Volume 54: Issue 3

We thank our 2018 manuscript reviewers for their hard work and dedication. We also thank retiring Editorial Board members Lawrence E. Armstrong, PhD, FACSM; Robert C. Cantu, MD; Thomas A. Cappaert, PhD, ATC, CSCS, CES; Michael G. Dolan, MA, ATC, CSCS; Kyle Ebersole, PhD, ATC; Sandra Fowkes Godek, PhD, ATC; Jolene M. Henning, EdD, ATC; Lennart D. Johns, PhD, ATC; Sarah B. Knowles, PhD, MPH; Michael C. Koester, MD, AT Ret; John E. Kovaleski, PhD, ATC; Kevin G. Laudner, PhD, ATC, FACSM; John Nyland, EdD, PT, SCS, ATC, CSCS; Scott G. Piland, PhD, ATC; Michael R. Sitler, EdD, ATC,

Context

Athletic trainers (ATs) must be equipped with evidence to inform their clinical practice. A systematic, inclusive, and continuous process for exploring research priorities is vital to the success of ATs and, more importantly, their patients' positive outcomes.

Objective

To identify research priorities and unify research with clinical practice to improve patient care and advance the profession.

Design

Mixed-methods study.

Setting

Focus groups and a Web-based survey.

Patients or Other Participants

A total of 87 ATs (43 men [49.4%], 44 women [50.6%]; age = 40 ± 11 years; experience = 18 ± 11 years) participated in focus groups. Of the 49 332 e-mails sent, 580 were undeliverable, 5131 ATs started the survey (access rate = 10.5%), and 4514 agreed to participate (response rate = 9.3%).

Main Outcome Measure(s)

Our study consisted of 6 focus-group sessions, a content-expert review, and a Web-based survey. Themes from the focus groups were used to develop the research priorities and survey instrument. We used the 25-item validated survey to determine whether the research priorities and findings of the focus groups were generalizable. Endorsement of research priorities and recommendations was achieved when respondents indicated they agreed or strongly agreed.

Results

Respondents endorsed 5 research priorities: health care competency (n = 4438/4493, 98.8%), vitality of the profession (n = 4319/4455, 96.9%), health professions education (n = 3966/4419, 89.8%), health care economics (n = 4246/4425, 96.0%), and health information technology (n = 3893/4438, 87.7%). We also made the following recommendations: (1) develop funding initiatives that align with the agenda, (2) develop postdoctoral fellowships focused on clinical research, (3) facilitate collaborative relationships between clinicians and researchers, and (4) make research evidence more readily available and more applicable.

Conclusions

Using a systematic and inclusive process, we developed a prioritized research agenda for the athletic training profession. The agenda was endorsed by the leaders of each Strategic Alliance organization and adopted as the Athletic Training Research Agenda.

Context

Athletic trainers (ATs) have indicated a desire to better understand the motivations of athletes during rehabilitation. Self-determination theory offers an ideal lens for conceptualizing the antecedents, mediators, and consequences of motivated behavior.

Objective

To explore athletes' perceptions of ATs' influence on their basic psychological needs as well as their motivation during sport injury rehabilitation.

Design

Qualitative study.

Setting

National Collegiate Athletic Association Division I universities in the northwestern and southeastern United States.

Patients or Other Participants

A total of 10 injured and previously injured athletes (7 women, 3 men; mean age = 20.9 ± 2.0 years) active in a variety of sports.

Data Collection and Analysis

Participants completed semistructured interviews, which were transcribed verbatim. The data were analyzed using consensual qualitative research methods. Trustworthiness techniques (eg, bracketing interview, discussion of biases, member checking, external auditor) were used throughout the process.

Results

Four domains were constructed: (a) athletes' concerns about injury and rehabilitation, (b) ATs' feedback and athletes' perceptions of competence, (c) a person-centered approach from ATs and athletes' perceptions of autonomy, and (d) a connection between ATs' and athletes' perceptions of relatedness. Athletes' experiences were largely influenced by the degree to which they perceived that ATs satisfied their 3 basic psychological needs, which, in turn, was determined by the presence or absence of particular AT behaviors, such as providing encouragement (competence), soliciting input (autonomy), and building rapport (relatedness). Furthermore, the degree to which they perceived these basic psychological needs were fulfilled (or thwarted) affected their overall motivation during sport injury rehabilitation.

Conclusions

Self-determination theory is a promising framework for ATs to consider when addressing motivational challenges among injured athletes.

Context

Patellofemoral pain (PFP) is a chronic condition that presents with lower extremity muscle weakness, decreased flexibility, subjective functional limitations, pain, and decreased physical activity. Patterned electrical neuromuscular stimulation (PENS) has been shown to affect muscle activation and pain after a single treatment, but its use has not been studied in a rehabilitation trial.

Objective

To determine the effects of a 4-week impairment-based rehabilitation program using PENS on subjective function, pain, strength, range of motion, and physical activity in individuals with PFP.

Design

Randomized controlled trial.

Setting

Laboratory.

Patients or Other Participants

A total of 21 patients with PFP (5 males, 16 females; age = 23.4 ± 7.6 years, height = 168.0 ± 7.5 cm, mass = 69.0 ± 19.5 kg).

Intervention(s)

Participants completed a 4-week supervised rehabilitation program in conjunction with random assignment to receive PENS or sham treatments.

Main Outcome Measure(s)

Subjective function, pain, strength, range of motion, and physical activity levels were assessed prerehabilitation and postrehabilitation. Subjective function and pain were also assessed at 6 and 12 months postrehabilitation. Repeated-measures analyses of variance and Tukey post hoc testing were conducted with α ≤ .05. We calculated Cohen d effect sizes with 95% confidence intervals.

Results

Both groups had statistically and clinically meaningful differences in subjective function, pain, strength, range of motion, and activity level after 4 weeks of impairment-based rehabilitation. Improved subjective function was observed in both groups at 6 and 12 months after the interventions. The PENS group had improvements in current pain for all 3 postrehabilitation times compared with baseline measures.

Conclusions

An impairment-based intervention effectively improved subjective function, pain, strength, range of motion, and physical activity levels in individuals with PFP. Participants who received PENS in addition to the rehabilitation program had improved current pain at 6 and 12 months postrehabilitation compared with baseline scores.

Trial Registration

ClinicalTrials.gov identifier: NCT02441712

Reliability and Validity of the Functional Assessment of Neurocognition in Sport (FANS): A Paradigm Shift in Post-Concussion Return-to-Sport Decision-Making

Landon B. LempkePhD, ATC,

Benjamin L. BrettPhD, and

Douglas P. TerryPhD,ABPP