Attributes of an exemplary curriculum in entry-level undergraduate athletic training education

Athletic training is an allied health profession that is currently undergoing reform of its educational curriculum standards and requirements for education programs. Despite the improvements in the curricula, initial passing rates on the National Athletic Trainers\u27 Association Board of Certification (NATABOC) examination are consistently low. The purpose of this study was to examine entry-level undergraduate athletic training curricula accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) to determine what elements constitute an exemplary curriculum and to formulate a model of an exemplary curriculum for others to replicate. It was hypothesized that an exemplary curriculum in entry-level undergraduate athletic training education exhibits a substantial exposure to clinical experiences, provides a variety of athletic training coursework, and provides intense program requirements. An objective of this research was to identify correlations between elements of an exemplary curriculum and initial success on the NATABOC examination. Data were collected via a questionnaire from 63 program directors of CAAHEP accredited undergraduate athletic training programs. Information regarding success rates for first-time NATABOC examinees during the 2000–2001 academic year, and data related to a variety of curriculum variables that may contribute to examination success were obtained. The results of the study indicate that all but one of the curriculum variables related to clinical education, courses and instruction, and program intensity are not positively related to initial success on the NATABOC examination. Additionally, no significant difference was found between programs with high rates of initial examination success and those programs that experience low success rates in terms of the variables tested. One element that correlates positively with initial success on the NATABOC examination is the number of clinical opportunities provided by a program. Although results of this study did not identify other statistically significant components of an ideal curriculum for athletic training, it demonstrates the importance of the experiential aspect of the curriculum. The results of this study have implications to the field suggesting that athletic training educators incorporate a comprehensive clinical experience in their curricula to enhance the preparation of future graduates and increase programmatic outcomes

Does blood flow restriction training improve quadriceps measures after arthroscopic knee surgery? A critically appraised topic

Introduction: Knee injuries are one of the most prevalent pathologies in sport. It is estimated that 100,000 - 250,000 ACL injuries occur per year3. It is common for patients to struggle with quadriceps strength impairment as high as 18% at two years post ACL repair11. Quadriceps strength is strongly associated with athletic performance and likelihood of re-injury after ACL repair4,5,10,12,13,19. Quadriceps strength deficits are also documented after other arthroscopic procedures and the presence of knee effusion 2,8,14,18. Blood flow restriction (BFR) training is an intervention gaining popularity in rehabilitation. BFR can improve strength and hypertrophy measures with loads as low as 20% of 1RM1. This makes BFR an ideal intervention when heavier loads are contraindicated.Research Question: To determine if BFR improves relevant measures of the quadriceps after arthroscopic knee surgery.Study Design: Critically Appraised TopicMethods: An online search was performed using the following terms; "blood flow restriction," "knee surgery," "knee arthroscopy," "anterior cruciate ligament," "kaatsu training," and "occlusion training."Results: Five of six articles included in this review support the utilization of BFR to improve post-op quadriceps measures. All five articles demonstrated a significant improvement in at least one quadriceps outcome. All studies consisted of small sample sizes, there was inconsistent initiation of BFR, and little consistency in protocols. There was variability among outcomes measured across the studies.Conclusion: There is low level evidence that BFR should be included to improve quadriceps following arthroscopic knee surgery. More high quality studies are needed to make stronger recommendations

THE EFFECTS OF AN OVER-THE-COUNTER ORTHOTIC ON LOWER EXTREMITY KINEMATICS IN RECREATIONAL RUNNERS

Abnormal foot mechanics during the stance phase of running may affect the kinematics of the lower extremities and predispose an individual to injuries of the foot, ankle, and knee. Custom made foot orthotics are often prescribed to correct abnormal mechanics during running by restoring dynamic stability to the closed chain of the lower extremity. However, custom made orthotics are expensive and must be made by a specially trained professional. An alternative to custom made orthotics are several brands of over-the-counter orthotics. However, there has been no research done to examine the efficacy of using an over-the-counter orthotic to correct abnormal gait mechanics. The purpose of this study was to examine the effects of an over-the counter orthotic on ankle and knee joint kinematics during running in individuals identified as excessive pronators

Hamstring tendon autograft vs. tibialis tendon allograft for ACL reconstruction: A critically appraised topic

Introduction: ACL injuries are extremely common especially in the young and active population. ACL tears require reconstruction surgery with the use of either an autograft or allograft. The purpose of this research is to find whether a hamstring autograft or tibialis allograft provides these patients with longer survivorship.Focused Clinical Question: Does a hamstring tendon autograft or tibialis tendon allograft provide superior outcomes in regards to re-injury rates and subjective functional outcome scores following an ACL tear in patients under the age of 35?Study Design: Critically Appraised Topic.Methods: Four relevant studies were chosen based on inclusion and exclusion criteria, three prospective randomized studies and one retrospective clinical study.Results: Hamstring tendon autografts and tibialis tendon allografts provide similar subjective and functional outcomes. The odds of tearing an ACL graft were significantly higher for the allograft group compared to the autograft group regardless of age.Conclusion: There is reasonable evidence (Level B) to support that the hamstrings autograft has superior survivorship compared to tibialis allografts

Posterolateral hip muscle strengthening in decreasing symptoms of patellofemoral pain syndrome: A critically appraised topic

Context: Patellofemoral pain (PFP) is an idiopathic condition characterized by aching pain in the peripatellar area, which is exacerbated by physical activities, such as climbing stairs, squatting, jumping, running, and prolonged sitting. PFP can often be managed by corrective exercise treatment that emphasizes strengthening of thigh and hip musculature, correction of malalignment of the lower extremity, and improvement of patellar incongruence. Evidence is inconclusive whether strengthening of the thigh or hip musculature is more beneficial in the treatment of PFP.Clinical Question: Does posterolateral hip muscle strengthening compared to quadriceps strengthening help decrease symptoms in individuals presenting with patellofemoral pain?Summary of Key Findings: A search of the following databases was conducted using search terms of hip strengthening, quadriceps strengthening, anterior knee pain, and patellofemoral pain (Pubmed, SPORTDiscus, EBSCO host, Trip Research, and Google Scholar). Only peer-reviewed studies that were randomized control trials, or systematic reviews were included in the analysis. Of the four articles that were included in this critically appraised topic, all recognized that hip strengthening had positive patient reported outcomes in decreasing symptoms of PFPS.Clinical Bottom Line: There is moderate evidence that shows decrease in symptoms of pain in patients presenting with PFP that participated in posterolateral hip strengthening compared to thigh musculature training alone.Strength of Recommendation: Level

Effects of low-intensity blood flow restriction training vs. no blood flow restriction training on measures of aerobic capacity in physically active individuals

Background: Blood flow restriction (BFR) training has become an extremely popular training method over the years. Improvements in measures of aerobic capacity (such as VO2max) are crucial for individuals whom seek to be physically active for longer periods of time. Recent studies have focused on the combination of BFR and aerobic exercise at lower training intensities as an adapted training method for either maintaining or improving measures of aerobic capacity in physically active individuals.Clinical Question: In physically active individuals, is low-intensity blood flow restriction training more effective than no blood flow restriction training at improving measures of aerobic capacity?Methods: A computer-assisted literature search of PubMed, MEDLINE, SPORTDiscus, and EBSCOHost databases (from inception to November 2019) was utilized to identify studies of level 3 evidence or higher that assessed the effect of low-intensity BFR training versus no BFR training on measures of aerobic capacity in physically active individuals. The main outcomes of interest were either pre-post testing assessments of aerobic fitness (such as VO2max or VO2peak) and/or pre-post testing assessments of aerobic performance (such as time to exhaustion).Summary of Key Findings: The search strategy revealed 4 studies that met the inclusion criteria. One study reported that there were no significant improvements in measures of aerobic capacity when using low-intensity BFR training versus not using BFR training (1.96%, p < 0.05), while two studies reported that there in fact were significant improvements in measures of aerobic capacity (VO2max: 6.5%, p < 0.05 and TTE: 15.4%, p < 0.01; VO2max: +9.1± 6.2%, P < 0.001). One study reported that there were significant improvements in aerobic capacity when using low-intensity BFR training versus low-intensity training without BFR (BFR group: 5.6 ± 4.2%, P = 0.006, ES = 0.33; LOW group: 0.4 ± 4.7%, P = 0.75); however, high-intensity training without BFR showed greater improvements in aerobic capacity when compared to low-intensity training with BFR (HIT group: 9.2 ± 6.5%, P = 0.002, ES = 0.9).Clinical Bottom Line: There is moderate evidence to support the use of low-intensity BFR training to improve aerobic capacity in physically active individuals.Strength of Recommendation: Grade B evidence exists that low-intensity BFR training is more effective than no BFR training at improving measures of aerobic capacity in physically active individuals

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 \u3e2 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

Accuracy of the lever sign test in a diagnostic exam of an acute anterior cruciate ligament (ACL) injury: a critically appraised topic

Context: The lever sign has been developed and researched, within the last ten years, as an alternative physical examination of the anterior cruciate ligament (ACL). The simplicity and practicality of the test has increased its presence within ACL clinical assessment literature. Multiple studies investigating the lever sign have shown significant sensitivity in diagnosing ACL tears. However, the patient population in the majority of these studies are those reporting with chronic knee injuries. Therefore, there is limited research showing the effectiveness of the lever sign in acute evaluations. This critically appraised topic explores the potential for the lever sign to be significantly effective in diagnosing acute ACL tears within the general population.Clinical Question: What is the accuracy of the lever sign test compared to the Lachman’s, pivot shift, and anterior drawer tests for the physical examination of acute ruptures to the anterior cruciate ligament (ACL) in the general population?Summary of Key Findings: The literature yielded three cohort studies evaluating acute anterior cruciate ligament (ACL) ruptures using the lever sign test within the general population. Two of the three studies analyzed the sensitivity of the lever sign, Lachman, and anterior drawer test in emergency department acute ACL injuries. One of the three studies compared the accuracy of the lever sign to the Lachman, anterior drawer and pivot shift clinical assessment of ACL. There were high-sensitivity findings of the lever sign in all three cohort studies; however, one cohort study found the Lachman test to be more sensitive and accurate.Clinical Bottom Line: There is moderate evidence to support high sensitivity of the lever sign as a diagnostic test; however, there is limited research to support the accuracy of the lever sign in acute evaluations of the anterior cruciate ligament (ACL).Strength of Recommendation: Grade B evidence does exist to show the effectiveness of the lever sign in identifying ACL ruptures during acute evaluations of the general population

How blood flow restriction (BFR) can assist therapeutic exercise in patients with chronic ankle instability (CAI)

Clinical scenario: The high recurrence of lateral ankle sprains progresses to chronic ankle instability and can affect many athletes in all sports. Chronic ankle instability (CAI) is often associated with a decrease in muscle strength, increase in pain, decrease in range of motion, and decrease in balance or neuromuscular control. The use of blood flow restriction with CAI can increase muscular outcomes and be used as a rehabilitation tool.Clinical Question: Is there evidence to suggest that blood flow restriction improves strength, muscle activation and (or) cross-sectional area (CSA) of the lower leg musculature in those with chronic ankle instability?Summary of Key Findings: The three studies evaluated one of the muscular outcomes of either strength, CSA, or muscle activation in result of BFR training. Each of the three studies reported a type of significant improvement in muscular outcomes using BFR for CAI.Clinical Bottom line: There is moderate evidence to support therapeutic exercise with low-intensity blood flow restriction in patients with chronic ankle instability. The evidence concluded a significant improvement in BFR to increase muscle activation of fibularis longus, anterior tibialis, vastus lateralis, and soleus.1-2 There is moderate evidence suggesting BFR can induce strength gains in the muscles dependent on the exercise selection.Recommendation: Grade B exists for the use of blood flow restriction with therapeutic exercise for patients with CAI. Further research in exercise selection and regimen can change confidence in efficacy

The development and applications of ultrafast electron nanocrystallography

We review the development of ultrafast electron nanocrystallography as a method for investigating structural dynamics for nanoscale materials and interfaces. Its sensitivity and resolution are demonstrated in the studies of surface melting of gold nanocrystals, nonequilibrium transformation of graphite into reversible diamond-like intermediates, and molecular scale charge dynamics, showing a versatility for not only determining the structures, but also the charge and energy redistribution at interfaces. A quantitative scheme for three-dimensional retrieval of atomic structures is demonstrated with few-particle (< 1000) sensitivity, establishing this nanocrystallographic method as a tool for directly visualizing dynamics within isolated nanomaterials with atomic scale spatio-temporal resolution.Comment: 33 pages, 17 figures (Review article, 2008 conference of ultrafast electron microscopy conference and ultrafast sciences