Play in Three Acts

In some fields, written reflection is commonplace whereas in others it is uncommon. While athletic therapy education aims to produce reflective practitioners, written reflection is not a typical pedagogy employed. In 2014, the athletic therapy program at our institution began the implementation of a clinical presentation (CP) approach to facilitate competency-based curriculum requirements. This innovation to pedagogy required a reimagined approach to teaching, learning, and assessment. We describe one aspect of a larger SoTL study on this transformation, inquiring into the development of reflective practice through reflective writing. Students were asked to regularly reflect on their experiences in the clinic or field as part of their program. In this qualitative component of the study, we were able to gain insight into how students perceived the reflective process, how that evolved over their program, what were enablers and barriers to their reflection, and what was the role of feedback in their learning. The characteristics of student perceptions in each year, which followed a learning arc which we describe sequentially as “confused, conflicted, and convinced,” is explored, along with implications for pedagogy in assisting students to develope reflective professional practice.

Athletic therapist's management of persistent musculoskeletal pain: Time to embrace a biopsychosocial lens.

Chronic musculoskeletal pain continues to be a rising cost and burden on individuals and society on a global level, thus driving the demand for improved management strategies. Despite the fact that the biopsychosocial model has long been a recommended approach to help manage chronic pain with its' consideration of the person and their experiences, psychosocial context and societal considerations, the biomedical model continues to be the basis of athletic therapy/training education programs and therefore clinical practice. For over 30 years, psychosocial factors have been identified in the literature to be predictors of outcomes relating to chronic pain, including (but not limited to) catastrophizing, fear-avoidance, and self-efficacy. Physical assessment strategies including use of validated outcome measures can be used by the Athletic Therapist and Athletic Trainer to determine the presence and/or severity of non-biogenic pain. Knowledge of these predictors and strategies will allow the Athletic Therapist and Athletic Trainer to frame use of exercise (e.g. graded exposure), manual therapy and/or therapeutic modalities in the appropriate way to improve clinic outcomes. Through change in educational curricula content, such as that recommended by the International Association for the Study of Pain (IASP), Athletic Therapists and Athletic Trainers can develop profession-specific knowledge and skills that will enhance clinical practice to better assist those living with chronic musculoskeletal pain conditions.

Patient Outcomes Significantly Improve When Receiving Treatment by Athletic Therapy Students

Context: Patient-reported outcome measures (PROMs) should be used in athletic training but are rarely incorporated in athletic training and athletic therapy internships. Student-run clinics are common in other health professions and provide effective treatment and a valuable learning environment.1–3 To our knowledge, no one has evaluated rehabilitation outcomes in patients treated by athletic training/athletic therapy students (ATSs). Objective: The purpose of our study was to measure the improvement in function in injured patients seeking treatment at an ATS-clinic. Design: Cohort study. Setting: ATS-clinic. Participants: Fifty-nine patients from the community with a variety of low back, lower extremity, and upper extremity injuries participated in this study. Interventions: ATSs were responsible for the injury assessment and rehabilitation program of their patients while being supervised by a certified AT. Main Outcome Measures: At baseline and at 6-week follow-up, all patients completed one of three scales depending on injury location to assess their injured level of function. Scales included the: Oswestry Disability Index (ODI) for low back injuries, Lower Extremity Functional Scale (LEFS) for lower extremity injuries and Disabilities of the Arm Shoulder and Hand (DASH) for upper extremity injuries. Results: On average, patients received 4.7±1.8 treatments across 48.8±16.1 days. Patients experienced a significant increase in function between assessment and follow-up (18.8%±20.3, p<0.001,d =1.06). Moreover, the amount of functional improvement was clinically significant, being greater than the minimal clinical difference for each scale. There was no significant difference in the efficacy of treatment regarding internship experience of ATSs. Conclusions: Patients improved their function significantly after treatment delivered by an ATS. Patient-reported outcome measures were useful for the students to monitor patient improvement however, more research is needed regarding effective treatment for chronic pain patients. Our results suggest that ATS-clinics provide effective treatments for patients, service to the community, and a learning opportunity for students.

Development and Validation of a New Competency Framework for Athletic Therapy in Canada

Context Competency-based education (CBE) is entrenched in educating health professionals in Canada. CBE is a framework that identifies desired performance characteristics in training competent, entry-level health professionals. Objective To update, develop, and validate a new Canadian Athletic Therapists Association (CATA) framework for athletic therapy education. Design Framework development occurred in 4 phases and was developed through a multistage process that involved a scoping review (phase 1) and consensus methodology (ie, a blending of modified Ebel and modified Delphi consensus methods; phases 2–4). Patients or Other Participants Phase 2: a total of 7 experts (program directors) from each Canadian accredited institution. Phase 3: a total of 14 experts (1 program director and educational expert from each accredited institution). Phase 4: a total of 7 experts (program directors) and 246 certified members of the CATA. Main Outcome Measure(s) Each phase consisted of a systematic process with 80% consensus agreement set a priori. In phase 1, a scoping review was conducted to identify common terminology that could be used to guide the framework development process and to identify competency frameworks used by other health professional organizations. Phase 2 consisted of adopting a common language that would serve to keep the expert group on the task at hand and avoid confusion. In phase 3, frameworks used by other health professional organizations were evaluated and used to determine the validity of the old CATA framework. In phase 4, the old CATA framework was updated and a new framework was developed and validated. Results In phase 1, the result of the scoping review yielded 368 papers, of which 5 were used to propose a common language for phase 2 and 9 highlighted competency frameworks used by other health professions for comparison in phase 3. In phase 3, the expert group voted unanimously to adopt and adapt the CanMEDS framework (ie, roles). In phase 4, the new CATA competency framework was validated, and most competencies achieved consensus. Competencies that did not achieve consensus in the first round of voting underwent face-to-face discussions via videoconferencing. After discussions, the remaining competencies were revised, and all newly worded competencies achieved consensus. Conclusions The resultant framework was validated, and most competencies achieved consensus. The new athletic therapy competency framework outlines the 165 competencies resulting from this methodical process and will hopefully facilitate interdisciplinary communication and practice.

The Influence of Chronic Pain and Catastrophizing on Patient Outcomes in an Athletic Therapy Setting

Context: Chronic pain is a challenge for Athletic Trainers and Athletic Therapists working in a clinical or university setting. The fear avoidance model, including catastrophizing, is well established in other health professions but is not established in Athletic Training and Athletic Therapy and may affect rehabilitation outcomes. Objective: To measure the influence of catastrophizing on rehabilitation outcomes of patients being treated in an Athletic Therapy setting. Design: Prospective single group pre–post design. Setting: Student Athletic Therapy clinic. Patients: A total of 92 patients were evaluated at initial assessment, and 49 were evaluated at follow-up. Intervention: All participants completed self-reported function questionnaires to assess level of injury and then received individualized treatments for a variety of musculoskeletal injuries. All measures were completed at initial assessment and at follow-up approximately 6 weeks later. Main Outcome Measures: The authors measured function using a variety of patient self-reported functional questionnaires: the Disability of the Arm, Shoulder, and Hand; Lower Extremity Functional Scale; the Neck Disability Index; and the Oswestry Disability Index depending on injury site. Catastrophizing was measured using the Pain Catastrophizing Scale. Results: Function significantly improved from the initial assessment to the follow-up (P > .001). Patients with acute pain experienced a significantly greater improvement in function between the initial assessment and follow-up compared with participants with chronic pain (P = .050). Those with high catastrophizing presented with lower levels of function at initial assessment (66.8%) and follow-up (72.1%) compared with those with low catastrophizing (80.8% and 87.0%, respectively). Conclusion: Similar to other studies in other professions, the function of patients with chronic pain does not improve as much compared with patients recovering from acute pain in an Athletic Therapy setting. It is important to measure patient-reported outcomes to evaluate patient rehabilitation progress. Rehabilitating patients with chronic pain is a challenge, and pain catastrophizing should be evaluated at the initial assessment since catastrophizing is associated with worse function.

Exploring Technology Integration in Canadian Athletic Therapy Education

There are many potential educational goals for using digital technologies in health professional education programs. Previous studies have suggested that technology can be used in these settings to facilitate knowledge acquisition, improve clinical decision making, improve psychomotor skill coordination, and practice rare or critical scenarios. However, when using technology for educational purposes, many educators do not consider the resulting pedagogical implications of using these tools to teach course content. The purpose of this study was to explore this phenomenon in a sample of athletic therapy educators, by investigating their views and attitudes towards using digital technologies in athletic therapy specific courses. Researchers used a sequential explanatory mixed-methods approach (via questionnaire and individual interviews) to explore this topic. It was found that the majority of athletic therapy educators in this sample (n = 21) did not in fact consider the pedagogical implications of technology integration and moreover used technology in rudimentary fashions (e.g., to deliver course content or to provide additional context to explain a topic). Conversely, those educators with higher levels of pedagogical and technological knowledge appeared to use technology in more constructive ways while considering the pedagogical impact of their technology integration decisions. Although this study focused on athletic therapy education, the findings are not unique to this discipline. Carefully designed, pedagogically-sound technologies have very specific and useful ways of empowering learning and have the potential to achieve many educational goals for any educator.

Signature Pedagogies in Athletic Therapy Education

Context Developing an understanding of the signature pedagogies in athletic therapy education may help to promote greater pedagogical development opportunities and encourage meaningful reflection for educators. Objective To gain an understanding of the perceived level of pedagogical knowledge in Canadian athletic therapy educators and how they developed such knowledge. Design Sequential explanatory mixed-methods. Setting Seven undergraduate Canadian Athletic Therapists Association–accredited institutions Patients or Other Participants Twenty-one athletic therapy educators (16 women, 5 men) responded to the initial questionnaire; 15 athletic therapy educators (11 women, 4 men) participated in individual phone interviews. Main Outcome Measure(s) An initial questionnaire was designed to explore general pedagogical knowledge in athletic therapy educators and how familiar participants were with different teaching strategies. Emergent trends from these questionnaires were used to design a specific interview schedule. Phone interviews further explored the institutional, personal, student, and cultural factors that affected the selection of different pedagogical approaches. Findings from the questionnaires and interviews were combined to identify participants' pedagogical approaches to teaching in an athletic therapy setting. Results A pedagogical distinction was observed, dividing the sample into 2 groups. One group used a traditional, passive lecturing format, and the other, more innovative pedagogies. Educators who followed traditional teaching practices were less likely to know about different pedagogies or understand how these strategies could contribute to more effective instruction. The other group of educators appreciated the use of different pedagogies and explained how different teaching strategies could be incorporated to enhance learning in the athletic therapy curriculum. Conclusions On the basis of these findings, Canadian athletic therapy educators would benefit from more formalized pedagogical training and/or development. These formalized opportunities could familiarize educators with innovative pedagogical strategies while also preparing them with the necessary skills required to self-evaluate their own teaching approaches.