Athletic Training Student and Student Aide Clinical Task Allowance in the Secondary School Setting

Purpose: Athletic training student aides (SA) are minors in high school that participate in an athletic training experience under the supervision of secondary school athletic trainers (SSAT). The NATA published an official statement on the proper supervision of SAs related to task allowance. As SSATs may also supervise athletic training students (ATSs), it is important to understand the differences in both. Therefore, the objective was to explore the training, task allowance, and perspectives of SAs and ATSs by SSATs during clinical experiences. Methods: We used a cross-sectional, web-based survey for this study. SSATs (n=3,567) from the ATLAS database were recruited and 614 participants (age=39±11years, years credentialed=12±9years) completed the study. An online survey was developed to reflect the NATA official statement for task allowance and supervision of SAs and ATSs. Dependent variables included requirements and task allowance of the SA and ATS based on supervision (direct, autonomous, and restricted), and the personal perceptions from SSATs. Results: 76.5% of SSATs reported having SAs involved in their clinical practice. Less than 50% of SSATs implemented recommended trainings related to emergency preparedness, first aid, and patient privacy. When exploring task allowance, most SSATs were following best practice guidelines for job-related tasks. Additionally, SSATs were allowing ATSs to perform more tasks autonomously as compared to SAs. Conclusions: SSATs are mostly following best practice recommendations for task allowance, whereby they are providing supervision to SAs in the appropriate areas and not allowing certain duties. However, 100% compliance was not met, thus increasing risks to patients and the profession. SSATs should improve training and preparedness for the SAs involved in their clinical practice Additionally, SSATs are allowing ATSs to perform job-related tasks autonomously or with directed supervision during clinical experiences with the exception to administrative tasks and autonomous clinical-decision making

Athletic Trainers’ Knowledge of Legal Practice within Information Technology and Social Media

Purpose: As healthcare and technology continue to connect in daily practice, athletic trainers (ATs) must be knowledgeable of the governing acts for ethical and legal clinical practice. This is vital to ensure ethical and legal practice as a clinician and protection of confidential protected health information (PHI). The objective of this study was to assess certified athletic trainers’ knowledge of regulations within technology and social media (SoMe). Methods: Certified ATs were recruited from the National Athletic Trainers’ Association membership database. Respondents completed an instrument of 28 questions, including 16 participant demographics, clinical site demographics, SoMe usage and general questions, and a 12-item knowledge assessment tool on a web-based survey platform. Validity of the instrument was determined through a Delphi panel of experts in athletic training, healthcare lawyers and an information technologist. We analyzed data using descriptive statistics. Results: Respondents reported a Master’s degree as their highest earned (n=106, 72.6%) with 33.6% of those degrees being at the professional level (n=49). Respondents predominately worked in the public secondary school setting (n=43, 29.5%) and worked 8-9 hours per day (n=78, 53.4%). Respondents self-reported an average of five active SoMe accounts with Facebook® (n=120,, 81.6%), LinkedIn® (n=75, 51%), Instagram® (n=70, 47.6%), Twitter® (n=70, 47.6%), Pinterest® (n=64, 43.5%), and Snapchat® (n=64, 43.5%) being the most common sites. Within their athletic training clinic, respondents predominately reported (n=76, 51.7%) that all their computers had a virtual private network, and had a SoMe policy that was enforced to some extent (n=63, 42.9%). Respondents (n=136, 92.5%) stated that they have not reported someone for a breach of HIPAA, and have not been reported themselves (n=146, 99.3%); however, respondents (n=16, 10.8%) indicated they had one or more full faced photos of patients on their SoMe accounts, breaching HIPAA. The majority of respondents have had formal education on HIPAA regulations (n=115, 78.2%). On the knowledge assessment, Respondents correctly scored 7.7±1.9 out of 12 possible points (mean score=59.2±14.5%). Conclusions: Respondents lacked the appropriate knowledge regarding HIPAA and Health Information Technology for Economic and Clinical Health (HITECH) Act regulations, and application of this knowledge within SoMe. Future research should focus on educational interventions of technology advancements for safe and legal practice as an AT

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

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

Athletic Trainers’ Perceived and Actual Knowledge of Cupping Therapy Concepts

Purpose: To date, there does not appear to be a study published that has examined the prevalence of clinical use and the perceived and actual knowledge of cupping therapy that clinicians possess. The purpose of this study was to determine the perceived and actual knowledge of cupping therapy among athletic trainers. Methods: 113 certified athletic trainers completed the study (age = 35 ± 10 years, years of certified experience = 12 ± 10 years). Participants were sent an electronic survey via email that assessed frequency of usage, perceived knowledge, and actual knowledge of cupping therapy. Data were downloaded and analyzed using a commercially-available statistics package (SPSS Version 25, IBM, Armonk, NY). Measures of central tendency (means, standard deviations, frequencies) were calculated for all survey items. A Pearson correlation was calculated for the perceived knowledge and actual knowledge items to identify a knowledge gap between what one believes they know and actually what they do know. Finally, an independent samples t-test was used to explore differences on the actual knowledge assessment based on prior education. Significance was set at P \u3c .05 a priori. Results: The majority of certified athletic trainers reported not viewing the use of cupping therapy as necessary to their clinical practice. However, the majority also reported using cupping therapy at least once in the past week when treating patients. Regarding perceived knowledge, the majority of respondents were in the mid-range of agreement/disagreement, indicating at least some level of uncertainty. Average scores on actual knowledge were 8.90±1.34 out of 12 questions. A poor positive relationship was found between perceived and actual knowledge (r = 0.125, P = 0.259). We also identified a poor positive relationship (r = 0.079, P = 0.439) between the actual knowledge assessment score and the likelihood to pursue continuing education item from the perceived knowledge assessment. Conclusions: While the majority of athletic trainers did not view cupping therapy as necessary to their clinical practice, the majority did use the tool in their weekly practice. The relationship between actual knowledge and pursuit of continuing education suggestion that continuing education may improve knowledge of cupping therapy

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

Examining Eating Attitudes and Behaviors in Collegiate Athletes, the Association Between Orthorexia Nervosa and Eating Disorders

Purpose: Orthorexia nervosa (Orthorexia) is an eating attitude and behavior associated with a fixation on healthy eating, while eating disorders (EDs) are clinically diagnosed psychiatric disorders associated with marked disturbances in eating that may cause impairment to psychosocial and physical health. The purpose of this study was to examine risk for Orthorexia and EDs in student-athletes across sex and sport type and determine the association between the two. Methods: Student-athletes (n = 1,090; age: 19.6 ± 1.4 years; females = 756; males = 334) completed a survey including demographics, the ORTO-15 test (values), the Eating Attitudes Test-26 (EAT-26; \u3e20 score), and additional questions about pathogenic behaviors to screen for EDs. Results: Using a ORTO-15, 67.9% were at risk for Orthorexia, a more restrictive threshold value of 17.7% prevalence across student-athletes with significant differences across sex [ \u3c40: \u3eχ2(1,1,090) = 4.914, p= 0.027; \u3c35: \u3eχ2(1,1,090) = 5.923, p = 0.015). Overall, ED risk (EAT-26 and/or pathogenic behavior use) resulted in a 20.9% prevalence, with significant differences across sex (χ2 = 11.360, p \u3c 0.001) and sport-type category (χ2 = 10.312, p = 0.035). Multiple logistic regressions indicated a significant association between EAT-26 subscales scores and Orthorexia, and between Orthorexia positivity, ORTO-15 scores, and risk for EDs. Conclusions: Risk for Orthorexia and ED is present in collegiate student-athletes. While healthy and balanced eating is important, obsessive healthy eating fixations may increase the risk for EDs in athletes. More education and awareness are warranted to minimize the risk for Orthorexia and EDs in student-athletes

The Admissions Criteria for Professional Athletic Training Programs: A 2018 Review of Post-Baccalaureate Degrees

Purpose: Athletic training education has advanced its professional degree to an entry level masters, a decision motivated by professional health education developments over the last 10 years. In respect to Commission on Accreditation of Athletic Training Education (CAATE) accreditation standards as well as evolutionary changes in athletic training education, current prerequisite expectations of entry level applicants are largely dependent upon program. Analysis of the publicly available documents via websites and other programmatic documents of professional athletic training including prerequisite classes, supplemental admissions requirements, length and credits of program, cost of attendance and degree level of core faculty. Methods: 144 professional athletic training programs delivered at the graduate level, regardless of program design, as identified on the CAATE website in November 2018 were eligible for the analysis. Data were collected and recorded into a custom spreadsheet by one researcher regarding program characteristics, admission requirements, costs, and core faculty descriptors. Descriptive analyses were performed. Results: Most of the programs (n=96, 66.7%) were active and in good standing with the CAATE. Admissions requirements vary largely by program with 54.9% (n=142) requiring biology, 69.7% (n=142) requiring chemistry, 65.5% (n=142) requiring physics, 81.0% (n=142) requiring psychology, 99.3% (n=142) requiring anatomy, and 99.3% (n=142) requiring physiology. The average required observation hours were 48+40 with a range of 0 to 200 (n=141). Prerequisite GPA requirements varied from 2.0 to 3.40 with a mean of 2.90+0.23. Conclusion(s): Professional programs are in need of adjustment for admissions requirements to address the 2020 standards related to admissions

Adolescent Perceptions of Injury and Pressures of Returning to Sport: A Retrospective Qualitative Analysis

The increase in sport participation among adolescents has led to the rise in sport-related injuries, many of which have unique characteristics based on the patient, their perceptions, and the pressures faced when returning to sport. The purpose of this study was to identify the underlying factors that contributed to adolescents’ perceptions of injury and the various pressures they experienced when returning to sport. Two themes emerged from the study: support and fear. Support was provided to participants through development, care, and the environment. Fear was the factor that affected the participant in their return to sport, which came in the form of worry and doubt

Health Behaviors of Athletic Trainers

Purpose: Health behaviors, such as diet, tobacco, and physical activity, may serve to prevent disease and promote wellness throughout the population including athletic trainers (AT). Good health behaviors act as disease prevention measures to decrease prevalence of pathologies. Hours of sleep, substance use, nutritional intake, and physical activity are behaviors that may impact the health of athletic trainers (AT). The objective of the study was to describe health behaviors of ATs in comparison to the general population and recommended behaviors. Methods: We used a cross-sectional, web-based survey of clinically practicing ATs recruited from the National Athletic Trainers’ Association member database. A total of 1,229 ATs completed the web-based survey. The survey contained the Healthy Eating Vital Sign (HEVS) Questionnaire with physical activity items and Center for Disease Control Annual Consensus Survey. We calculated statistics of central tendency (means, frequency, and mode) to describe the characteristics of the athletic training population represented by our sample. The main outcome measures were hours of sleep, frequency of alcohol consumption and number of drinks consumed while drinking, weekly consumption of fast food, daily consumption of vegetables, daily servings of caffeine, smoking behavior in the last month, and exercise in the last day and week. Results: We found that the majority of ATs sleep 5-8 hours per night. From the sample, 66.2% of ATs reported eating fast food at least one time per week, while 95.7% ate vegetables at least one time per day. Only 1.9% of ATs reported smoking a cigarette in the last 30 days as compared to the national average of 15.5%. Finally, 50% of ATs performed physical activity on three or more occurrences per week. ATs most frequently report drinking alcohol weekly with an average of three alcohol beverages per sitting. Conclusion(s): Overall, the health of ATs is similar to the general population except ATs consume fast food more frequently and fewer athletic trainers smoke compared to the general population. Despite ATs base knowledge, many ATs do not engage in at the recommended health behaviors and may place themselves at increased risk of poorer health and chronic disease