUDY

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00064 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0006

Author(s):

Corinna C Franklin ◽

Kevin Moran ◽

◽

Keyword(s):

Upper Extremity ◽

Peer Relationships ◽

Sports Medicine ◽

Outcome Measurement ◽

Clinical Care ◽

Hospital System ◽

Early Results ◽

Significant Difference ◽

Patient Reported ◽

The Impact

Introduction: Parents/caregivers are a crucial part of young athletes’ support systems, as their beliefs can have a profound effect on the athletes’ treatment and recovery. However, it is unknown to what degree sports medicine patients and their parents/caregivers are in agreement about their function. We recently instituted the use of a Patient Reported Outcome Measurement Information System (PROMIS) for all patients in our hospital system. In this study, we propose to use PROMIS scores to evaluate whether parents/caregivers have the same perception of their child’s function as the child them self. This is a report of our early findings from one site. Methods: IRB approval was obtained for this study. Patients already take PROMIS evaluations as part of their clinical care. After obtaining informed consent, one parent (ideally the primary caregiver) per patient at one visit took the parent-proxy version of PROMIS, in which the parent is asked to answer identical questions on the child’s behalf, without consulting either the patient or their physician. PROMIS domains included mobility, upper extremity, pain, and peer relationships. All parent-child dyads were through sports medicine clinic with an injury or diagnosis related to sports medicine. Patients and parents were compared using independent samples t-tests. Results: Twenty-four ( n=24) patient-parent dyads were included in this analysis. Fourteen patients ( n=14) were female and n=10 male. Sixteen patient/parent ( n=16) dyads had similar genders and n=8 were opposite genders. There were significant differences between the patient and their parent for both the pain and peer relationship domains ( p=0.02 for both). Parents rated the patients’ pain as more severe ( M=48.1, SD = 9.3) than the patient rated their own pain ( M=42.2, SD=7.3). Parents also rated the patients’ peer relationships as worse/more affected ( M=53.0, SD=9.4) than did the patients themselves ( M=58.9, SD=7.2). No significant differences were found for the mobility and upper extremity domains, p>0.05. There was no significant difference in concordance between same or opposite gender dyads, p>0.05. Conclusion: Early results of this study suggest that parents rate athletes with sports injuries as having more pain and worse/more affected peer relationships than do the athletes themselves. Further study is required to elucidate the impact of this difference on athletes’ performance and recovery.

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The Evolution of the Athletic Training Profession

Kinesiology Review ◽

10.1123/kr.2021-0027 ◽

2021 ◽

pp. 1-11

Author(s):

Eleni Diakogeorgiou ◽

R. Richard Ray ◽

Sara Brown ◽

Jay Hertel ◽

Douglas J. Casa

Keyword(s):

Health Care ◽

Health Disparities ◽

Athletic Training ◽

Sports Medicine ◽

Athletic Trainers ◽

Athletic Training Education ◽

Critical Component ◽

Current State

Athletic training is a health care profession with roots in athletics and kinesiology that has evolved into a critical component of contemporary sports medicine. The aim of this article is to review the history and evolution of the athletic training profession, contextualize the current state of athletic training education and research, and address priorities and challenges that the athletic training profession must confront if it is to continue to thrive. Specific challenges include addressing health disparities in sports medicine, increasing the diversity of the athletic training profession, clearly delineating athletic training’s place in the health care arena, and increasing salaries and retention of athletic trainers in the profession.

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Preparation, Expectations, Experience, and Environment of a College/University Athletic Training Residency: An Ethnographic Study

Athletic Training Education Journal ◽

10.4085/1947-380x-20-114 ◽

2021 ◽

Vol 16 (3) ◽

pp. 178-187

Author(s):

Lindsey E. Eberman

Keyword(s):

Health Care ◽

Athletic Training ◽

Residency Program ◽

Sports Medicine ◽

Teaching And Learning ◽

Ethnographic Study ◽

Full Time ◽

Health Care Administrators ◽

Depth Of Knowledge ◽

Field Notes

Context Athletic training residency programs are proliferating rapidly, yet only 1 accredited residency is housed outside of physician-practice or clinic settings. Objective The focus of this article was to explore the structural and cultural factors that support a residency program in a college/university athletic training facility. Design Qualitative ethnographic study. Setting Boston University Commission on Accreditation of Athletic Training Education–accredited residency program. Patients or Other Participants The unit includes 16 full-time athletic trainers (2 of whom are residents, 6 of whom are residency faculty/preceptors) and 3 fellowship-trained primary care sports medicine physicians. Data Collection and Analysis I made observations, engaged in discussions, and conducted interviews for 34 days (159.5 hours) over 4 months. Data analysis involved examining transcriptions, field notes, and observational summaries of dialogue and behaviors, reactions, and my own interpretations. I used an inductive coding process to develop meaningful concepts, grouping them together to classify the data and identify themes and subthemes characterizing the structures of the culture. Results I identified 3 themes: resident preparation and expectations, residency experience, and environment. In the first theme, I identified that the residents came into the residency having some deficiencies and incongruent expectations of the program. In the second theme, I observed the residents gained depth of knowledge, skills, and abilities in their focused area of practice, and they improved self-reflective practices through their exposure to clinical specialists and the varied pedagogical approaches within the program. The environment included both benefits and challenges in having a residency. Engagement in interprofessional and collaborative practice and a culture of teaching and learning supported the residency environment. Conclusions Athletic health care administrators must clearly communicate expectations when recruiting candidates, consider the training and commitment of their staff, and ensure culture of health care education within their unit before developing a residency, regardless of setting.

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“Exercise is Medicine” in Latin America: training health care professionals in physical activity prescription

Swiss Sports & Exercise Medicine ◽

10.34045/ssem/2014/15 ◽

2014 ◽

Vol 62 (2) ◽

Keyword(s):

Physical Activity ◽

Health Care ◽

Clinical Practice ◽

Latin American ◽

Health Care Professionals ◽

Sports Medicine ◽

Positive Impact ◽

Training Experience ◽

Before And After ◽

Long Term Impact

Health care professionals (HCPs) play an important role promoting healthy habits to patients, yet they lack knowledge, training and self-efficacy to effectively prescribe physical activity (PA). In 2011, the “Exercise is Medicine” Latin American Regional Center developed a one-day (8 hours) in-person course on PA and exercise prescription for HCPs, with theoretical and practical components. Contents include evidence-based health benefits of PA, screening for major risk factors, key behavioral change strategies, basic exercise testing, and prescription and referrals principles. Participants take a multiple-choice evaluation before and after the training. Those who score 80% or higher in the final evaluation receive an international certification endorsed by the American College of Sports Medicine. Since 2013, they also report current PA habits and counselling in clinical practice at the beginning of the course. Sustainability of this initiative, including free enrollment of participants, has been achieved with the support from the industry, scientific societies, and sports and exercise authorities. As of October 2013, 40 courses have been carried out in 15 cities and 7 countries of the region. A total of 1206 HCP have participated (26.4% general practitioners, 47.8% specialists, 20% other HCP), and 625 physicians have been certificated. Participants scored, on average, 20% higher in the final versus the initial evaluation. In total, 379 participants completed the questionnaire, 61.2% of which reported to currently comply with international PA level recommendations. Also, 52.2% and 57.5% reported to always assess or recommend PA in their clinical practice. The overall quality of the course was scored 4.5 out of 5. Participants have shared personal testimonies, stating the positive impact of the training experience on their own personal exercise habits and clinical practice. This course is a promising strategy to help incorporate PA promotion in health care settings. Evaluation of its medium and long-term impact is in progress.

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Educational Technique: Using a Phased Approach to Integrate Diagnostic Ultrasound into Athletic Training Education

Athletic Training Education Journal ◽

10.4085/1304372 ◽

2018 ◽

Vol 13 (4) ◽

pp. 372-376

Author(s):

Kellie C. Huxel Bliven ◽

Barton E. Anderson ◽

Saskia D. Richter ◽

Inder Raj S. Makin

Keyword(s):

Health Care ◽

Clinical Practice ◽

Athletic Training ◽

Ultrasound Imaging ◽

Manual Therapy ◽

Sports Medicine ◽

Diagnostic Ultrasound ◽

Physical Exam ◽

Initial Exposure ◽

Hands On

Context: The use of point-of-care diagnostic ultrasound is increasing in health care, specifically among sports medicine clinicians as an adjunct to the physical exam. Given the role of athletic trainers in interdisciplinary sports medicine teams, athletic training educational programs should consider integrating this noninvasive imaging modality into curricula. Objective: To provide a framework for integrating diagnostic ultrasound imaging content into existing athletic training curricula. Background: A phased approach to incorporating ultrasound imaging into existing courses with minimal disruption is important for adoption. Foundational knowledge for skill performance begins with early exposure to ultrasound concepts and is followed by phased integration of hands-on ultrasound imaging into athletic training courses. Description: Content delivery considerations, such as online modules and technology needs, to enhance hands-on learning is discussed. Examples of integrating diagnostic ultrasound imaging throughout the curriculum, including anatomy, clinical assessment, and manual therapy courses, are provided. Clinical Advantage(s): Integrating ultrasound throughout curricula teaches students how to use and interpret ultrasound images as an adjunct to physical exam, enhancing the athletic trainer's value on a health care team and improving clinical practice. Ultrasound imaging can also be used as a valuable feedback mechanism during the performance of hands-on athletic training skills, including special tissue tests and manual therapy techniques. Conclusion(s): Following initial exposure to ultrasound imaging, the inclusion of diagnostic ultrasound instruction in athletic training curricula can expose students to ultrasound imaging, basic concepts, transducer characteristics, and image interpretation, which is a valuable adjunct to clinical practice.

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Prevalence of SARS-CoV-2 infection in previously undiagnosed health care workers at the onset of the U.S. COVID-19 epidemic

10.1101/2020.04.20.20072470 ◽

2020 ◽

Cited By ~ 16

Author(s):

Emily S. Barrett ◽

Daniel B. Horton ◽

Jason Roy ◽

Maria Laura Gennaro ◽

Andrew Brooks ◽

...

Keyword(s):

Health Care ◽

Confidence Interval ◽

Health Care Workers ◽

Prospective Cohort ◽

Healthcare Workers ◽

Absolute Risk ◽

Risk Difference ◽

Care Workers ◽

Community Transmission ◽

The U.S

AbstractImportanceHealthcare workers are presumed to be at increased risk of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection due to occupational exposure to infected patients. However, no epidemiological study has examined the prevalence of SARS-CoV-2 infection in a cohort of healthcare workers during the early phase of community transmission.ObjectiveTo determine the baseline prevalence of SARS-CoV-2 infection in a cohort of previously undiagnosed healthcare workers and a comparison group of non-healthcare workers.DesignProspective cohort studySettingA large U.S. university and two affiliated university hospitalsParticipants546 health care workers and 283 non-health care workers with no known prior SARS-CoV-2 infectionExposureHealthcare worker status and roleMain outcome(s) and measure(s)SARS-CoV-2 infection status as determined by presence of SARS-CoV-2 RNA in oropharyngeal swabs.ResultsAt baseline, 41 (5.0%) of participants tested positive for SARS-CoV-2 infection, of whom 14 (34.2%) reported symptoms. The prevalence of SARS-CoV-2 infection was higher among healthcare workers (7.3%) than in non-healthcare workers (0.4%), representing a 7.0% greater absolute risk (95% confidence interval for risk difference 4.7%, 9.3%). The majority of infected healthcare workers (62.5%) worked as nurses. Positive tests increased across the two weeks of cohort recruitment in line with rising confirmed cases in the hospitals and surrounding counties.Conclusions and relevanceIn a prospective cohort conducted in the early phases of community transmission, healthcare workers had a higher prevalence of SARS-CoV-2 infection than non-healthcare workers, attesting to the occupational hazards of caring for patients in this crisis. Baseline data reported here will enable us to monitor the spread of infection and examine risk factors for transmission among healthcare workers. These results will inform optimal strategies for protecting the healthcare workforce, their families, and their patients.Clinicaltrials.gov registration number:NCT04336215Key pointsQuestionAmong previously undiagnosed individuals, is the prevalence of SARS-CoV-2 infection higher in U.S. healthcare workers compared to non-healthcare workers in the early phase of the U.S. COVID-19 epidemic?FindingsThe prevalence of SARS-CoV-2 infection was 7.3% in healthcare workers and 0.4% in non-healthcare workers, representing 7.0% greater absolute risk in the former (95% confidence interval for risk difference 4.7%, 9.3%). Infections were most common among nursing staff.MeaningHealth care workers, particularly those with high levels of close patient contact, may be particularly vulnerable to SARS-CoV-2 infection. Additional strategies are needed to protect these critical frontline workers.

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Droperidol dropped; consultants not consulted

Psychiatric Bulletin ◽

10.1017/s0955603600002786 ◽

2003 ◽

Vol 27 (08) ◽

pp. 301-304

Author(s):

Gavin Reid ◽

Mark Hughson

Keyword(s):

Questionnaire Survey ◽

Clinical Care ◽

Postal Questionnaire ◽

Clinical Implications ◽

The West ◽

Abrupt Withdrawal ◽

Before And After ◽

Adequate Evaluation ◽

Psychiatric Profession ◽

The Impact

Aims and Method We conducted a postal questionnaire survey of the practice of rapid tranquillisation among 215 consultant psychiatrists in the West of Scotland, before and after the withdrawal of droperidol by the manufacturer. Results One hundred and eighty questionnaires (84% of those sent) were returned. Droperidol had been used extensively, often combined with lorazepam, for rapid tranquillisation. The main replacement suggested for droperidol was haloperidol. About half of the respondents to our survey chose to comment on the withdrawal of droperidol. More than half of the comments were unfavourable, including lack of an adequate replacement and lack of consultation with the psychiatric profession. Clinical Implications The abrupt withdrawal of droperidol, partly for commercial reasons, was regrettable. There was no time for an adequate evaluation of possible replacement medications and a lack of consultation with the profession regarding the impact on clinical care.

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Quality of Life for Children with Persistent Sinonasal Symptoms

Otolaryngology ◽

10.1067/mhn.2003.41 ◽

2003 ◽

Vol 128 (1) ◽

pp. 17-26 ◽

Cited By ~ 97

Author(s):

David J. Kay ◽

Richard M. Rosenfeld

Keyword(s):

Quality Of Life ◽

Clinical Care ◽

Longitudinal Change ◽

Good Test ◽

Routine Clinical Care ◽

Before And After ◽

The Mean ◽

The Individual ◽

Sinonasal Symptoms

OBJECTIVE: The goal was to validate the SN-5 survey as a measure of longitudinal change in health-related quality of life (HRQoL) for children with persistent sinonasal symptoms. DESIGN AND SETTING: We conducted a before and after study of 85 children aged 2 to 12 years in a metropolitan pediatric otolaryngology practice. Caregivers completed the SN-5 survey at entry and at least 4 weeks later. The survey included 5 symptom-cluster items covering the domains of sinus infection, nasal obstruction, allergy symptoms, emotional distress, and activity limitations. RESULTS: Good test-retest reliability ( R = 0.70) was obtained for the overall SN-5 score and the individual survey items ( R ≥ 0.58). The mean baseline SN-5 score was 3.8 (SD, 1.0) of a maximum of 7.0, with higher scores indicating poorer HRQoL. All SN-5 items had adequate correlation ( R ≥ 0.36) with external constructs. The mean change in SN-5 score after routine clinical care was 0.88 (SD, 1.19) with an effect size of 0.74 indicating good responsiveness to longitudinal change. The change scores correlated appropriately with changes in related external constructs ( R ≥ 0.42). CONCLUSIONS: The SN-5 is a valid, reliable, and responsive measure of HRQoL for children with persistent sinonasal symptoms, suitable for use in outcomes studies and routine clinical care.

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