Physical Therapists’ Assessment of Patient Self-Efficacy for Home Exercise Programs

# Background Patient adherence to home exercise programs (HEPs) is low, and poor patient self-efficacy is a barrier clinicians can influence. However, little evidence suggests that clinicians assess level of patient self-efficacy before prescribing HEPs. # Purpose To determine the importance of patient self-efficacy to physical therapists (PTs) when addressing patient barriers, determine how PTs assess and use patient self-efficacy for HEPs, and describe the barriers facing PTs when assessing patient self-efficacy for HEPs. # Study Design Survey. # Methods Practicing PTs were recruited from the American Physical Therapy Association’s Orthopedic Section and emailed the electronic survey. # Results Email invitations were sent to 17730 potential participants, and 462 PTs completed the survey over one month. PTs rated self-efficacy as “very” to “extremely” important for patient adherence (58%, 265/454). Most (71%, 328/462) reported assessing self-efficacy before prescribing HEPs and did so through verbal discussion and observation of the patient (50% and 38% respectively). Half of respondents individualized HEPs through self-efficacy related themes. PTs not assessing self-efficacy reported not knowing how (51%, 68/134), being unsure what to do with the information (24%, 32/134), or reporting other barriers (21%, 28/134). # Conclusions Most PTs indicated that self-efficacy was important for patient adherence, but assessment strategies reported, such as verbal discussion and observation, may not be the most accurate. PTs who did not assess self-efficacy reported not knowing how or what to do with the information once collected. These findings suggest that there is a gap in knowledge related to how to evaluate self-efficacy for HEPs. Better assessment of self-efficacy may lead to more appropriate and effective implementation strategies. # Level of Evidence Level I

Athletic Trainers’ Perceptions of and Experience with Social Determinants of Health

The role that social determinants of health (SDHs) play in athletic healthcare is gaining attention, yet little is known about athletic trainers’ (ATs) perceptions of and encounters with the impact of SDHs. The purpose of this study was to evaluate ATs’ perceptions of various SDHs and their experience treating patients whose health and well-being were influenced by SDHs. This was a cross-sectional, web-based survey completed by 1694 ATs (completion rate = 92.6%; 61.1% female; age = 36.6 ± 10.8 years). The survey consisted of several multipart questions focusing on specific SDHs. Descriptive statistics were used to report frequencies and percentages. Results indicated widespread agreement that SDHs matter to patient health and are of concern in athletic healthcare. The SDHs that ATs most commonly reported encountering included lifestyle choices (n = 1306/1406; 93.0%), social support (n = 1185/1427; 83.0%), income (n = 1167/1502; 77.7%), and access to quality and timely healthcare (n = 1093/1420, 77.0%). The SDHs that ATs least commonly reported having experience with was governmental policy (n = 684/1411; 48%). The perceived importance of SDHs among ATs and their commonly reported experiences managing patient cases in which SDHs negatively influence patients’ health and healthcare suggest that efforts to assess these factors are needed so that strategies to address their influence on athletic healthcare can be identified

Changes in Patient-Reported Outcome Measures From The Time of injury to Return to Play in Adolescent Athletes At Secondary Schools with An Athletic Trainer

© by the National Athletic Trainers’ Association, Inc. Context: Typically, athletic trainers rely on clinician-centered measures to evaluate athletes’ return-to-play status. However, clinician-centered measures do not provide information regarding patients’ perceptions. Objective: To determine whether clinically important changes in patient-reported outcomes were observed from the time of lower extremity injury to the time of return to play in adolescent athletes. Design: Cross-sectional study. Setting: The National Athletic Treatment, Injury and Outcomes Network (NATION) program has captured injury and treatment data in 31 sports from 147 secondary schools across 26 states. A subsample of 24 schools participated in the outcomes study arm during the 20122013 and 20132014 academic years. Patients or Other Participants: To be included in this report, student-athletes must have sustained a knee, lower leg, ankle, or foot injury that restricted participation from sport for at least 3 days. A total of 76 initial assessments were started by athletes; for 69 of those, return-to-play surveys were completed and analyzed. Main Outcome Measure(s): All student-athletes completed generic patient-reported outcome measures (Patient-Reported Outcomes Measurement Information System [PROMIS] survey, Global Rating of Change scale, and Numeric Pain Rating Scale) and, depending on body region, completed an additional region-specific measure (Knee Injury and Osteoarthritis Outcome Score or Foot and Ankle Ability Measure). All applicable surveys were completed at both the initial and return-to-play time points. Means and standard deviations for the total scores of each patient-reported outcome measure at each time point were calculated. Change scores that reflected the difference from the initial to the return-to-play time points were calculated for each participant and compared with established benchmarks for change. Results: The greatest improvement in patient-reported outcomes was in the region-specific forms, with scores ranging from 9.92 to 37.73 on the different region-specific subscales (Knee Injury and Osteoarthritis Outcome Score or Foot and Ankle Ability Measure; scores range from 0100). The region-specific subscales on average still showed a 21.8- to 37.5-point deficit in reported health at return to play. The PROMIS Lower Extremity score increased on average by 13 points; all other PROMIS scales were within normative values after injury. Conclusions: Adolescent athletes who were injured at a high school with an athletic trainer may have shown improvement in patient-reported outcomes over time, but when they returned to play, their outcome scores remained lower than norms from comparable athlete groups

Physical Therapists\u27 Assessment of Patient Self-Efficacy for Home Exercise Programs

Background: Patient adherence to home exercise programs (HEPs) is low, and poor patient self-efficacy is a barrier clinicians can influence. However, little evidence suggests that clinicians assess level of patient self-efficacy before prescribing HEPs. Purpose: To determine the importance of patient self-efficacy to physical therapists (PTs) when addressing patient barriers, determine how PTs assess and use patient self-efficacy for HEPs, and describe the barriers facing PTs when assessing patient self-efficacy for HEPs. Study Design: Survey. Methods: Practicing PTs were recruited from the American Physical Therapy Association\u27s Orthopedic Section and emailed the electronic survey. Results: Email invitations were sent to 17730 potential participants, and 462 PTs completed the survey over one month. PTs rated self-efficacy as very to extremely important for patient adherence (58%, 265/454). Most (71%, 328/462) reported assessing self-efficacy before prescribing HEPs and did so through verbal discussion and observation of the patient (50% and 38% respectively). Half of respondents individualized HEPs through self-efficacy related themes. PTs not assessing self-efficacy reported not knowing how (51%, 68/134), being unsure what to do with the information (24%, 32/134), or reporting other barriers (21%, 28/134). Conclusions: Most PTs indicated that self-efficacy was important for patient adherence, but assessment strategies reported, such as verbal discussion and observation, may not be the most accurate. PTs who did not assess self-efficacy reported not knowing how or what to do with the information once collected. These findings suggest that there is a gap in knowledge related to how to evaluate self-efficacy for HEPs. Better assessment of self-efficacy may lead to more appropriate and effective implementation strategies. Level of Evidence: Level II

Epidemiology of Secondary School Boys\u27 and Girls\u27 Basketball injuries: National Athletic Treatment, Injury and Outcomes Network

© by the National Athletic Trainers\u27 Association, Inc Context: Little is known about non-time-loss (NTL) injury patterns in basketball athletes. Knowledge of these patterns may aid in the development of prevention and management strategies for patients with these injuries. Objective: To describe the epidemiology of time-loss (TL) and NTL injuries sustained by secondary school boys\u27 and girls\u27 basketball athletes. Design: Descriptive epidemiology study. Setting: Eighty-six unique schools provided data, with 84 and 83 contributing to boys\u27 and girls\u27 basketball, respectively. Patients or Other Participants: Athletes participating in secondary school-sponsored boys\u27 and girls\u27 basketball. Main Outcome Measure(s): Boys\u27 and girls\u27 basketball data from the National Athletic Treatment, Injury and Outcomes Network (NATION) injury-surveillance program (2011-2012 through 2013-2014 years) were analyzed. Injury counts, rates, and rate ratios (IRRs) were reported with 95% confidence intervals (CIs). Results: The NATION captured 2653 injuries over 364 355 athlete-exposures (AEs) for boys\u27 basketball and 2394 injuries over 288 286 AE for girls\u27 basketball, producing rates of 7.28/ 1000 AEs (95% CI = 7.00, 7.56) for boys and 8.30/1000 AEs (95% CI = 7.97, 8.64) for girls. The overall injury rates were slightly lower for boys (IRR = 0.88; 95% CI = 0.83, 0.93). For boys, 559 (21.1%) injuries were TL and 2094 (78.9%) were NTL, producing a TL injury rate of 1.53/1000 AEs (95% CI = 1.40, 1.66) and an NTL injury rate of 5.75/1000 AEs (95% CI = 5.50, 5.99). For girls, 499 (20.8%) injuries were TL and 1895 (79.2%) were NTL, producing a TL injury rate of 1.73/1000 AEs (95% CI = 1.58, 1.88) and an NTL injury rate of 6.57/1000 AEs (95% CI = 6.28, 6.87). Rates of TL injuries were similar between boys\u27 and girls\u27 basketball (IRR = 0.89; 95% CI = 0.79, 1.00); NTL injury rates were lower for boys (IRR = 0.87; 95% CI = 0.82, 0.93). Conclusions: When NTL injuries were included, the rates of injury in boys\u27 and girls\u27 secondary school basketball were higher than previously reported

Non–Time-Loss and Time-Loss Softball Injuries in Secondary School Athletes: A Report From The National Athletic Treatment, Injury and Outcomes Network (NATION)

Ó by the National Athletic Trainers’ Association, Inc Context: Most studies of injury trends associated with softball focus on injuries requiring at least 24 hours of missed participation time (time-loss [TL] injuries), with little focus on those that do not (non–time-loss [NTL] injuries). A better understanding of injury trends associated with softball will improve athlete care. Objective: To describe NTL and TL injuries experienced by secondary school girls’ softball players. Design: Descriptive epidemiology study. Setting: Secondary school athletic training clinics. Patients or Other Participants: Secondary school girls’ softball players. Main Outcome Measure(s): Aggregate data were collected from schools participating in the National Athletic Treatment, Injury, and Outcomes Network surveillance program during the 2011–2012 through 2013–2014 academic years. Frequencies and rates of injuries (NTL and TL) according to time of season, event type, body part injured, and diagnosis were analyzed. Results: In total, 1059 injuries were reported during 140 073 athlete-exposures (AEs): overall injury rate ¼ 7.56/1000 AEs. Of these injuries, 885 (83.6%) were NTL (NTL rate ¼ 6.32/1000 AEs) and 174 (16.4%) were TL (TL rate ¼ 1.24/1000 AEs). Of the NTL and TL injuries, the largest numbers occurred during the regular season (NTL: n ¼ 443 [50.1%]; TL: n ¼ 131 [75.3%]). Injuries sustained during practices accounted for the majority of NTL and TL injuries (NTL: n ¼ 631 [71.3%]; TL: n ¼ 104 [59.8%]). The NTL injuries occurred most often at the shoulder (n ¼ 134 [15.1%]) and hand/fingers (n ¼ 109 [12.3%]) and were diagnosed as contusions (n ¼ 316 [35.7%]), strains (n ¼ 157 [17.7%]), and abrasions (n ¼ 151 [17.1%]). The largest numbers of TL injuries were to the head/face (n ¼ 71 [40.8%]) and diagnosed as concussions (n ¼ 50 [28.7%]) and strains (n ¼ 28 [16.1%]). Conclusions: Secondary school softball players sustained a larger proportion of NTL injuries than TL injuries. Although NTL injuries may be less severe, they are numerous. Efforts are needed to ensure that injury-prevention programs are incorporated into the care of softball athletes to promote health and reduce injury occurrence