Athletic Trainers' Beliefs About and Implementation of Evidence-Based Practice

Improving Concussion Education: Do Athletic Trainers' Opinions Match Expert Consensus?

CONTEXT

The National Collegiate Athletic Association and Department of Defense (NCAA-DoD) Mind Matters Challenge created "useful and feasible" consensus recommendations to improve concussion care-seeking behavior in collegiate athletes and military cadets. Given athletic trainers' (ATs') role as providers of concussion education and medical care, it is important to understand if they agree with the expert panel that the recommendations are useful and feasible.

OBJECTIVE

To describe and compare the perceptions of ATs in the secondary school (SS) and collegiate settings of the utility and feasibility of the NCAA-DoD Mind Matters Challenge recommendations on improving concussion education.

DESIGN

Cross-sectional study.

SETTING

Electronic survey.

PATIENTS OR OTHER PARTICIPANTS

Five hundred fifteen (515) ATs (age = 40.7 ± 12.4 years, 53.1% female gender) practicing in the SS (60.6%) or collegiate (38.4%) setting.

MAIN OUTCOME MEASURE(S)

An online survey asked participants about their awareness of the statement followed by 17 pairs of Likert-item questions regarding each recommendation's utility and feasibility with responses ranging from no (1) to yes (9). Mimicking the consensus process, we defined consensus as a mean rating of ≥7.00. We compared utility and feasibility rating responses between SS and collegiate setting participants using Mann-Whitney U tests with α = .05.

RESULTS

Two-thirds (66.6%) of participants were unaware of the consensus statement. Participants felt all recommendations were useful (all means ≥ 7.0); however, 4 recommendations related to collaborating with stakeholders did not meet the feasibility cutoff (mean range = 6.66-6.84). Secondary school ATs rated lower feasibility related to educational content (P value range = .001-.014), providing patient education throughout recovery (P = .002), and promoting peer intervention (P = .019) but higher utility (P = .007) and feasibility (P = .002) for providing parent education than collegiate ATs.

CONCLUSIONS

The NCAA-DoD Mind Matters Challenge recommendations require further dissemination. Athletic trainers rated collaboration with stakeholders as a feasibility barrier. Secondary school ATs require more resources for educational content, messaging, and promoting peer intervention but find educating athletes' parents more useful and feasible than collegiate ATs.

Assessing Evidence-Based Practice Knowledge, Self-Efficacy, and Use Among Respiratory Therapists

BACKGROUND

Evidence-based practice is at the forefront of providing quality patient care by using the best available evidence and clinical expertise, while also considering patient needs and preferences for clinical decisions. However, evidence-based practice may not be consistently used even when the evidence supports the therapy. The purpose of this study was to assess the factors associated with the use of evidence-based practice among respiratory therapy faculty teaching in a large community college system and post-professional students enrolled in a university-based, respiratory therapy baccalaureate degree-advancement program.

METHODS

A non-probability, descriptive survey research design was used to develop and administer an online questionnaire.

RESULTS

All respondents demonstrated sufficient knowledge and understanding of introductory concepts of evidence-based practice but knowledge of specific components of the evidence-based practice process was not as strong. Self-efficacy in knowledge and the use of evidence-based practice among faculty and degree-advancement students varied. Faculty and students rated their self-efficacy high in assessing patients' needs, values, and treatment preferences but ratings were lower for using the PICO (patient/population/problem, intervention, comparison, outcome) technique and interpreting common statistical tests. Students viewed their previous evidence-based practice learning experiences more favorably compared with faculty (P = .008). Faculty and students searched and read the research literature more often compared with critically appraising and using the research literature. Logistic regression analysis indicated no statistically significant relationship of knowledge, self-efficacy, and learning experiences to the use of evidence-based practice among respiratory therapy students, Χ 2 (4, N = 54) = 7.73; P = .10.

CONCLUSIONS

Analysis of the results suggested that respiratory therapy faculty and students were knowledgeable and confident with regard to evidence-based practice but their use of evidence-based practice in clinical decisions was limited. Although the evidence-based practice knowledge, self-efficacy, and learning experiences had minimal influence on the use of evidence-based practice, the results of the study provide a foundation for future research.

Athletic Trainer and Emergency Medical Technician or Paramedic Opinions of Each Other's Understanding of Essential Emergent Football Injury Situation Tasks

OBJECTIVE

Improving the role understanding between essential emergency healthcare providers may improve teamwork and efficacy. This study asked licensed athletic trainers (ATs) and emergency medical technicians (EMTs) or paramedics for their opinions of the others' understanding of essential tasks in an emergent football injury situation. The hypothesis was that groups would have differing opinions.

METHODS

An electronic survey was emailed to 160 licensed EMTs or paramedics and 45 licensed ATs. All participants were full-time employees with ≥1 year experience at their current position. In addition to demographic questions (age, sex, experience), respondents completed 11, 5-point Likert-scale type questions (end range: "strongly agree" or "strongly disagree") regarding their opinion of the other profession's understanding of essential tasks in an emergent football injury situation. Participants also answered questions about the amount of control of the injury situation they assumed upon scene arrival and how frequently they partnered with the other profession when covering a game. An α level of P ≤ 0.05 was selected to indicate statistical significance.

RESULTS

Thirty-four EMTs or paramedics (21% return) and 12 ATs (26.7% return) responded. Group demographics did not differ with the exception of the EMT or paramedic group having more men ( P = 0.006). Emergency medical technicians/paramedics perceived that ATs better understood facemask removal timing ( P = 0.002), facemask removal technique ( P = 0.04), and extremity splinting ( P = 0.02). Athletic trainers perceived that EMTs/paramedics better understood proper airway management ( P < 0.001) and cardiopulmonary resuscitation ( P < 0.001). EMT/paramedics more strongly perceived control of the injury situation upon scene arrival than ATs ( P = 0.005). As AT experience increased, they more strongly agreed that they frequently partnered with EMTs/paramedics ( r = 0.84, P < 0.001); however, an insignificant relationship was observed for EMTs/paramedics.

CONCLUSIONS

Opinions differed about the other profession's understanding of essential tasks. More experienced ATs partnered more strongly with EMTs/paramedics. Both professional groups would benefit from collaborative workshops or seminars to improve the teamwork needed to optimize an emergent football injury situation. The development and implementation of practices such as these may also improve teamwork and patient-center healthcare at mass participant sporting events such as marathons, triathlons, and road cycling events.

Tibiofemoral Dislocation Management in a Rural High School Football Scenario: Development of a Popliteal Artery Injury Suspicion Index

OBJECTIVE

This study evaluated the knowledge and preparedness of athletic trainers (ATs) for diagnosing and managing an anterior tibiofemoral knee dislocation in a rural or limited-resource high school football setting scenario. The study hypothesis was that more experienced ATs would display greater preparedness than less experienced ATs. A secondary objective was to develop evidence-based guidelines to help the AT provide better emergency triage care.

METHODS

This prospective cross-sectional study distributed a rural high school football game scenario survey electronically to a random sample of 2000 certified ATs to determine their perceptions of readiness to diagnose and manage an anterior tibiofemoral knee dislocation with signs or symptoms of possible popliteal artery injury.

RESULTS

A total of 249 surveys (12.5%) were completed. Years of athletic training experience were ≤5 years (n = 82, group 1) and ≥6 years (n = 167, group 2). Both groups perceived that they could not "rule out" an arterial injury and had similar "red flag" sign and symptom rankings. Group 2 perceived a more serious situation than group 1 (77.5 ± 15 vs 70.8 ± 14, P < 0.0001) and were more likely to activate the emergency action plan (74.5 ± 25 vs 64.4 ± 26, P = 0.005). Both groups were "neutral" about their ability to diagnose the condition or manage the case, had poor ankle-brachial index test familiarity, and agreed that evidence-based guidance was needed.

CONCLUSIONS

More experienced ATs perceived a more serious situation than less experienced ATs and were more likely to activate the emergency action plan. Both groups were neutral about their ability to diagnose the condition or manage the case, had poor ankle-brachial index test familiarity, and agreed that they would benefit from evidence-based guidance. Proposed guidelines provide the AT with a more measured, evidence-based index of suspicion for potential popliteal artery injury in anterior tibiofemoral dislocation cases. This will complement existing hospital emergency department-based management algorithms, decreasing the likelihood of this condition progressing to limb loss or death.

The Relationship of Evidence-Based Nursing Attitudes of Nurses Working in Surgical Wards With Patient-Centered Care Competencies

PURPOSE

The aim of this study was to determine the relationship between the evidence-based nursing attitudes of nurses working in surgical wards and their patient-centered care competencies.

DESIGN

This was a prospective, correlational, and cross-sectional study.

METHODS

The sample for this study included 209 surgical nurses working in the surgical clinics of a research hospital. Data were collected between March and July 2020 using the Nurses' Descriptive Characteristics form, Evidence-Based Attitude Toward Nursing Scale (EATNS) and the patient-centered care competency of the nurses, Patient-Centered Care Competency Scale (PCCS). Descriptive statistics and correlation analysis were conducted to analyze the data.

FINDINGS

The mean total EATNS was moderate (53.93 ± 7.18, out of 75), and their approach to patient-centered care behaviors was high (69.46 ± 8.64, out of 85).

CONCLUSIONS

We found a medium level of positive correlation and a significant relationship between the attitudes toward evidence-based nursing and patient-centered care competencies of the nurses participating in the study (r = 0.507, P < .05).

Determining Attitudes of Nurses Toward Evidence-Based Nursing in a University Hospital Sample

AIM

This study aimed to determine the attitudes of nurses working in a university hospital toward evidence-based nursing.

METHOD

This descriptive and cross-sectional research included 529 nurses working in a university hospital during November 1 to November 30, 2018. Data were collected using the information form and Attitude Toward Evidence-Based Nursing Questionnaire (AEBNQ). Descriptive statistical methods, the Shapiro–Wilk test, the Mann–Whitney U test, and the Kruskal–Wallis test were used for statistical analyses.

RESULTS

The average age of the nurses was 36.55±9.29 years, 91.1% were female, and the average work experience was 12.61±9.56 years. Moreover, 53.4% of the nurses were working in surgical departments, and 50.3% were working as clinical nurses. The total mean score of AEBNQ of the nurses was 58.23±9.34, and it was determined that their attitudes toward evidence-based nursing was positive. It was confirmed that for some subscales, the mean scores of AEBNQ of the female nurses and nurses working in internal disease departments were significantly high.

CONCLUSION

Attitudes of the nurses toward evidence-based nursing were found to be positive. It was concluded that the department in which the nurses worked and being female affected their attitudes toward evidence-based nursing.

College Athletic Trainers' Perceptions of Rest and Physical Activity When Managing Athletes With a Sport-Related Concussion

CONTEXT

Cognitive and physical rest are commonly utilized when managing a sport-related concussion (SRC); however, emerging research now suggests that excessive rest may negatively impact recovery. Despite current research recommendations, athletic trainers (ATs) may be behind in implementing this emerging research into clinical practice.

OBJECTIVE

To assess college ATs' perceptions and implementation of an emerging SRC management approach (cognitive and physical rest and activity).

DESIGN

Cross-sectional study.

SETTING

Survey.

PARTICIPANTS

A total of 122 (11.8%) ATs (53.3% female; 10.8 [9.8] y experience; 8.7 [6.9] SRCs managed annually) responded to the survey, which was randomly distributed to 1000 members of the National Athletic Trainers' Association, as well as 31 additional ATs from varying universities.

MAIN OUTCOME MEASURES

A 5-point Likert scale assessed the ATs' perceptions and clinical practices as they relate to specific athlete behaviors (ie, texting, sleeping). The ATs were asked about their willingness to incorporate physical activity into clinical practice.

RESULTS

Playing video games (95.9%) and practicing (93.4%) were the activities most perceived to extend SRC recovery. However, sleeping more than usual (7.4%) and increased time in a dark environment (11.5%) were viewed as less likely to extend recovery. ATs restricted practicing (98.4%) and working out (91.8%) for athletes with SRC, while sleeping more than usual (6.6%) and increased time in a dark environment (13.1%) were less restricted. About 71% of the ATs would implement light physical activity for athletes with a symptom score of 1 to 5, 31% with scores of 6 to 10, and 15% with scores of 11 to 20. About 43%, 74%, and 97% believe that light, moderate, and vigorous physical activity, while symptomatic, will extend recovery, respectively.

CONCLUSIONS

The ATs were receptive to including light physical activity into their SRC management, although only in certain situations. However, most ATs' beliefs and clinical practices did not completely align with emerging research recommendations for the management of SRCs.

Use of Patient-Reported Outcome Measures in Athletic Training: Common Measures, Selection Considerations, and Practical Barriers

CONTEXT

Current evidence suggests that a low percentage of athletic trainers (ATs) routinely use patient-reported outcome measures (PROMs). An understanding of the perceptions of ATs who use (AT-USE) and who do not use (AT-NON) PROMs as well as any differences due to demographic characteristics (eg, use for patient care or research, job setting, highest education level) may help facilitate the use of PROMs in athletic training.

OBJECTIVE

To describe commonly used PROMs by AT-USE, the criteria by which AT-USE select PROMs, and reasons for non-use by AT-NON.

DESIGN

Cross-sectional study.

SETTING

Online survey.

PATIENTS OR OTHER PARTICIPANTS

A convenience sample of 1784 ATs (response rate = 10.7% [1784/17972]; completion rate = 92.2% [1784/1935]) who worked in a variety of settings.

MAIN OUTCOME MEASURE(S)

Participants completed an anonymous electronic online survey. Descriptive statistics were used to describe commonly used PROMs, PROM selection criteria, and reasons for PROM non-use.

RESULTS

Participants were classified as AT-USE (n = 370, 20.7%) or AT-NON (n = 1414, 79.3%). For the AT-USE group, the most common type of PROMs used were specific (eg, region, joint; n = 328, 88.6%), followed by single-item (n = 258, 69.7%) and generic (n = 232, 62.7%). Overall, the PROMs most frequently endorsed by the AT-USE group were the Numeric Pain Rating Scale (n = 128, 34.6%); Lower Extremity Functional Scale (n = 108, 29.2%); Disability of the Arm, Shoulder and Hand (n = 96, 25.9%); Owestry Disability Index (n = 80, 21.6%); and Foot and Ankle Ability Measure (n = 78, 21.1%). The most important criteria reported by AT-USE for selecting PROMs were that the measure was valid and reliable, easy for patients to understand, and easy for clinicians to understand and interpret. Common reasons for non-use were that PROMs were too time consuming for the clinician, too time consuming for the patient, and more effort than they were worth.

CONCLUSIONS

The Numeric Pain Rating Scale; Lower Extremity Functional Scale; Disability of the Arm, Shoulder and Hand; Owestry Disability Index; and Foot and Ankle Ability Measure were the PROMs most commonly endorsed by AT-USE and should be considered for athletic training use. To further facilitate the use of PROMs in athletic training, future authors should identify strategies to address organizational and time-constraint obstacles. Interpretation of our study findings may require caution due to a relatively low response rate and because "routine use" was not operationalized.

Occupational Therapists' Self-Reported Research Utilization and Use of Online Evidence Sources

Research utilization of occupational therapists may positively influence the quality and cost-effectiveness of service delivery; however, previous studies suggest that therapists' overall use of research in clinical practice is limited. This cross-sectional study used survey methodology to investigate the research utilization behaviors of occupational therapists and examine the differences in behaviors between those who had and had not used the Navigator^®. The Navigator^® online competence assessment platform supports research utilization through recommended readings and access to online databases with full-text articles. Findings showed a low level of research utilization overall, with Navigator^® users more likely to use online databases than non-users. Future research should examine if access to online platforms, such as the Navigator^®, combined with context-specific training that integrates active learning approaches could improve occupational therapists' research utilization for increased implementation of evidence-based practice.

The Modified Readiness for Interprofessional Learning Scale in Currently Practicing Athletic Trainers

Context:

Athletic trainers are encouraged to work collaboratively with other health care professionals to improve patient outcomes. Interprofessional education (IPE) experiences for practicing clinicians should be developed to improve interprofessional collaborative practice postcertification. An outcome measure, such as the modified Readiness for Interprofessional Learning Scale (mRIPLS), could be used to determine the clinician's attitudes toward IPE and to determine the effectiveness of the experience.

Objective:

To determine select psychometric properties of the mRIPLS in practicing athletic trainers.

Design:

Cross-sectional.

Setting:

Online survey.

Patients or Other Participants:

A survey was sent to 2000 randomly selected practicing athletic trainers. A total of 173 (8.7%) participated, and complete data were available for 145 (7.3%).

Intervention(s):

The survey consisted of a demographic section and the mRIPLS. The mRIPLS consists of 23 statements scored on a 5-point Likert scale divided into 3 subscales: teamwork and collaboration (TWC), patient-centeredness (PC), and sense of professional identity (PI).

Main Outcome Measure(s):

Cronbach α was used to examine the internal consistency. The presence of a ceiling effect (&gt;50% respondents selected the highest score) was determined for each question by examining means and percentages.

Results:

The overall internal consistency of the mRIPLS was acceptable (α = 0.872) along with the TWC (α = 0.917) and PC (α = 0.862) subscales. The PI subscale (α = 0.632) was not acceptable. A ceiling effect was identified for 10 questions, and ≥70% of respondents selected highly agree or agree for 22 questions.

Conclusions:

While the mRIPLS demonstrated overall acceptable internal consistency, all 3 subscales did not. In addition, the presence of a ceiling effect makes the use of this instrument as an outcome measure trivial. Therefore, the current version of the mRIPLS may not be the best outcome to assess openness for IPE or to measure the effectiveness of IPE experiences in practicing athletic trainers.