Mindfulness Training\u27s 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

Comprehensive Knowledge Assessment for Athletic Trainers: Part I

Purpose: Continuing education (CE) is intended to help clinicians maintain competence, develop and advance knowledge and skills, and enhance knowledge, skills, and abilities beyond the levels required for entry-level practice. Based on previous literature, the current mode of CE in athletic training does not appear to be helping clinicians maintain competence. The purpose of this research was to validate a comprehensive assessment based on the Role Delineation Study/Practice Analysis (6th ed.) through item analysis and estimates of reliability to be used to assess athletic trainers’ actual knowledge. Method: We conducted an instrumentation validation study using Qualtrics® web-based platform. Athletic trainers (n=191; age=31.5±8.1yrs; years of experience=8.9±11.1yrs) in good standing with the NATA and BOC completed both administrations of the assessment. Six experts developed 220 multiple-choice items for inclusion with broad application across the five domains of clinical practice (Injury/Illness and Wellness Protection [49 items], Clinical Evaluation and Diagnosis [63 items], Immediate and Emergency Care [29 items], Treatment and Rehabilitation [29 items], and Organizational and Professional Health and Wellbeing [50 items]). A random sample of NATA members were recruited via email, received weekly reminders, and then after four weeks, they completed a second administration of the assessment. We evaluated the assessment tool for item difficulty, item discrimination, internal consistency, item total statistics, and test-retest reliability. Results: We eliminated 42 items from the tool created by the experts that were too difficult (0.90). We eliminated 50 additional items due to point-biserial correlations between item performance and total domain score performance below 0.20. We identified additional weaknesses in 57 items through intraclass correlation coefficients (ICCConclusions: We developed a valid and reliable assessment tool to measure athletic trainers’ actual knowledge. Future research should utilize a validated assessment of actual knowledge to guide continuing education activities

Effects of Compex as a Warm up for Glenohumeral Range of Motion

Purpose: Research regarding proper upper extremity warm-up protocols remains inconclusive, especially for electrical stimulation methods like the Compex Sport Elite® unit. The purpose of this study is to evaluate the acute effects of a single treatment of the Compex® using the pre-warm-up protocol on glenohumeral range of motion compared to a standardized upper body ergometer (UBE) warm-up protocol. Methods: Thirty-five healthy, young adults completed the study (19 men, 16 women; age=22±2y; height=172.1±9.4cm; mass=71.3±16.1kg; right-hand dominant=28; left-hand dominant=7). Participants came to the research laboratory on two occasions, at least 48 hours apart. Participants were randomly assigned the order to complete an upper body ergometer protocol (UBE) and Compex Sport Elite®. All participants completed both intervention conditions. The UBE protocol consisted of five minutes of arm cycling at a perceived intensity of “somewhat hard” or 13 on the rating of perceived exertion scale. The Compex Sport Elite® protocol was based on manufacturer guidelines. Electrical stimulation was delivered for 25 minutes. Dominant arm passive glenohumeral internal rotation (IROT) and external rotation (EROT) ROM were measured before, immediately after, and 30 minutes after intervention. The average of three trials was used. The Global Rating of Change (GROC) scale was used after both post-intervention ROM measurements. Outcome measures were recorded by a researcher blinded to the interventions. Results: No significant interaction effect (λ=0.97; F(2,33)=0.54; p=0.59; ES=0.03) or main effects were observed for IROT. For EROT, no significant interaction effect was found (λ=0.88; F(2,33)=2.18; p=0.13; ES=0.12); however we found a main effect of time (λ=0.77; F(2,33)=5.03; p=0.12; ES=0.234). Follow-up pairwise comparisons indicated significant increase in EROT immediately post-intervention (1.508±.475; p=0.01) regardless of intervention. GROC values following dependent t-test resulted in no significant changes for either IROT or EROT (immediate post-intervention t34=0.72, p=0.48; 30 minutes post-intervention t34=0.59, p=0.56). Conclusions: No significant difference was found between the use of Compex® and UBE for warm-up of the glenohumeral joint. However, both interventions resulted in increased EROT immediately following application of intervention. Clinicians should select an intervention appropriate to meet patient goals, which may include a range of interventions or activities

Orchard Sports Injury Classification System 10.1 Plus: An End-User Study

International Journal of Exercise Science 10(2): 284-293, 2017. The purpose of this study was to establish the level of ease of use and effectiveness of the Orchard Sport Injury Classification System (OSICS) 10.1 Plus for recording injuries and interventions. Three hundred and forty-two (males=148, females=192, no response=2; age=30.9±9.5y; experience=9.1±10.5y) athletic trainers (ATs) in the United States completed the survey. Participants were primarily employed in the secondary school (n=135) or collegiate setting (n=171). Participants entered system includes the OSICS 10.1 to catalog injuries and Current Procedural Terminology (CPT) codes to document interventions. Participants completed an 18-item end-user evaluation to assess the ease of use and effectiveness of the OSICS 10.1 Plus (5-point Likert scale). Participants indicated that the OSICS 10.1 Plus is overall easy to use (4.1±0.7pts), easy to enter an injury (4.1±0.8pts), and easy to enter the associated interventions (3.9±0.8pts). Respondents were neutral about whether the OSICS 10.1 Plus matched their current injury (3.5±1.0pts) or intervention (3.5±0.9pts) records. A majority of participants indicated that they could find the injury (281/342, 82.2%) and interventions (225/342, 65.8%) of interest. A majority of respondents (205/342, 60.0%) indicated they would consider using OSICS 10.1 Plus for injury surveillance in clinical practice. The OSICS 10.1 Plus could serve as an effective and useful mechanism for injury surveillance with minor modifications; however, we, as professionals in sports healthcare, need to improve regular medical documentation first so that we are better able to conduct injury surveillance among our patients

Comparison of Whole-Body Cooling Techniques for Athletes and Military Personnel

International Journal of Exercise Science 10(2): 294-300, 2017. The purpose of this study was to evaluate cooling rates of The Polar Life Pod®, a military protocol and cold water immersion. A randomized, repeated measures design was used to compare three treatment options. Participants exercised in an environmental chamber, where they followed a military march protocol on a treadmill, followed by the application of one of three treatments: Cold water immersion tub (5 – 10 °C), Polar Life Pod® (5 – 10 °C), Ice sheets at onset (5 – 10 °C). Mean cooling rate for CWI was 0.072 ºC/min, 0.046ºC/min for ice sheets, and 0.040ºC/min for The Polar Life Pod®. There was a significant difference between conditions (F2,26=13.564, p=0.001, ES=0.511, 1-β=0.969). There was a significant difference in cooling rate among The Polar Life Pod® and CWI (p = 0.006), and no significant difference among The Polar Life Pod® and Ice Sheets (p = 0.103). There was a significant difference of time to cool among the three conditions F2,26 = 13.564, p = 0.001 , ES = 0.401, 1-β = 0.950. Our results support multiple organizations that deem CWI as the only acceptable treatment, when compared to the cooling rates of The Polar Life Pod® and ice sheets

Athletic Trainers’ Hand Hygiene Behaviors During the COVID-19 Pandemic

Purpose: Hand hygiene (HH) is a cost-effective public health intervention to prevent infectious disease transmission, including COVID-19. Health care professionals have shown poor adherence to HH best practices, and little is known about athletic trainer (AT) HH. ATs typically work in dynamic, unpredictable environments, creating barriers to HH compliance. The purpose of this study was to understand the self-reported behaviors and challenges with adherence to HH of secondary school ATs, particularly related to mitigating infection transmission during the COVID-19 pandemic. Methods: In this qualitative study, we conducted 11 semi-structured interviews with secondary school ATs actively engaged in direct patient care (age=31±9 years; experience=9±8 years). A 2-person data analysis team used a multi-phase inductive coding process to identify emerging domains and themes to create a codebook. Trustworthiness and credibility were established with member checking, multi-researcher analysis, and internal auditing. Results: We identified four themes: 1) best practices awareness, 2) impact of COVID-19, 3) resources, and 4) community-based prevention. Participants indicated HH training was included during on-boarding, but lacked contextual knowledge for HH in clinical practice, despite identifying ATs as health care providers. Participants expressed increased HH frequency due to the COVID-19 pandemic and concern for transmission. Participants noted an overall positive perception of access to physical resources, like hand sanitizer, sinks, and soap, as well as financial support to provide those resources. Participants noted decreased perceived risk and lack of formal policy or enforcement of HH expectations for facility users. Conclusion: ATs have general knowledge and resources but lack contextual knowledge and behaviors to employ HH best practices. The COVID-19 pandemic increased awareness, but HH by athletic training facility users remains poor. ATs should engage in HH based on best practice recommendations consistent with a traditional healthcare facility. Policies should be developed and enforced to limit disease transmission

Locus of Control in Athletic Training

Purpose: Locus of control (LOC) is the level of control an individual feels they have over the outcomes in their life; work locus of control (WLOC) is the control someone feels over their work. Both LOC and WLOC can be internally or externally affected and influence athletic trainers’ ability to change their clinical circumstances. The purpose of this study was to explore athletic trainers’ LOC and WLOC. Method: Cross-sectional web-based survey. Two validated surveys were used to measure locus of control and work locus of control in athletic trainers along with the collection of 8 demographic variables. Results: Of the 213 participants, athletic trainers expressed an external LOC (n=108, 50.7%) in their personal lives while reporting an internal WLOC (n=197, 92.5). Conclusion: Participants demonstrated external LOC and internal WLOC. Future investigations should examine LOC and WLOC with work conditions like burnout and job satisfaction to understand barriers faced in the workplace by athletic trainer

The Effects of Deep Oscillation Therapy for Individuals with Lower-Leg Pain

Purpose: Lower extremity (LE) pain accounts for 13-20% of injuries in the active population. LE pain has been contributed to inflexibility and fascial restrictions. Deep oscillation therapy (DOT) has been proposed to improve range of motion and reduce pain following musculoskeletal injuries. Therefore, our objective was to determine the effectiveness of DOT on ankle dorsiflexion range of motion (ROM) and pain in individuals with and without lower-leg pain. Methods: We used a single blind, pre-post experimental study in a research laboratory. Thirty-two active participants completed this study. Sixteen individuals reporting lower-leg pain and sixteen non-painful individuals completed the study. Participants received a single session of DOT performed by one researcher to their affected limb or matched limb. The intervention parameters included a 1:1 mode and 70-80% dosage. The intervention began by stimulating the lymphatic channels at the cisterna chyli, the inguinal lymph node, and the popliteal lymph node at a frequency of 150 Hz all for a minute each. Next, the researcher treated the triceps surae complex for 11 minutes at three different frequencies. Finally, the participant was treated distal to the popliteal lymph node at 25 Hz for 5 minutes. The main outcome measures included pain using the VAS and ankle dorsiflexion ROM with the weight-bearing lunge test (WBLT). Statistical analyses included descriptive statistics and F-test comparisons between and within groups. Results: The average WBLT measures for all participants increased 0.6 cm, which not to the minimal detectable change for passive ankle dorsiflexion ROM. Significant differences from pre-post measures were identified for pain on the VAS. Conclusion: While increases in ROM were identified, the difference was not clinically important. DOT was successful in decreasing lower-leg pain

Practice of and Barriers to Prevention by Secondary School Athletic Trainers

Purpose: Prevention is a key aspect of care from athletic trainers. There is limited research on the practice strategies employed to prevent injury by secondary school athletic trainers (SSATs). The purpose of this study was to describe the prevention practice strategies and barriers faced by secondary school athletic trainers. Methods: Athletic trainers (n=3010) were recruited from secondary schools through e-mails provided by the national professional organization database. Secondary school athletic trainers were surveyed on their self-reported prevention practices and barriers using a web-based survey platform. Respondents were 28±3 years, predominantly female (n=260/359, 72.4%), with about 5 years (±2yrs) of clinical experience. The survey contained prevention strategies items with tasks from Domain 1 of the Board of Certification Role Delineation Study (6th ed.) that relates to athletic training clinical practice. Barrier items were developed from previous literature about implementing evidence-based practice strategies. Partial data (completion rate=359/473, 75.9%) was used for the analyses. Data were analyzed by using frequencies, medians with percentiles, means, and standard deviations. Results: The least frequently practiced environmental illness monitoring techniques and addressing patient-specific nutritional needs were identified. In contrast, secondary school athletic trainers most frequently practiced compliance for both equipment maintenance and maintaining a clean facility. The most common ‘always practiced’ skills align with Task 102, 103, and 104 in Domain 1 of the Board of Certification Role Delineation Study. These include pre-participation and screening, personal protective equipment, and maintaining treatment and rehabilitation areas through regulatory standards. A lack of time, workload, player compliance, available space, and coach support were the most commonly cited barriers to prevention practice. Conclusions: Overall, secondary school athletic trainers engaged in prevention strategies frequently, yet external factors were barriers to implementation. The consistent and continual practice of prevention skills are essential to risk mitigation. As a result, always practicing the skill is essential and should not be completed as an occasional duty of the athletic training. As many prevention strategies are required for all patient encounters, the frequency of task performance must improve for clinical practice