Resistin is elevated following traumatic joint injury and causes matrix degradation and release of inflammatory cytokines from articular cartilage in vitro

OBJECTIVE

Resistin is a secreted factor that is elevated in rheumatoid arthritis (RA) and believed to drive joint inflammation in vivo. This study was undertaken to determine if resistin is present in the joint following joint injury and to elucidate the role of resistin in cartilage degradation.

METHODS

The level of resistin was measured in paired synovial fluid (SF) and serum samples from patients following joint injury (anterior cruciate ligament, ACL or meniscus tear). Localization of resistin was visualized by immunohistochemistry of synovial tissue and cartilage from healthy and OA donors. Mouse and human cartilage cultures were used to assess the effect of resistin on cartilage metabolism.

RESULTS

In trauma patients, resistin levels declined with increasing time post injury. The resistin levels were highest in samples collected up to 1 week following traumatic injury (SF: 2980 pg/ml, serum: 7901 pg/ml) and lowest in samples collected 6-26 years post injury (SF: 686 pg/ml, serum: 5682 pg/ml). Resistin was shown to be expressed in macrophage-like cells in both healthy and OA synovial tissue. Treatment of mouse cartilage cultures with recombinant resistin led to a dose dependent loss of proteoglycan and induction of inflammatory cytokine and PGE(2) production. Recombinant resistin inhibited proteoglycan synthesis in human cartilage explants.

CONCLUSION

Resistin is elevated both systemically and locally in the weeks immediately following joint injury and has a direct effect on cartilage matrix turnover and cytokine production. Resistin may play a role in the early stages of trauma-induced OA and may represent a new therapeutic target to slow joint destruction in OA.

A model to increase rehabilitation adherence to home exercise programmes in patients with varying levels of self-efficacy

Patient adherence to rehabilitation programmes is frequently low - particularly adherence to home exercise programmes. Home exercise programmes have been identified as complementary to clinic-based physical therapy in an orthopaedic setting. Barriers to patient adherence have previously been identified within the literature. Low self-efficacy is a barrier to adherence that clinicians have the ability to have an impact on and improve. The theory of self-efficacy is defined as a person's confidence in their ability to perform a task. This theory examines the ability of a person to change through exerting control over inner processes of goal setting, self-monitoring, feedback, problem solving and self-evaluation. If clinicians are able to identify patients with low self-efficacy prior to the prescription of a home exercise programme, adjustments to individualized care can be implemented. Individualized care based on improving self-efficacy for home exercise programmes may improve patient adherence to these programmes. The purpose of this article was to use the theory of self-efficacy to direct clinicians in providing individualized programmes to patients with varying levels of self-efficacy.

MRI-based extended ordered values more efficiently differentiate cartilage loss in knees with and without joint space narrowing than region-specific approaches using MRI or radiography--data from the OA initiative

OBJECTIVE

The sensitivity to change of quantitative analysis of cartilage in knee osteoarthritis using magnetic resonance imaging (MRI) is compromised by the spatial heterogeneity of cartilage loss. We explore whether extended (medial-lateral) "ordered values" (OVs) are superior to conventional approaches of analyzing subregional cartilage thickness loss and to radiography, in differentiating rates of progression in knees with and without joint space narrowing (JSN).

METHODS

607 Osteoarthritis Initiative (OAI) participants (308 without and 299 with baseline JSN at baseline) were studied over 12 months. Subregional femorotibial cartilage loss was determined in all knees, and changes in minimum joint space width (mJSW) in a subset of 290 knees. Subregional thickness changes in medial and lateral tibial and femoral cartilages were sorted in ascending order (OV1-16). A Wilcoxon rank-sum test was used to compare rates of change in knees with and without JSN.

RESULTS

JSN-knees displayed greater cartilage loss than those without JSN, with minimal P-values of 0.008 for femorotibial subregions, 3.3×10(-4) for medial OV1, and 5.4×10(-7) for extended (medial and lateral) OV1. mJSW measurements (n=290) did not discriminate between longitudinal rates of change in JSN vs no-JSN knees (P=0.386), whereas medial OV1 (P=5.1×10(-4)) and extended OV1 did (P=2.1×10(-5)).

CONCLUSION

Extended OVs showed higher sensitivity to detecting differences in longitudinal rates of cartilage loss in knees with and without baseline JSN than anatomical (sub)regions and radiography. The OV technique also circumvents challenges of selecting particular regions "a priori" in clinical trials and may thus provide a powerful tool in studying risk factors or treatment efficacy in osteoarthritis.

Glenohumeral and Hip Range-of-Motion and Strength Measures in Youth Baseball Athletes

CONTEXT

The repetitive demands of throwing affect glenohumeral (GH) range of motion (ROM) and strength. Less is known about hip alterations in skeletally immature athletes.

OBJECTIVE

To compare GH and hip ROM and strength between age, position, and side of youth baseball athletes.

DESIGN

Cross-sectional study.

SETTING

Multicenter testing.

PATIENTS OR OTHER PARTICIPANTS

Seventy-two healthy baseball athletes. Participants' self-reported characteristics were age group (7-11 years [n = 28] or 12-18 years [n = 44]), position (pitcher [n = 22], position player [n = 47], unreported [n = 3]), and side (throwing or nonthrowing arm, lead or stance leg).

MAIN OUTCOME MEASURE(S)

Bilateral GH and hip internal- and external-rotation ROM were measured passively and summed for total arc of motion (TAM). Glenohumeral and hip rotation and gluteus medius strength were measured. Analyses included linear mixed models.

RESULTS

Glenohumeral internal rotation was less in throwing than in nonthrowing arms (P < .05) except in younger pitchers (P = .86). Compared with older athletes, younger athletes had more GH external rotation (103.3° ± 7.7° versus 97.5° ± 9.4°; P = .002), TAM (156.4° ± 8.7° versus 147.9° ± 10.9°; P = .04), and external rotation in throwing compared with nonthrowing arms (101.9° ± 1.2° versus 97.9° ± 1.1°; P < .001). Glenohumeral TAM was less in throwing than in nonthrowing arms (150.5° ± 2.1° versus 154.9° ± 1.3°; P = .01). Younger athletes had more hip internal rotation (38.9° ± 6.8° versus 31.2° ± 7.5°; P < .001) and TAM (68.4° ± 10.0° versus 60.7° ± 9.8°; P = .001) than older athletes. Lead-leg hip internal-rotation ROM was greater than in the stance leg (34.8° ± 8.9° versus 32.8° ± 7.7°; P = .01). Overall, older players were stronger than younger players (P < .05), and the throwing arm was stronger in internal rotation than the nonthrowing arm (10.12 ± 3.72 lb [4.59 ± 1.69 kg] versus 9.43 ± 3.18 lb [4.28 ± 1.44 kg]; P = .047).

CONCLUSIONS

Youth baseball athletes had typical GH ROM adaptations of less internal rotation and more external rotation in the throwing versus the nonthrowing arm. Greater ROM in younger athletes may be explained by prepubertal characteristics. We obtained hip-strength values in youth baseball athletes, and as expected, older athletes were stronger.

Measurements of self-efficacy in musculoskeletal rehabilitation: A systematic review

OBJECTIVES

Low self-efficacy is a barrier to rehabilitation adherence. Before an intervention can be implemented to improve self-efficacy, assessment is required. It is currently unknown if a standard measure of self-efficacy has been used to assess this in patients with musculoskeletal conditions, specifically for home exercise programmes (HEPs). The aim of the present study was to determine which self-efficacy scales are being used in conjunction with exercise adherence, identify if any scale has been developed to evaluate self-efficacy for HEPs and evaluate their psychometric properties.

METHODS

Data sources included CINAHL, MEDLINE, Pubmed, PsycInfo, and Sport Discus. Studies had to include patients suffering from a musculoskeletal injury, pain or disorder; a measure of rehabilitation adherence; and patient's self-efficacy. The study population, self-efficacy measurement used, study quality as identified with the Modified Downs and Black checklist, results pertaining to self-efficacy, and level of evidence were extracted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed and 29 articles were included.

RESULTS

A total of 14 scales assessing self-efficacy were identified but no scale to assess self-efficacy for HEPs was found. Many scales report internal consistency but lack test-retest reliability and validity.

CONCLUSIONS

The scales identified were specific to condition or tasks, and not applicable for all musculoskeletal patient populations. It is important, both for use in the clinic and for research, that outcome measures used are reliable and valid. Unfortunately, no scale was found to assess self-efficacy for HEPs, which is problematic as self-efficacy is task specific. As HEPs are essential to rehabilitation, there should be a scale designed specifically to assess self-efficacy for this task.

Considerations of Conservative Treatment After a Partial Ulnar Collateral Ligament Injury in Overhead Athletes: A Systematic Review

CONTEXT

Ulnar collateral ligament (UCL) reconstructions continue to increase without consensus on an evidence-based treatment protocol for nonoperative management. Currently, there is no consensus on an effective nonoperative protocol for partial UCL injuries that uses return-to-play (RTP) rates in determining the outcome of conservative treatment.

OBJECTIVE

To systematically review RTP rates after conservative treatment of partial UCL injuries in overhead athletes along with descriptive components of each conservative intervention to identify an effective evidence-based nonoperative rehabilitation protocol.

DATA SOURCES

Articles in PubMed, CINAHL, MEDLINE, Academic Search Complete, and SPORTDiscus were identified in October 2018 based on the following terms: overhead athlete, ulnar collateral ligament, nonoperative treatment, and return to play.

STUDY SELECTION

Seven retrospective, level 4 studies (n = 196) qualified for analysis.

STUDY DESIGN

Systematic review.

LEVEL OF EVIDENCE

Level 4.

DATA EXTRACTION

Study design, level of evidence, demographics, sample size, sports involved, level of competition, grade or type of UCL diagnosis, conservative treatment components, and percentage RTP were extracted.

RESULTS

Overall, RTP rates after conservative treatment ranged between 42% and 100% (mean, 78% ± 20%). The most frequently reported components of rehabilitation protocols were (1) a period of rest, (2) stretching, (3) strengthening, and (4) a throwing program. Platelet-rich plasma injections were included in 5 (71%) of the 7 protocols with a rehabilitation period.

CONCLUSION

Conservative treatment is a viable option for partial UCL tears in overhead athletes. A successful rehabilitation protocol includes the use of patient-reported outcomes, a sport-specific tailored treatment plan, kinetic chain strengthening, and an interval throwing program. Factors such as age, grading of tear, level of play, sport, and athlete's perceived well-being should all be considered during treatment decisions.

Pitch Volume and Glenohumeral and Hip Motion and Strength in Youth Baseball Pitchers

CONTEXT

  Increased pitch volume and altered glenohumeral (GH) and hip range of motion (ROM) and strength contribute to injury risk in baseball pitchers. Although these factors affect one another, whether they are related is unknown.

OBJECTIVE

  To examine relationships among cumulative and seasonal pitch volume, ROM, and strength of the GH and hip joints in youth baseball pitchers.

DESIGN

  Cross-sectional study.

SETTING

  Baseball practice facilities.

PATIENTS OR OTHER PARTICIPANTS

  A total of 28 healthy baseball pitchers (age = 13.9 ± 2.9 years).

MAIN OUTCOME MEASURE(S)

  A demographic and pitching questionnaire was used to quantify pitch volume. Glenohumeral internal-rotation (IR) and external-rotation (ER) ROM and strength of the throwing arm; total arc of motion (IR + ER ROM); and bilateral hip IR, ER, and total arc of motion ROM and strength in IR, ER, and abduction were measured. A goniometer was used to assess ROM; a handheld dynamometer, to assess strength. Frequency analyses and bivariate correlations (age covariate) described data and identified relationships.

RESULTS

  Correlations between years of competitive play and increased strength in lead-leg hip IR ( r = 0.52, P = .02) and abduction ( r = 0.48, P = .04) and stance-leg hip IR ( r = 0.45, P = .05) were fair to good. The number of months played in the last year had a fair correlation with decreased GH IR strength ( r = -0.39, P = .04) and increased stance-leg hip IR strength ( r = 0.44, P = .05). Limited pitch time had a fair correlation with increased GH ER ROM ( r = 0.40, P = .04) and an excellent correlation with increased lead-leg hip IR ROM ( r = 0.79, P < .001). Increased innings pitched per game had a fair to good correlation with decreased GH IR strength ( r = -0.41, P = .04) and stance-leg hip ER ROM ( r = -0.53, P = .03). More pitches per game had a fair to good correlation with increased GH ER ROM ( r = 0.44, P = .05) and decreased stance-leg hip ER ROM ( r = -0.62, P = .008).

CONCLUSIONS

  The significant relationships identified in this study suggest the need to further examine youth and adolescent cumulative and seasonal pitch guidelines.

Elastic Resistance Effectiveness on Increasing Strength of Shoulders and Hips

Picha, KJ, Almaddah, MR, Barker, J, Ciochetty, T, Black, WS, and Uhl, TL. Elastic resistance effectiveness on increasing strength of shoulders and hips. J Strength Cond Res 33(4): 931-943, 2019-Elastic resistance is a common training method used to gain strength. Currently, progression with elastic resistance is based on the perceived exertion of the exercise or completion of targeted repetitions; exact resistance is typically unknown. The objective of this study was to determine whether knowledge of load during elastic resistance exercise will increase strength gains during exercises. Participants were randomized into 2 strength training groups, elastic resistance only and elastic resistance using a load cell (LC) that displays force during exercise. The LC group used a Smart Handle (Patterson Medical Supply, Chicago, IL, USA) to complete all exercises. Each participant completed the same exercises 3 times weekly for 8 weeks. The LC group was provided with a set load for exercises, whereas the elastic resistance only group was not. The participant's strength was tested at baseline and program completion, measuring isometric strength for shoulder abduction (SAb), shoulder external rotation (SER), hip abduction (HAb), and hip extension (HEx). Independent t-tests were used to compare the normalized torques between groups. No significant differences were found between groups. Shoulder strength gains did not differ between groups (SAb p > 0.05; SER p > 0.05). Hip strength gains did not differ between groups (HAb p > 0.05; HEx p > 0.05). Both groups increased strength because of individual supervision, constantly evaluating degree of difficulty associated with exercise and providing feedback while using elastic resistance. Using an LC is as effective as supervised training and could provide value in a clinical setting when patients are working unsupervised.

Patterns and Associations of Shoulder Motion, Strength, and Function in MARSOC Personnel Without History of Shoulder Injury

Introduction

Military personnel are at an increased risk of shoulder injuries due to training and deployment demands, however, there is a lack of information on the tactical athlete's upper extremity profile. Therefore, the purpose of this study was to examine shoulder musculoskeletal characteristics, including range of motion (ROM), strength, and function, and the relationships between these measures in Marine Corps Forces Special Operations Command (MARSOC) personnel without history of shoulder injury.

Materials and Methods

Participants included 195 full-duty male MARSOC personnel (age: 25.38 ± 2.85 yr; height: 1.79 ± 0.06 m, mass: 82.79 ± 7.88 kg) without history of shoulder injury. Measurements of ROM, strength, and function were obtained bilaterally. Shoulder internal rotation (IR) and external rotation (ER) ROM were summed to calculate total arc of motion (ARC). Shoulder IR and ER strength were assessed using an isokinetic dynamometer. Function was evaluated with an explosive push-up.

Results

MARSOC personnel present with significantly increased ER ROM, and decreased IR ROM and ARC in their dominant shoulder. They demonstrated greater IR strength and peak force during the explosive push-up on the dominant side but no bilateral differences in average or peak rate were found. Correlation analyses suggest a weak inverse relationship between strength and ARC (r = -0.15 to -0.24). Positive relationships between strength and function were identified except for dominant IR strength and push-up variables. Those with the greatest ARC demonstrated significantly weaker IR and ER strength compared to those with less motion.

Conclusions

MARSOC personnel demonstrate shoulder ROM and strength symmetry patterns similar to overhead athletes. Increased dominant shoulder strength does appear to translate to a bilateral functional performance, but overall performance may be limited by the weaker nondominant upper extremity. As ARC increases, IR and ER rotation strength decrease. Repetitive, increased loading of the dominant shoulder during functional movements and training may increase risk of chronic, overuse-type injuries, common to the military. Unilateral exercises and movement analysis should be incorporated to encourage proper development of bilateral shoulder strength, which may be particularly important in those with high ranges of ARC.

Line Hops and Side Hold Rotation Tests Load Both Anterior and Posterior Shoulder: A Biomechanical Study

BACKGROUND

Clinical tests should replicate the stressful positions encountered during sport participation. Evaluating the kinetic and electromyographical demands of clinical tests enables clinicians to choose appropriate tests for specific sports.

PURPOSE

To describe the shoulder forces and muscle activation levels during closed chain functional tests of Line Hops (LH) and Side Hold Rotation (SHR).

STUDY DESIGN

Descriptive biomechanical study.

METHODS

Ten asymptomatic participants were examined in a university laboratory. Two functional tests were evaluated using three-dimensional video analysis and electromyography to measure shoulder forces, moments, and muscular activity levels.

RESULTS

SHR produced a peak average posterior translation force of 4.84 N/kg (CI95 4.32-5.36N/kg) and a peak average anterior translational force of 1.57 N/kg (CI95 1.10-2.01N/kg). High levels of serratus anterior (98% maximum voluntary isometric contraction (MVIC) and infraspinatus (52 %MVIC) were recorded during SHR. LH produced a posterior translational force of 4.25 N/kg (CI95 3.44-5.06N/kg). High levels of serratus anterior (105 %MVIC) and infraspinatus (87 %MVIC) were recorded during the push off phase of this activity.

CONCLUSIONS

LH and SHR placed large posterior translational forces that approached half of a person's bodyweight on shoulder structures. SHR produced an anterior translation force at extremes of horizontal abduction placing approximately 18% of bodyweight on shoulder structures. The LH test required the serratus anterior to provide power to push the upper torso of the ground while both the serratus and the infraspinatus provides scapular and humeral stability, respectively.

LEVEL OF EVIDENCE

4: Case series.

Social Determinants of Health: Considerations for Athletic Health Care

Health disparities are prevalent issues in the United States and a frequent topic of conversation in the public health realm. Causes of health disparities include social inequities and social determinants of health. Although social determinants of health have been suggested to contribute more to individual and population health than the health care provided, this concept in athletic health care has received little attention. Therefore, the purpose of this article is to describe social determinants of health, present examples of social determinants, and discuss awareness of actionable steps for the athletic training profession to be more culturally proficient. By increasing awareness of and acknowledging social determinants of health, athletic trainers will be positioned to improve patient outcomes more readily and contribute to ongoing conversations at the policy level of health care.

Physical Therapists' Assessment of Patient Self-Efficacy for Home Exercise Programs

BACKGROUND

Patient adherence to home exercise programs (HEPs) is low, and poor patient self-efficacy is a barrier clinicians can influence. However, little evidence suggests that clinicians assess level of patient self-efficacy before prescribing HEPs.

PURPOSE

To determine the importance of patient self-efficacy to physical therapists (PTs) when addressing patient barriers, determine how PTs assess and use patient self-efficacy for HEPs, and describe the barriers facing PTs when assessing patient self-efficacy for HEPs.

STUDY DESIGN

Survey.

METHODS

Practicing PTs were recruited from the American Physical Therapy Association's Orthopedic Section and emailed the electronic survey.

RESULTS

Email invitations were sent to 17730 potential participants, and 462 PTs completed the survey over one month. PTs rated self-efficacy as "very" to "extremely" important for patient adherence (58%, 265/454). Most (71%, 328/462) reported assessing self-efficacy before prescribing HEPs and did so through verbal discussion and observation of the patient (50% and 38% respectively). Half of respondents individualized HEPs through self-efficacy related themes. PTs not assessing self-efficacy reported not knowing how (51%, 68/134), being unsure what to do with the information (24%, 32/134), or reporting other barriers (21%, 28/134).

CONCLUSIONS

Most PTs indicated that self-efficacy was important for patient adherence, but assessment strategies reported, such as verbal discussion and observation, may not be the most accurate. PTs who did not assess self-efficacy reported not knowing how or what to do with the information once collected. These findings suggest that there is a gap in knowledge related to how to evaluate self-efficacy for HEPs. Better assessment of self-efficacy may lead to more appropriate and effective implementation strategies.

LEVEL OF EVIDENCE

Level II.

Exploring physical therapists' approach to addressing home exercise program-related low self-efficacy: knowledge, strategies, and barriers

PURPOSE

Self-efficacy is the strongest predictor of completing home exercise programs (HEPs). How physical therapists address low levels of self-efficacy is unknown. Our objectives were to determine (1) knowledge and confidence in addressing patients' self-efficacy; (2) strategies used to address low self-efficacy; and (3) barriers.

MATERIAL AND METHODS

Licensed physical therapists who are actively treating patients in the United States participated in our mixed-methods study consisting of: (1) a survey on knowledge, barriers, and confidence; and (2) interviews on strategies used to address low self-efficacy. Descriptive statistics were calculated on all quantitative data. Braun and Clarke's 6-phase thematic analysis was used for the qualitative data.

RESULTS

All 37 participants believed that self-efficacy impacts HEP completion. The majority (72.9%) reported addressing low self-efficacy. Barriers that impacted the ability to address low self-efficacy (Theme 1) included lack of knowledge, confidence, tools, guidance, and community resources, patients' past experiences and complexities, inability to follow-up with patients, and reimbursement. Due to these barriers, participants primarily addressed patients' low self-efficacy via communication (Theme 2) and ensuring successful exercise completion (Theme 3).

CONCLUSION

Instead of using Bandura's fours sources of self-efficacy (i.e., mastery experiences, verbal persuasion, vicarious experiences, physiological state), participants verbalized addressing low self-efficacy via communication and successful exercise completion. Thus, implementation studies evaluating strategies to overcome the identified barriers are needed.

Athletic Trainers' Perceptions of and Experience with Social Determinants of Health

The role that social determinants of health (SDHs) play in athletic healthcare is gaining attention, yet little is known about athletic trainers' (ATs) perceptions of and encounters with the impact of SDHs. The purpose of this study was to evaluate ATs' perceptions of various SDHs and their experience treating patients whose health and well-being were influenced by SDHs. This was a cross-sectional, web-based survey completed by 1694 ATs (completion rate = 92.6%; 61.1% female; age = 36.6 ± 10.8 years). The survey consisted of several multipart questions focusing on specific SDHs. Descriptive statistics were used to report frequencies and percentages. Results indicated widespread agreement that SDHs matter to patient health and are of concern in athletic healthcare. The SDHs that ATs most commonly reported encountering included lifestyle choices (n = 1306/1406; 93.0%), social support (n = 1185/1427; 83.0%), income (n = 1167/1502; 77.7%), and access to quality and timely healthcare (n = 1093/1420, 77.0%). The SDHs that ATs least commonly reported having experience with was governmental policy (n = 684/1411; 48%). The perceived importance of SDHs among ATs and their commonly reported experiences managing patient cases in which SDHs negatively influence patients' health and healthcare suggest that efforts to assess these factors are needed so that strategies to address their influence on athletic healthcare can be identified.

Applying the National Institute on Minority Health and Health Disparities Research Framework to Social Determinants of Health in the Context of Sport-Related Concussion: A Clinical Commentary

Sport-related concussion (SRC) is a prevalent injury. Significant disparities in SRC outcomes exist across racial and ethnic groups. These disparities may be attributed to the unequal distribution of political power (or influence) and resource allocation in various communities, shaping individuals' social determinants of health (SDOH). However, the influence of SDOH on SRC outcomes remains understudied. In this clinical commentary, we use the National Institute on Minority Health and Health Disparities Research Framework and describe how its application can help address gaps in our understanding of SDOH and SRC. This framework provides a comprehensive approach to investigating and addressing health disparities by considering SDOH along multiple levels and domains of influence. Using this framework, athletic trainers can identify areas requiring intervention and better understand how SDOH influence SRC outcomes. This understanding can help athletic trainers develop tailored interventions to promote equitable care for patients with SRC.

Athletic Trainers' Observations of Social Determinants of Health in the Collegiate Setting: A Card Study

CONTEXT

Addressing social determinants of health (SDOH) in all populations improves patient outcomes, leading to better patient-centered care. Despite known influences of SDOH, little is known about the ability of athletic trainers (ATs) to observe SDOH in practice.

OBJECTIVE

To explore ATs' observations of SDOH and describe actions taken at the point of care in collegiate and university settings.

DESIGN

Descriptive via an observational card study.

SETTING

Athletic training facilities.

PATIENTS OR OTHER PARTICIPANTS

Collegiate and university ATs (23 participants across 20 institutions).

DATA COLLECTION AND ANALYSIS

The ATs used a modified observation card to document observations of SDOH during patient encounters in the collegiate or university setting. The cards contained instructions for completion and a table with 4 columns: (1) a list of 19 predetermined SDOH, (2) a checkbox for observed SDOH, (3) a checkbox for the perceived negative influence of observed SDOH on patient health, and (4) an open box to write in what actions, if any, were taken to address the observed SDOH.

RESULTS

Overall, 424 cards were collected. Of 725 observed SDOH, access to social media (153/725, 21.1%), academic stressors (131/725, 18.1%), and behavioral health issues (71/725, 9.8%) were the most commonly observed. Nearly 39% (281/725) had a perceived negative influence. Of those, academic stressors (49/281, 17.4%), behavioral health issues (46/281, 16.4%), and transportation issues (32/281, 11.4%) were most common. For the 23.0% (166/725) of SDOH acted upon, ATs used counseling and education (73/166), provided additional resources (60/166), referred to others (29/166), or communicated with others (4/166).

CONCLUSIONS

Because ATs are positioned to accurately assess SDOH, they can promote better patient-centered care and improve patient outcomes. Our results suggest that many SDOH observed by ATs in the collegiate or university setting have a negative influence on patient health. Better support for patients with academic stressors and behavioral health issues is important because of these SDOH.

Athletic Trainers' Familiarity, Comfort, Knowledge, and Recognition of Social Determinants of Health

CONTEXT

Social determinants of health (SDOH)-education, transportation, housing, employment, health systems and services, economic status, and physical and social environments-influence patient outcomes; therefore, athletic trainers (ATs) need to understand and address these factors. However, little is known about how ATs perceive SDOH or how knowledgeable they are about social factors that contribute to patient health and well-being.

OBJECTIVE

To evaluate ATs' familiarity and comfort with SDOH and their perceived knowledge and recognition of SDOH.

DESIGN

Cross-sectional study.

SETTING

Online survey.

PATIENTS OR OTHER PARTICIPANTS

Our survey was distributed to 17 000 ATs; 1829 accessed it (access rate = 10.8%), and 1694 completed it (completion rate = 92.6%, AT experience = 15.2 ± 10.6 years, age = 36.6 ± 10.8 years).

MAIN OUTCOME MEASURE(S)

The survey included multipart questions that evaluated ATs' perceptions of their familiarity, comfort, and knowledge about SDOH. Data were summarized using descriptive statistics.

RESULTS

Few respondents (4.1%, 70/1691) reported being extremely familiar with SDOH. Most indicated being moderately familiar (45.0%, 761/1691), minimally familiar (34.7%, 587/1691), or not familiar at all (16.1%, 273/1691). For questions about comfort, few described being extremely comfortable (3.5%, 59/1691) with SDOH, and most reported being moderately comfortable (35.4%, 598/1691), minimally comfortable (41.1%, 695/1691), or not comfortable at all (18.6%, 314/1691). For questions about knowledge, few indicated being extremely knowledgeable (2.7%, 46/1686) about SDOH, and the majority described being moderately (36.8%, 622/1686), minimally (41.8%, 704/1686), or not knowledgeable at all (18.6%, 314/1686). Over half of ATs accurately categorized 8 of the 9 SDOH listed in the survey, and 22% endorsed more correct than incorrect items.

CONCLUSIONS

A majority of ATs perceived their familiarity, comfort, and knowledge about SDOH to be moderate to low, which may reflect the relatively recent emphasis on SDOH in athletic health care. Because SDOH can have a major effect on patient health and well-being, strategies should be developed for educating ATs about SDOH. Developing strategies to increase comfort with SDOH in patient care is critical to ensure that those factors that can be addressed at the patient level are identified and managed.

Athletic Trainers' Observations of Social Determinants of Health in the Secondary School Setting: A Card Study

CONTEXT

Athletic trainers (ATs) are in a unique position to mitigate the negative influences of social determinants of health (SDH) in their patients. In the secondary school setting, understanding common SDH may inform strategies that reduce these influences. However, little is known about the types of SDH that ATs observe in patients in this setting.

OBJECTIVE

To investigate SDH observed by ATs at the point of care in the secondary school setting.

DESIGN

Descriptive, observational card study.

SETTING

Secondary schools.

PATIENTS OR OTHER PARTICIPANTS

Twenty-seven ATs (average age = 29.9 ± 5.6 years, 23 [85.2%] female).

MAIN OUTCOME MEASURE(S)

Athletic trainers recorded SDH on a standardized observation card during patient interactions. Cards provided instructions for completion and had a 4-column table with a list of 19 predetermined SDH, a checkbox for observed SDH, a checkbox for perceived negative influence of observed SDH on patient health, and an open box to write in actions taken to address the observed SDH.

RESULTS

Overall, 676 cards with 748 observed SDH were collected from 27 secondary schools. Of those, 46.9% (351/748) were perceived to have a negative influence on patient health. The top 3 observed SDH were academic stressors (14.2%, 106/748), access to social media (12.6%, 94/748), and lack of health literacy (11.4%, 85/748). The ATs reported acting on 37.7% of negatively perceived SDH through counseling and education (48.6%, 137/282), additional resources (20.6%, 58/282), referral to others (17.4%, 49/282), and communication with others (13.5%, 38/282).

CONCLUSIONS

Our results indicated ATs in the secondary school setting were observing and acting to mitigate the negative influence of SDH. However, these ATs should be prepared to provide resources for patients negatively influenced by academic stressors, social media, and lack of health literacy. Resources, referrals, and additional education for patients may support a healthier community and positively influence athlete health and well-being.