Utilizing Low-Intensity Blood Flow Restriction Training to Improve Aerobic Capacity in Physically Active and Injured Individuals: A Critically Appraised Topic

Purpose: To determine if, in physically active individuals, low-intensity Blood Flow Restriction (BFR) training is more effective than training without BFR at improving measures of aerobic capacity. Methods: A database search was conducted for articles that matched inclusion criteria (minimum level 2 evidence, physically active participants, comparison of low-intensity BFR to no BFR training, comparison of pre-post testing with aerobic fitness or performance, training protocols >2 weeks, studies published after 2010) by two authors and assessed by one using the PEDro scale (a minimum of 5/10 was required) to ensure level 2 quality studies that were then analyzed. Results: Four studies met all inclusion criteria. Three of the studies found significant improvements in aerobic capacity (VO2max) using BFR compared to no BFR. While the fourth study reported significant improvements in time to exertion (TTE) training with BFR, this same study did not find significant improvements in measures of aerobic capacity with BFR training. All compared BFR to non-BFR training. It was noted that high-intensity training without BFR was superior to both low-intensity training with and without BFR with respect to improvements in aerobic capacity. Conclusions: Moderate evidence exists to support the use of low-intensity BFR training to improve measures of aerobic capacity in physically active individuals over not using BRF. Clinicians seeking to maintain aerobic capacity in their patients who are unable, for various reasons, to perform high levels of aerobic activity may find low-intensity BFR training useful as a substitution while still receiving improvements in measures of aerobic capacity.

The Impact Grit and Achievement Goal Orientation have on Athletic Training Students' Persistence

Purpose: Athletic training education continues to evolve thereby increasing the importance of student retention. Understanding student motivation through achievement goal orientation and grit scores may help support student’s persistence in an athletic training program. The purpose was to determine if a relationship exists between achievement goal orientation and grit to help provide educators a better understanding of their students’ reasons for persisting to help improve retention. Methods: An achievement goal orientation survey and grit scale were administered, and quantitative data was analyzed statistically from Commission on Accreditation of Athletic Training Education- accredited programs in good standing for the 2018-2019 academic year. Results: A total of 520 professional athletic training students participated. There was a significant main effect (F(1,3)=690.0, pConclusions: Athletic training students have similar grit scores across all cohorts and classify higher with mastery goal orientation compared to performance-approach, performance-avoidant, and work-avoidant orientations. Educators should understand students’ motivation to provide support and challenging tasks for their passion and perseverance for athletic training. Key Words: grit, mastery, performance-approach, performance-avoidant, work-avoidant.

Access to Care, Reporting Behaviors, and Quality of Athletic Training Service Interactions for Reserve Officers' Training Corps cadets

Purpose: Reserve Officers’ Training Corps (ROTC) programs prepare student-civilians to become leaders through strenuous physical and leadership training. Unlike their student-athlete counterparts who have direct access to athletic training services, ROTC cadets may or may not have a healthcare provider available. The purpose of this study was to examine the access to care and reporting behaviors of ROTC cadets with a secondary aim exploring the quality of healthcare service interactions relative to patient-centered care. Methods: An online survey assessed access to care using a self-report tool on the type of medical providers available to the ROTC cadets (n=132, age=20±3 y) dispersed between the Army, Navy, Air Force, and Marines, and their illness/injury history and reporting behaviors. The participants who sought care for an injury/illness also completed the Consultation and Relational Empathy tool to measure the level of patient-centered care by the healthcare provider with follow-up analysis using the Consultation Care Measure tool for all athletic training service interactions. Data were analyzed using descriptive statistics. Results: ROTC cadets reported access to 2±1 healthcare providers including a designated civilian physician (26.5%), athletic trainer (23.5%), and ROTC peer first responder (14.4%). However, 50.8% of respondents stated they were unsure what healthcare providers were available. In total, 22.7% of cadets reported being injured and 26.5% reported being sick/ill while participating in ROTC activities. Of those who stated they had sustained an injury during ROTC, 59.9% seldomly or never reported their injury. The ROTC cadets who sought healthcare expressed they were satisfied with their injury (35.96±10.60) and illness (35.48±13.10) treatment from a patient-centered viewpoint. Conclusions: The ROTC cadets reported a general unfamiliarity with the healthcare providers available to them. Despite the reporting behaviors, the cadets reported being satisfied with the care they received.

Mindfulness Training's Effect of Pain Outcomes in Musculoskeletal Pain: A Systematic Review

Purpose: Athletic trainers frequently address and treat musculoskeletal pain (MSK). Complementary and alternative techniques for treating pain are becoming more widely accepted and utilized in clinical practice. Mindfulness based stress reduction (MBSR) is a meditation-based program that is designed to help patients learn to feel things in a non-judgmental way. Previous systematic reviews on mindfulness training have focused a range of conditions including IBS, fibromyalgia, and migraines. The purpose of this systematic review was to examine if the literature supports the use of MBSR as an intervention for MSK pain. Methods: We completed a systematic review utilizing PRISMA guidelines. Inclusion criteria were English language, human subjects, peer reviewed, randomized controlled trial, mindfulness training as an intervention, and MSK pain as an outcome measure. An electronic search was conducted using the single phrase “mindfulness training and musculoskeletal pain”. PubMed, Cochran Database, EBSCOhost, and Google Scholar were searched. Articles were first eliminated by title, and then by abstract contents. Remaining articles were given a full review and articles not meeting inclusion criteria were eliminated. Articles were assessed using the PEDRO scale with a cutoff score of 6 used to determine inclusion in the systematic review. Final analysis included 19 articles. Results: Study populations included patients diagnosed with cancer, nonspecific low back pain, chronic MSK pain, chronic tension headache, Gulf War illness, upper extremity injury, and one study employed healthy subjects and used experimentally induced pain. Intervention lengths ranged from single day to 10 weeks. Of the 19 studies in the analysis, nine of them indicated statistically significant results in favor of the meditation group for pain outcomes. Other studies noted improvement in the meditation group, but results did not reach statistically significant levels. Conclusion: MBSR has the potential to provide a beneficial effect in the treatment of MSK pain. The results of this systematic review indicate that the benefits of MBSR treatment may depend on the specific patient population and type of MSK pain. Further research is needed, but the systematic review suggests that MBSR may be an effective tool as part of a larger, complementary, and patient-centered care plan.

Concussion-related Alterations in Neural Activity During Emotion Recognition: Case Studies of Short-term and Residual Effects

Concussions have recently become an area of concern among the general public, but a clear understanding of their total consequence is still being developed. Symptoms of concussions are wide-ranging, encapsulating a plethora of cognitive and emotional abilities that could be affected. Concussions transiently disrupt neural activation as well as behavioral responses across multiple categories. Skills pertaining to various aspects of emotions are often affected yet have rarely been studied after concussions. We present two case studies of collegiate athletes with a history of multiple concussions. This paper highlights the case of a collegiate athlete who had obtained two previous concussions with the most recent being sustained sixteen days prior to neuroimaging. A second athlete with two lifetime concussions was tested one year after the most recent injury. The current study utilized a novel emotional recognition task to assess the behavioral and neural effects of this injury. A group of five controls responded with high accuracy rates and quick response times to the task. They showed activation in regions of the frontal lobe as well as facial recognition areas of the occipital lobe. The 16-day case subject was impaired in recognizing emotions relative to controls and showed little to no overlap in brain activity for regions involved in emotional face processing. The athlete with a longer post-concussion period also showed residual effects of neural activity alteration when compared to controls with few overlapping active regions. Specific brain regions were activated in this group but not in controls including the sensorimotor cortex, supramarginal gyrus, and lateral occipital cortex. By taking a more individual approach in examination of neural activity post-concussion, we may be able to gain a better understanding of this heterogeneous injury.

A Comparison of Treatment Options for Carpal Boss: A Critically Appraised Topic

Context: Carpal bossing is a bony growth or mass that typically occurs at the 2nd or 3rd carpometacarpal joint. Carpal bossing is often overlooked placing the patient at an increased risk for pain or injury, such as osteoarthritis or inflammatory joint disease if left untreated. Individuals such as combat sport athletes who experience repetitive trauma to this area are at a high risk to develop carpal bossing. The literature suggests conservative or surgical interventions to manage symptoms. The goal of this systematic review is to synthesize the current literature for clinical knowledge and intervention outcomes for carpal bossing. Methods: A systematic search of the literature was performed across 3 electronic databases (Science Direct, PubMed, and EBSCOhost) to identify articles that investigated the effects of surgical intervention or conservative management for carpal bossing. A combination of the keywords and Boolean operators (Carpal Bossing, Carpal Boss, Surgical Intervention, Wedge Resection, Excision, Conservative Treatment, and Intervention) related to the research question were used. The search was restricted to full text, human studies (including cadaveric studies) research, and manuscripts available in English. Articles were included if they examined the effect of either conservative or surgical interventions for the treatment of carpal bossing. Articles were excluded from the review if the study did not examine carpal bossing treatment options or did not include pain, range of motion, strength, or functional measures of the hand and wrist. Two independent reviewers used the Joanna Briggs Institute Checklist for Case Reports and the Checklist for Case Studies to appraise the quality of the articles. A score of 50% was used to remove low-quality studies. The Strength of Recommendation Taxonomy (SORT) method was used to grade the evidence for the articles included. Results: After the initial search, 10 articles met the inclusion criteria, while 3 were eliminated due to low quality appraisal scores. The average scores for case reports and case studies were 5.5/7 or 7.5/9 respectively. There was a total of 58 participants across the 7 studies. Generally speaking, conservative treatment reduced average daily pain and patients were able to return to full participation within 2 weeks. Conversely, patients undergoing surgical intervention experienced episodic pain, including over the surgical incision, typically averaging 2/10 on the visual analog scale. Findings from the surgical intervention showed inconsistent measurements for wrist/hand strength and range of motion. There is level C evidence on the treatment for carpal bossing. Conclusion: The limited evidence suggests conservative management may reduce pain and improve clinical outcomes. However, clinicians should consider the level C evidence with skepticism as the quality of evidence on this topic is low. Further investigations should be performed with more rigor.