Collegiate Athletic Trainers' Experiences With External Pressures Faced During Decision Making

Collaborative Mental Health Care in Collegiate Athletics: Behavioral Health Providers' Perceived Role of the Athletic Trainer

CONTEXT

Developing effective interprofessional teams is vital to achieving quality care for those dealing with behavioral health concerns. Athletic trainers (ATs) play a vital role, as they are often the first health care providers to interact with student-athletes participating in intercollegiate athletics. However, research regarding how behavioral health providers view the AT's role on interprofessional behavioral health teams is limited.

OBJECTIVE

To explore behavioral health providers' perceived role of ATs in collaborative behavioral health care.

DESIGN

Qualitative study.

SETTING

Individual interviews.

PATIENTS OR OTHER PARTICIPANTS

Nine behavioral health care providers (women = 6, men = 3; age range = 30-59 years, years in clinical practice = 6-25) from National Collegiate Athletic Association Power 5 schools were interviewed.

DATA COLLECTION AND ANALYSIS

Participants were contacted via publicly available information on their university websites. Participants engaged in individual, audio-only interviews using a commercially available teleconferencing platform. All interviews were recorded, transcribed, and returned to participants for member checking. A phenomenological approach with inductive coding and multianalyst triangulation was performed to analyze the transcripts for common themes and subthemes.

RESULTS

CONCLUSIONS

Collaborative care models can enhance providers' abilities and maximize support of student-athlete wellness. In this study, we demonstrated that behavioral health providers working within a collaborative care model with ATs had overall positive experiences with such collaboration and that clear role delineation and responsibilities helped to foster high-quality patient care.

National Collegiate Athletic Association athletic trainers' response to the Arrington settlement: management, compliance, and practice patterns

The primary purpose of this study was to assess Athletic Trainers' (ATs) report of NCAA member institution compliance with the Arrington settlement, the concussion lawsuit vs. the NCAA, and to elucidate compliance predictors. A secondary purpose was to provide a contemporary concussion management clinical practice pattern description among NCAA collegiate athletic trainers. Head Athletic Trainers from NCAA Division I, II, and III completed an electronic questionnaire in August 2020 regarding their institution's response to the Arrington Settlement and their current concussion management clinical practice patterns. The 37-item questionnaire included AT and institution demographics, current concussion management policies, and response to the Arrington settlement with a specific focus on the five settlement requirements. An overall compliance score on the five requirements, compliance on the individual requirements, and concussion management practices are reported with descriptives. Regression was used to identify specific predictors of both overall and individual settlement requirements. An ANOVA compared compliance by NCAA division level. Being pressured to be non-compliant was assessed between sexes by a chi-square. There were 223 respondents (21.8%), and overall compliance was high (4.1 ± 0.7) with the five required Arrington Settlement components. Settlement requirement 1, pre-season baseline testing, and requirement 5, presence of trained personnel at all contact sport practices, had the lowest compliance rates at 44.8% and 73.3%, respectively. The number of sports the institution offered was the only significant predictor of each requirement. There was no difference in compliance between NCAA divisions. Although the overall rate of being non-compliant pressure was low (13.8%), females were 3.28x more likely report being pressured than males. NCAA institutions are generally compliant with the Arrington settlement; however, lack of clarity in the requirements, particularly requirement 1, raises potential concerns. Concussion management practices continue to incorporate multifaceted approaches and are largely consistent with current best practices.

Time-loss and recurrence of lateral ligament ankle sprains in male elite football: A systematic review and meta-analysis

A literature search was conducted to systematically review and meta-analyze time-loss and recurrence rate of lateral ankle sprains (LAS) in male professional football players. Six electronic databases (PubMed, Scopus, Web of Science, PEDRO, CINAHL, and Cochrane) were searched independently, separately both for time-loss and recurrence from inception until April 30, 2021. In addition, reference lists were screened manually to find additional literature. Cohort studies, case reports, case-control studies and RCT in English language of male professional football players (aged more than 16 years) for which data on time-loss or recurrence rates of LAS were available were included. A total of 13 (recurrence) and 12 (time-loss) studies met the inclusion criteria. The total sample size of the recurrence studies was 36,201 participants (44,404 overall initial injuries; 7944 initial ankle sprain [AS] injuries, 1193 recurrent AS injuries). 16,442 professional football players (4893 initial AS injuries; 748 recurrent AS injuries) were meta-analyzed. A recurrence rate of 17.11% (95% CI: 13.31-20.92%; df = 12; Q = 19.53; I² = 38.57%) based on the random-effects model was determined. A total of 7736 participants were part of the time-loss studies (35,888 total injuries; 4848 total ankle injuries; 3370 AS injuries). Out of the 7736 participants, 7337 participants met the inclusion criteria with a total of 3346 AS injuries. The average time-loss was 15 days (weighted mean: 15.92; median: 14.95; min: 9.55; max: 52.9). We determined a priori considerable heterogeneity (CI: 18.15-22.08; df = 11; Q = 158; I² = 93%), so that the data on time-loss are only presented descriptively. There is an average time-loss of 15 days per LAS and a recurrence rate of 17%. LAS is one of the most common types of injury with higher recurrence rates than ACL injuries (9%-12%) in professional football players. Nevertheless, the focus of research in recent years has been mostly on ACL injuries. However, the high recurrence rates and long-term consequences show the necessity for research in the field of LAS in elite football. Yet, heterogeneous data lead to difficulties concerning the aspect of comparability.

Lessons Learned and Potential Long-Term Effects on Athletic Trainers and Clinical Practice After a Global Pandemic

CONTEXT

Perceived stress and burnout are significant concerns among athletic trainers (ATs) due to growing professional demands. The global COVID-19 pandemic brought additional stressors, especially for health care providers, including the need to learn and integrate new skill sets in order to continue providing safe and effective patient care.

OBJECTIVE

To explore the influence of COVID-19 stressors on ATs engaged in patient care.

DESIGN

Cross-sectional study.

SETTING

Internet survey.

PATIENTS OR OTHER PARTICIPANTS

A total of 429 ATs (age = 33 ± 9 years; experience = 11 ± 9 years; 74 men, 355 women) currently providing patient care.

MAIN OUTCOME MEASURE(S)

We recruited participants from social media sites to complete a questionnaire with the Coronavirus Anxiety Scale (CAS), Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS MP), and qualitative questions related to the effects of COVID-19. We calculated correlations between CAS and MBI-HSS MP composite scores (emotional exhaustion, personal accomplishment, and depersonalization) and used regression analysis to explore if CAS scores could be predicted by vaccination status (vaccinated or unvaccinated), sex, and MBI-HSS MP composite scores. We analyzed the qualitative data using a phenomenological, inductive approach with multianalyst triangulation and peer review as trustworthiness strategies.

RESULTS

Significant correlations existed between CAS and MBI-HSS MP composite scores (P < .001). Emotional exhaustion (P < .001) and depersonalization (P = .008) explained 28% of the variance in CAS scores (F2,405 = 81.29, P < .001). Three major areas of focus emerged: effects on wellness, emphasis on the value of athletic training, and the lessons learned and future innovation to inform potential long-term changes in the athletic training profession.

CONCLUSIONS

Key factors of emotional exhaustion and depersonalization during the pandemic may have exacerbated the potential for burnout among ATs. The pandemic affected ATs' wellness, changed perceptions of ATs, and altered operating procedures. Healthy coping strategies and organizational support are suggested for those who are struggling.