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Improving the Diagnosis of Menstrual Dysfunction through Quality Improvement. Pediatr Qual Saf 2022; 7:e505. [PMID: 35071948 PMCID: PMC8782115 DOI: 10.1097/pq9.0000000000000505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 08/04/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction: Prevalence of menstrual dysfunction (MD) in high school athletes ranges from 7% to 54%. Early recognition and intervention are crucial to prevent future consequences. The purpose of this Quality Improvement project was to optimize the institution’s Epic Best Practice Advisory (BPA) screening tool and synthesize new patient questionnaires to diagnose MD in athletes greater than 12 years of age presenting to a pediatric sports medicine clinic. Methods: Using Quality Improvement methodology, we evaluated clinic flow, the Epic BPA tool, and actions by the physician following the appropriate triggering of the BPA. Diagnoses targeted were primary amenorrhea, oligomenorrhea, or irregular menstruation unspecified. Areas for intervention were global staff education, patient education, and provider alert fatigue. Our team implemented interventions using monthly Plan-Do-Study-Act cycles to address our key drivers. Proper implementation of questionnaire data and restructuring of the Epic BPA promoted identification and diagnosis of MD. The clinician discussed the diagnosis with the patient and family and provided an educational handout on MD. Results: The rate of appropriate diagnosis of MD in athletes greater than 12 years of age seen at a pediatric sports medicine clinic increased from a baseline of 2.1% to 30% over ten months. Identification of three key drivers ultimately drove the success and achievement of our aim. Conclusions: Using Quality Improvement methodology, we optimized the EPIC BPA and subsequently increased the rate of appropriate diagnosis of MD. Identification of the proper diagnosis improves our patient education. Ultimately, this project provided the framework for applicable discussion, interventions, and work-up for at-risk athletes.
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Goldstein R, Carlson J, Tenforde A, Golden N, Fredericson M. Low-Energy Availability and the Electronic Preparticipation Examination in College Athletes: Is There a Better Way to Screen? Curr Sports Med Rep 2021; 20:489-493. [PMID: 34524193 DOI: 10.1249/jsr.0000000000000880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT The electronic preparticipation physical examination (ePPE) is commonly used to identify health conditions that would affect participation in sports for athletes, including disordered eating and/or low energy availability (EA). A secondary analysis was performed using a cohort study of female college athletes attending a Division 1 university between 2008 and 2014. Descriptive statistics and logistic regression analyses were used to explore the association between responses to questions on the ePPE related to eating behaviors and Female Athlete Triad (Triad). Risk categories (low, moderate, or high) were assigned to 239 athletes participating in 16 sports. The majority of responses on the ePPE did not identify athletes associated with moderate-/high-risk categories. Our findings suggest that ePPE may not sufficiently identify athletes at elevated risk for health concerns of the Triad. Our findings suggest that future ePPE may consider validated screening tools for disordered eating to help identify athletes at risk of low EA.
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Affiliation(s)
- Rachel Goldstein
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Stanford, CA
| | - Jennifer Carlson
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Stanford, CA
| | - Adam Tenforde
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Spaulding National Running Center, Harvard Medical School, Cambridge, MA
| | - Neville Golden
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Stanford, CA
| | - Michael Fredericson
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Stanford University, Stanford, Stanford University, Palo Alto, CA
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Lodge MT, Ackerman KE, Garay J. Knowledge of Triad and RED-S in Female Cross-Country Athletes and Support Staff. J Athl Train 2021; 57:385-392. [PMID: 35439313 PMCID: PMC9020605 DOI: 10.4085/1062-6050-0175.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Female endurance athletes exhibit an increased risk of Female Athlete Triad (Triad) and Relative Energy Deficiency in Sport (RED-S). Triad and RED-S are conditions that explore the health and performance consequences of low energy availability (LEA). Few studies to date have assessed the knowledge that athletes, coaches, and athletic trainers (ATs) have regarding Triad/RED-S. Proper education has been shown to be effective in increasing knowledge of sports medicine concerns for athletes. Yet, there are no known continuing education programs for Triad/RED-S at collegiate institutions. OBJECTIVE The primary purpose of this study was to assess the knowledge, confidence, and impact of identifying, screening, treating, and preventing Triad/RED-S. DESIGN Cross-sectional study. SETTING An evidence-based online survey was developed and administered via QualtricsTM. PARTICIPANTS Female collegiate cross-country athletes (n = 275; 20 ± 1 yrs.), collegiate cross-country coaches (n = 55, 34 ± 9 yrs.), and ATs working with cross-country teams (n = 30, 36 ± 11 yrs.). MAIN OUTCOME MEASURE Knowledge, confidence, and impact scores were assessed between groups using ANOVA. Independent t-tests were used to determine differences in impact scores between people who had or had not received education. RESULTS Female cross-country athletes' total knowledge, confidence, and impact scores (mean scores of 25.00 ± 5.27, 95.42 ± 28.83, 18.81 ± 7.05 respectively) were significantly different from scores of coaches (mean scores of 26.92 ± 5.02, 111.35 ± 24.14 and 22.41 ± 6.33) and ATs (mean scores of 28.66 ± 4.02, 117.67 ± 22.53, and 23.93 ± 5.69) (p < 0.05). CONCLUSIONS Knowledge, confidence, and impact scores of Triad/RED-S were lowest in female cross-country athletes and highest in ATs. These findings support the call for education, which should be regarded as the primary tool to increase knowledge to improve the prevention and treatment of Triad/RED-S.
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National Collegiate Athletic Association Athletic Departments’ Mental Health Screening Practices: Who, What, When, and How. JOURNAL OF CLINICAL SPORT PSYCHOLOGY 2021. [DOI: 10.1123/jcsp.2021-0036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
College student athletes face unique, sport-related stressors that may lead to, or exacerbate, mental health (MH) concerns and symptoms. Although the National Collegiate Athletic Association has identified MH screening as a best practice, minimal data exist regarding contemporary screening practices. We explored National Collegiate Athletic Association Division I (DI), Division II (DII), and Division III (DIII) athletic departments’ current MH screening practices (N = 264). Compared with DII/DIII (53%), a greater percentage of Division I (89%) conducted formal MH screening. At DII/DIII institutions, athletic trainers were more likely to both administer and review screeners than any other sports medicine professional; sport psychologists primarily oversaw these tasks at DI schools. DI, compared with DII/DIII, institutions were more likely to have had a student athlete attempt suicide (62% vs. 40%) and participate in inpatient treatment (69% vs. 43%). There is a clear need for the National Collegiate Athletic Association to continue to promote policies that support MH screening and to create mechanisms in which it can monitor institutional involvement.
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Walsh M, Crowell N, Merenstein D. Exploring Health Demographics of Female Collegiate Rowers. J Athl Train 2020; 55:636-643. [PMID: 32396472 DOI: 10.4085/1062-6050-132-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
CONTEXT Limited information exists about health patterns among female rowers at the collegiate level. Furthermore, the element of weight class (lightweights classified as <130 lb [59 kg]) as a factor in the physical and mental health of female collegiate athletes has not been investigated, despite weight requirements in sport being a risk factor for the female athlete triad. OBJECTIVE To test the hypotheses that (1) components of the female athlete triad were more prevalent in lightweight than in openweight rowers; (2) perceived stress levels were greater in lightweight than in openweight rowers; and (3) rowers who were unable to row due to injury had greater perceived stress levels than uninjured athletes. DESIGN Cross-sectional study. SETTING Twelve collegiate women's rowing programs consisting of 6 National Collegiate Athletic Association Division I openweight and 6 Intercollegiate Rowing Association-level lightweight teams. PATIENTS OR OTHER PARTICIPANTS A total of 158 female collegiate rowers (78 lightweight, 80 openweight). MAIN OUTCOME MEASURE(S) An electronic survey addressing injury history, diet and eating habits and body image (according to the triad screening questionnaire), stress levels (Perceived Stress Scale), and athlete identity (Athlete Identity Measurement Scale) was administered. RESULTS Lightweight rowers reported limiting or carefully controlling foods more frequently than openweight rowers (41.9% to 29.9%, P = .013). A history of an eating disorder was more prevalent among lightweight than openweight rowers (25.7% to 13.0%, P = .048). Prevalences of stress fractures and menstrual irregularities did not differ between weight classes. Lightweight and openweight rowers' scores on the Perceived Stress Scale (16.0 ± 9.9 and 17.3 ± 6.4, respectively) were not different. Injured rowers scored higher on the Perceived Stress Scale (19.4 ± 7.2) than did uninjured rowers (16.6 ± 5.72). CONCLUSIONS Weight class did not contribute to differences in the prevalence of female athlete triad components or perceived stress, although lightweight rowers were more likely to have a history of eating disorder. Injury may be a risk factor for increased stress in this population.
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Foley Davelaar CM, Ostrom M, Schulz J, Trane K, Wolkin A, Granger J. Validation of an Age-Appropriate Screening Tool for Female Athlete Triad and Relative Energy Deficiency in Sport in Young Athletes. Cureus 2020; 12:e8579. [PMID: 32670715 PMCID: PMC7358951 DOI: 10.7759/cureus.8579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background The purpose of this study was to determine the concurrent validity of a newly created relative energy deficiency in sport (RED-S) specific screening tool (RST) by comparing scores with the validated pre-participation gynecological examination (PPGE). We hypothesized that the investigators would observe no significant difference between the means of the RST and the PPGE survey. Methods This was a crossover study of 39 female subjects who completed both the RST and the PPGE. The survey order was randomized. Results The RST was validated compared with the PPGE (Pearson’s r = 0.697, p < 0.001). Conclusion The administration of an RST to middle- and high-school female athletes was validated compared with the PPGE. Formatting limitations of the screening tool were highlighted, leading to changes that improved the accuracy of the screening tool prior to application in a clinical setting. The RST is an age-appropriate screening tool that can be used by coaches, athletic trainers, physical therapists, and other healthcare practitioners to detect RED-S risk and allow for earlier intervention.
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Affiliation(s)
| | - Megan Ostrom
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, USA
| | - Justine Schulz
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, USA
| | - Katelyn Trane
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, USA
| | - Amy Wolkin
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, USA
| | - Julie Granger
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, USA
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Kroshus E, DeFreese JD, Kerr ZY. Collegiate Athletic Trainers' Knowledge of the Female Athlete Triad and Relative Energy Deficiency in Sport. J Athl Train 2017; 53:51-59. [PMID: 29251536 DOI: 10.4085/1062-6050-52.11.29] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
CONTEXT The female athlete triad (Triad) and relative energy deficiency in sport (RED-S) specify the consequences of energy imbalance. Athletic trainers (ATs) are positioned to identify athletes who are fueling themselves inadequately and experiencing related health and performance consequences. OBJECTIVE To assess the knowledge of collegiate ATs about the Triad and RED-S and to examine variability in related screening and referral behaviors among National Collegiate Athletic Association divisions. DESIGN Cross-sectional study. SETTING Collegiate athletic training departments. PATIENTS OR OTHER PARTICIPANTS Head ATs at National Collegiate Athletic Association member institutions (n = 285, response rate = 33%). MAIN OUTCOME MEASURE(S) An electronic survey was administered. The number of Triad components that were correctly identified and screening and referral behaviors related to Triad components were measured. RESULTS Nearly all respondents (98.61% [n = 281]) had heard of the Triad; a smaller proportion (32.98% [n = 94]) had heard of RED-S. On average, respondents correctly identified 2 components of the Triad. We observed differences by sex, with women correctly identifying more components than men ( U = 12.426, P = .003). More than half (59.93% [n = 163]) indicated that athletes at their institutions were screened for eating disorders. Nearly three-quarters (70.55% [n = 115]) of respondents indicated that all female athletes at their institutions were screened annually for menstrual dysfunction. More comprehensive referral behaviors for athletes identified as experiencing menstrual dysfunction or a bone injury (eg, athlete referred to a nutritionist, dietitian, or counselor) occurred at Division I institutions than at Division II and III institutions. CONCLUSIONS Continuing education for ATs about the Triad and RED-S may encourage a more comprehensive approach to referral and screening after a diagnosis of menstrual dysfunction or bone-stress injury. Using institutional opportunities, such as preparticipation screening, for identifying components of the Triad or RED-S and specifying protocols for referring athletes who screen positive for 1 of these components should also be explored.
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Affiliation(s)
- Emily Kroshus
- Department of Pediatrics, University of Washington, Seattle.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, WA
| | - J D DeFreese
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
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Rizzone KH, Ackerman KE, Roos KG, Dompier TP, Kerr ZY. The Epidemiology of Stress Fractures in Collegiate Student-Athletes, 2004-2005 Through 2013-2014 Academic Years. J Athl Train 2017; 52:966-975. [PMID: 28937802 DOI: 10.4085/1062-6050-52.8.01] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Stress fractures are injuries caused by cumulative, repetitive stress that leads to abnormal bone remodeling. Specific populations, including female athletes and endurance athletes, are at higher risk than the general athletic population. Whereas more than 460 000 individuals participate in collegiate athletics in the United States, no large study has been conducted to determine the incidence of stress fractures in collegiate athletes. OBJECTIVE To assess the incidence of stress fractures in National Collegiate Athletic Association (NCAA) athletes and investigate rates and patterns overall and by sport. DESIGN Descriptive epidemiology study. SETTING National Collegiate Athletic Association institutions. PATIENTS OR OTHER PARTICIPANTS National Collegiate Athletic Association athletes. MAIN OUTCOME MEASURE(S) Data were analyzed from the NCAA Injury Surveillance Program for the academic years 2004-2005 through 2013-2014. We calculated rates and rate ratios (RRs) with 95% confidence intervals (CIs). RESULTS A total of 671 stress fractures were reported over 11 778 145 athlete-exposures (AEs) for an overall injury rate of 5.70 per 100 000 AEs. The sports with the highest rates of stress fractures were women's cross-country ( 28.59/100 000 AEs), women's gymnastics ( 25.58/100 000 AEs), and women's outdoor track ( 22.26/100 000 AEs). Among sex-comparable sports (baseball/softball, basketball, cross-country, ice hockey, lacrosse, soccer, swimming and diving, tennis, indoor track, and outdoor track), stress fracture rates were higher in women (9.13/100 000 AEs) than in men (4.44/100 000 AEs; RR = 2.06; 95% CI = 1.71, 2.47). Overall, stress fracture rates for these NCAA athletes were higher in the preseason (7.30/100 000 AEs) than in the regular season (5.12/100 000 AEs; RR = 1.43; 95% CI = 1.22, 1.67). The metatarsals (n = 254, 37.9%), tibia (n = 147, 21.9%), and lower back/lumbar spine/pelvis (n = 81, 12.1%) were the most common locations of injury. Overall, 21.5% (n = 144) of stress fractures were recurrent injuries, and 20.7% (n = 139) were season-ending injuries. CONCLUSIONS Women experienced stress fractures at higher rates than men, more often in the preseason, and predominantly in the foot and lower leg. Researchers should continue to investigate biological and biomechanical risk factors for these injuries as well as prevention interventions.
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Affiliation(s)
- Katherine H Rizzone
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, NY
| | | | - Karen G Roos
- Department of Kinesiology, California State University, Long Beach
| | - Thomas P Dompier
- Department of Athletic Training, Lebanon Valley College, Annville, PA
| | - Zachary Y Kerr
- Datalys Center for Sports Injury Research and Prevention, Inc, Indianapolis, IN
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Abstract
Exertional leg pain is a common condition seen in runners and the general population. Given the broad differential diagnosis of this complaint, this article focuses on the incidence, anatomy, pathophysiology, clinical presentation, diagnostic evaluation, and management of common causes that include medial tibial stress syndrome, tibial bone stress injury, chronic exertional compartment syndrome, arterial endofibrosis, popliteal artery entrapment syndrome, and entrapment of the common peroneal, superficial peroneal, and saphenous nerves. Successful diagnosis of these conditions hinges on performing a thorough history and physical examination followed by proper diagnostic testing and appropriate management.
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Affiliation(s)
- Sathish Rajasekaran
- Department of Orthopaedics and Rehabilitation, University of Iowa Sports Medicine, 2701 Prairie Meadow Drive, Iowa City, IA 52242, USA; Division of Physical Medicine and Rehabilitation, University of Alberta, 10230 111 Avenue Northwest, Edmonton, AB T5G 0B7, Canada.
| | - Jonathan T Finnoff
- Department of Physical Medicine and Rehabilitation, Mayo Clinic School of Medicine, 200 1st St SW, Rochester, MN 55905, USA; Department of Physical Medicine and Rehabilitation, University of California Davis School of Medicine, 4860 Y Street, Sacramento, CA 95817, USA; Mayo Clinic Sports Medicine Center, Mayo Clinic Square, 600 Hennepin Avenue, Suite 310, Minneapolis, MN 55403, USA
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Kroshus E. Variability in Institutional Screening Practices Related to Collegiate Student-Athlete Mental Health. J Athl Train 2016; 51:389-97. [PMID: 27111587 DOI: 10.4085/1062-6050-51.5.07] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Universal screening for mental health concerns, as part of the preparticipation examination in collegiate sports medicine settings, can be an important and feasible strategy for facilitating early detection of mental health disorders. OBJECTIVE To assess whether sports medicine departments at National Collegiate Athletic Association (NCAA) member colleges have policies related to identifying student-athlete mental health problems, the nature of preparticipation examination screening related to mental health, and whether other departmental or institutional screening initiatives are in place. I also aimed to characterize the variability in screening by institutional characteristics. DESIGN Cross-sectional study. SETTING College sports medicine departments. PATIENTS OR OTHER PARTICIPANTS Team physicians and head athletic trainers at NCAA member colleges (n = 365, 30.3% response rate). MAIN OUTCOME MEASURE(S) Electronic survey of departmental mental health screening activities. RESULTS A total of 39% of respondents indicated that their institution had a written plan related to identifying student-athletes with mental health concerns. Fewer than half reported that their sports medicine department administers a written or verbal screening instrument for symptoms of disordered eating (44.5%), depression (32.3%), or anxiety (30.7%). The strongest predictors of mental health screening were the presence of a written plan related to identifying student-athlete mental health concerns and the employment of a clinical psychologist. Additionally, Division I institutions and institutions with a greater ratio of athletic trainers to student-athletes tended to engage in more screening. CONCLUSIONS The substantial among-institutions variability in mental health screening suggests that opportunities exist to make these practices more widespread. To address this variability, recent NCAA mental health best-practice guidelines suggested that institutions should screen for a range of mental health disorders and risk behaviors. However, at some institutions, staffing deficits may need to be addressed to allow for implementation of screening-related activities.
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Affiliation(s)
- Emily Kroshus
- Department of Pediatrics, University of Washington; Seattle Children's Research Institute, Center for Child Health, Behavior, and Development
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Curry EJ, Logan C, Ackerman K, McInnis KC, Matzkin EG. Female Athlete Triad Awareness Among Multispecialty Physicians. SPORTS MEDICINE-OPEN 2015; 1:38. [PMID: 26587370 PMCID: PMC4642583 DOI: 10.1186/s40798-015-0037-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 09/11/2015] [Indexed: 12/31/2022]
Abstract
Background The female athlete triad (Triad) is a serious condition with lifelong consequences seen in physically active females. Prior studies assessing Triad knowledge among coaches/athletic trainers reported surprisingly low awareness results. Our aims were to (1) determine the percentage of physicians across multiple specialties who had heard of the phrase “female athlete triad” and (2) determine the percentage who can properly diagnose or have a high comfort level appropriately referring these patients. Methods Via electronic survey, we recruited medical staff, residents, and fellows at three large academic institutions across specialties to answer an eight-item test on Triad awareness and knowledge. Results A total of 931 physician participants were recorded. Of the total responders (40 % male and 60 % female), 23 % were residents, 12 % were fellows, and 65 % were attending physicians. Overall, 37 % had heard of the Triad. Of these respondents, an average of 2.1 ± 1.1 of the three components were properly identified with an overall average score on the Triad awareness test of 71 ± 18 % out of a possible 100 %. Fifty-one percent reported feeling either comfortable treating or referring a patient with the Triad. When assessing awareness among specialties, the awareness rates were highest among orthopedic surgery (80 %), followed by obstetrics and gynecology (55 %) and physical medicine and rehabilitation/rheumatology (52 %). The three with the lowest awareness were anesthesia (9 %), radiology (10 %), and psychiatry (11 %). Conclusions Our findings suggest that approximately one third of the physicians surveyed have heard of the Triad. Approximately one half of physicians were comfortable treating or referring a patient with the Triad. Increased awareness through education to properly identify and manage the Triad is essential for all physicians.
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Affiliation(s)
- Emily J Curry
- Women's Sports Medicine, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA USA
| | - Catherine Logan
- Women's Sports Medicine, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA USA
| | - Kathryn Ackerman
- Division of Sports Medicine, Boston Children's Hospital, Boston, MA USA
| | - Kelly C McInnis
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA USA
| | - Elizabeth G Matzkin
- Women's Sports Medicine, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA USA ; Harvard Medical School, Boston, MA 02115 USA
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Burrus MT, Werner BC, Starman JS, Gwathmey FW, Carson EW, Wilder RP, Diduch DR. Chronic leg pain in athletes. Am J Sports Med 2015; 43:1538-47. [PMID: 25157051 DOI: 10.1177/0363546514545859] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Chronic leg pain is commonly treated by orthopaedic surgeons who take care of athletes. The sources are varied and include the more commonly encountered medial tibial stress syndrome, chronic exertional compartment syndrome, stress fracture, popliteal artery entrapment syndrome, nerve entrapment, Achilles tightness, deep vein thrombosis, and complex regional pain syndrome. Owing to overlapping physical examination findings, an assortment of imaging and other diagnostic modalities are employed to distinguish among the diagnoses to guide the appropriate management. Although most of these chronic problems are treated nonsurgically, some patients require operative intervention. For each condition listed above, the pathophysiology, diagnosis, management option, and outcomes are discussed in turn.
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Affiliation(s)
- M Tyrrell Burrus
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jim S Starman
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - F Winston Gwathmey
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Eric W Carson
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Robert P Wilder
- Physical Medicine and Rehabilitation Department, University of Virginia Health System, Charlottesville, Virginia, USA
| | - David R Diduch
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
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Reider B. Another annual autumn epidemic. Am J Sports Med 2015; 43:23-5. [PMID: 25552673 DOI: 10.1177/0363546514564935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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The Prevalence of and Attitudes Toward Oligomenorrhea and Amenorrhea in Division I Female Athletes. INTERNATIONAL JOURNAL OF ATHLETIC THERAPY & TRAINING 2014. [DOI: 10.1123/ijatt.2014-0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Brown KN, Wengreen HJ, Beals KA. Knowledge of the female athlete triad, and prevalence of triad risk factors among female high school athletes and their coaches. J Pediatr Adolesc Gynecol 2014; 27:278-82. [PMID: 25023979 DOI: 10.1016/j.jpag.2013.11.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 11/11/2013] [Accepted: 11/14/2013] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE This study aimed to determine awareness/knowledge of the Triad and its health implications among female high school athletes and their coaches, and to evaluate coaches' Triad screening/intervention practices. DESIGN Cross-sectional survey. SETTING Two high schools in the western United States. PARTICIPANTS Female athletes from a variety of sports (N = 240) ages 14-18 years and their coaches (N = 10). INTERVENTION Participants completed surveys that assessed Triad knowledge and athlete Triad risk factors. MAIN OUTCOME MEASURES Frequency of responses to Triad knowledge, Triad risk factor, and Triad education/screening procedures questions; athlete summative knowledge score. RESULTS Half (N = 120) of participants reported menstrual irregularity, and 42% (N = 101) had 2 or more Triad risk factors: past amenorrhea (N = 39), past stress fracture (N = 41), self-reported not eating enough (N = 53), underweight (BMI-for-age < 5(th) percentile) (N = 10), pressure to be a certain weight (N = 143), and wanting to lose >10 pounds when self-reported weight was in a healthy range (N = 34). Average athlete Triad knowledge score was 2.97 ± 1.61 out of 8. Coach Triad knowledge was limited; however, most (9/10) were comfortable discussing menstruation with their athletes. Barriers to Triad screening/education were coaches' insufficient time, knowledge, and educational resources. CONCLUSION Triad risk factors were prevalent among athletes and coach and athlete Triad knowledge was low. Providing coaches with Triad screening/education training may increase Triad knowledge and decrease Triad risk among high school athletes.
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Affiliation(s)
- Katie N Brown
- College of Agriculture, Department of Nutrition, Dietetics, and Food Sciences, Utah State University, Logan, Utah
| | - Heidi J Wengreen
- College of Agriculture, Department of Nutrition, Dietetics, and Food Sciences, Utah State University, Logan, Utah.
| | - Katherine A Beals
- College of Health, Department of Nutrition, University of Utah, Salt Lake City, Utah
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Mountjoy M, Sundgot-Borgen J, Burke L, Carter S, Constantini N, Lebrun C, Meyer N, Sherman R, Steffen K, Budgett R, Ljungqvist A. The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S). Br J Sports Med 2014; 48:491-7. [DOI: 10.1136/bjsports-2014-093502] [Citation(s) in RCA: 720] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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De Souza MJ, Nattiv A, Joy E, Misra M, Williams NI, Mallinson RJ, Gibbs JC, Olmsted M, Goolsby M, Matheson G. 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad: 1st International Conference held in San Francisco, California, May 2012 and 2nd International Conference held in Indianapolis, Indiana, May 2013. Br J Sports Med 2014; 48:289. [DOI: 10.1136/bjsports-2013-093218] [Citation(s) in RCA: 327] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Javed A, Tebben PJ, Fischer PR, Lteif AN. Female athlete triad and its components: toward improved screening and management. Mayo Clin Proc 2013; 88:996-1009. [PMID: 24001492 DOI: 10.1016/j.mayocp.2013.07.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 06/25/2013] [Accepted: 07/02/2013] [Indexed: 11/30/2022]
Abstract
As female athletic participation has increased, the positive effects of exercise on health have become evident. However, with this growth in sports activity, a set of health problems unique to the female athlete has emerged. The female athlete triad as first described in 1992 by the American College of Sports Medicine consisted of disordered eating, amenorrhea, and osteoporosis; the definition was updated in 2007 to include a spectrum of dysfunction related to energy availability, menstrual function, and bone mineral density. For this review, a comprehensive search of databases-MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Scopus, from earliest inclusive dates to January 2013-was conducted by an experienced librarian with input from the authors. Controlled vocabulary supplemented with keywords such as female athlete triad, amenorrhea, oligomenorrhea, fracture, osteopenia, osteoporosis, bone disease, anorexia, bulimia, disordered eating, low energy availability was used to search for articles on female athlete triad. Articles addressing the prevalence, screening, and management of the female athlete triad were selected for inclusion in the review. This article reviews the current definitions of the triad components, epidemiology, pathophysiology, and recommended screening and management guidelines. The lack of efficacy of current screening of athletes is highlighted. Low energy availablity, from either dietary restriction or increased expenditure, plays a pivotal role in development of the triad. Athletes involved in "lean sports" (those that emphasize weight categories or aesthetics, such as ballet, gymnastics, or endurance running) are at highest risk. Treatment is centered on restoring energy availability to reverse adverse changes in the metabolic milieu. Prevention and early recognition of triad disorders are crucial to ensure timely intervention. Caregivers and physicians of female athletes must remain vigilant in education, recognition, and treatment of athletes at risk.
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Affiliation(s)
- Asma Javed
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Endocrinology, Mayo Clinic, Rochester MN, USA.
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Chen YT, Tenforde AS, Fredericson M. Update on stress fractures in female athletes: epidemiology, treatment, and prevention. Curr Rev Musculoskelet Med 2013; 6:173-81. [PMID: 23536179 PMCID: PMC3702771 DOI: 10.1007/s12178-013-9167-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Stress fractures are a common type of overuse injury in athletes. Females have unique risk factors such as the female athlete triad that contribute to stress fracture injuries. We review the current literature on risk factors for stress fractures, including the role of sports participation and nutrition factors. Discussion of the management of stress fractures is focused on radiographic criteria and anatomic location and how these contribute to return to play guidelines. We outline the current recommendations for evaluating and treatment of female athlete triad. Technologies that may aid in recovery from a stress fracture including use of anti-gravity treadmills are discussed. Prevention strategies may include early screening of female athlete triad, promoting early participation in activities that improve bone health, nutritional strategies, gait modification, and orthotics.
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Affiliation(s)
- Yin-Ting Chen
- Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Stanford University, 450 Broadway Street, Pavilion A, 2nd Floor MC 6120, Redwood City, CA 94063 USA
| | - Adam S. Tenforde
- Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Stanford University, 450 Broadway Street, Pavilion A, 2nd Floor MC 6120, Redwood City, CA 94063 USA
| | - Michael Fredericson
- Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Stanford University, 450 Broadway Street, Pavilion A, 2nd Floor MC 6120, Redwood City, CA 94063 USA
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Abstract
Updated prevalence estimates of all 3 components of the Female Athlete Triad, a syndrome characterized by low energy availability, functional hypothalamic amenorrhea, and osteoporosis, is low (0 %-16 %), however, estimates of 1 or 2 concurrent components approach 50 %-60 % among certain athlete groups. Recent research identifies components of the Triad among female adolescent athletes, particularly those participating in leanness sports, such as endurance running. This is alarming, as adolescents require adequate nutrition and normal hormone function to optimize bone mineral gains during this critical developmental period. Current literature highlights new assessments, such as measurements of bone microarchitecture and hormone levels to better evaluate bone strength and the hormonal and metabolic profile of athletes with and at risk for the Triad. Recent data also provides support for additional potential consequences of the Triad, such as endothelial dysfunction and related cardiovascular effects, stress fractures, and musculoskeletal injuries. Additional prospective research is needed to evaluate long-term indicators and consequences of the Triad and identify effective behavioral treatment strategies.
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Affiliation(s)
- Michelle T Barrack
- Department of Family and Consumer Sciences, California State University, 18111 Nordhoff St, Northridge, CA, 91330-8308, USA,
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Abstract
The passage of Title IX in 1972 resulted in a tremendous increase in the number of females participating in high school and collegiate athletics. This rise in female athletes sparked new focus areas of research in sports medicine related to woman with an important area emerging in 1980, the female athlete triad. This triad consisting of low energy availability, menstrual irregularities, and bone health disruption spans a spectrum of severity and has evolved both in diagnosis and in management throughout the years. Many health questions arise for female athletes and their health care providers, often concerning the most effective management and treatment strategies for this triad. This review examines the research and latest advancements in recognizing and understanding the female athlete triad and explores the most current recommendations for treatment and prevention.
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