Attitudes Toward Injury-Prevention Program Participation Based on Race and Collegiate Division in Female Athletes.

CONTEXT: Injury-prevention programs (IPPs) have been effective in reducing lower extremity injury rates, but user compliance plays a major role in their effectiveness. Race and collegiate division may affect attitudes toward participation in IPPs and compliance in female collegiate athletes. OBJECTIVE: To compare attitudes toward IPPs based on race and collegiate division. DESIGN: Cross-sectional study. SETTING: Survey. PATIENTS OR OTHER PARTICIPANTS: A total of 118 female collegiate athletes (age = 19.71 ± 1.47 years, height = 169.46 ± 9.09 cm, mass = 69.57 ± 11.57 kg) volunteered. MAIN OUTCOME MEASURE(S): Participants completed the Health Belief Model Scale and the Theory of Planned Behavior Scale (TPBS) on 1 occasion. The Health Belief Model Scale contains 9 subscales (perceived susceptibility, perceived consequences, fear of injury, perceived benefits, perceived barriers, community-led self-efficacy, individual self-efficacy, general health cues, external health cues), whereas the TPBS has 5 subscales (perceived benefits, perceived barriers, perceived social norms, social influence, intention to participate). The independent variables were race (White versus Black, Indigenous, and other people of color [BIPOC]) and National Collegiate Athletic Association division (I and III). Mann-Whitney U tests were used to detect differences in attitudes toward IPP participation based on race and collegiate division. RESULTS: White female athletes perceived fewer TPBS barriers to participation in IPPs (P = .003) and more community-led self-efficacy when compared with BIPOC female athletes (P = .009). Division I athletes perceived a greater fear of injury (P = .002) and more general health cues (P = .01) than Division III athletes. CONCLUSIONS: For lower extremity IPPs, BIPOC and Division III female collegiate athletes may need different implementation strategies. Individuals who identify as BIPOC may benefit from interventions focusing on solutions for common barriers to participation and improving community-led self-efficacy, and Division III athletes may benefit from interventions focusing on education related to the risk of injury and general preventive health behaviors.

An intervention based on the health belief model led to improvements in self-efficacy towards ERIPP participation and functional performance in club sport athletes: a pilot study.

OBJECTIVES: To determine if an intervention based on the Health Belief Model (HBM) could improve attitudes towards exercise-related injury prevention program (ERIPP) participation and functional performance in club sport participants. DESIGN: Repeated measures METHODS: Participants completed the HBM Scale (HBMS) and Theory of Planned Behavior Scale (TPBS) to assess attitudes towards ERIPP participation at three time points (pre-measure, post-measure, follow-up measure). The HBM based intervention was delivered immediately following the pre-measure containing: 1) education on ERIPPs, benefits and barriers to participating, strategies to overcome barriers, risk factors and consequences for lower extremity injuries, and strategies to prevent lower extremity injuries 2) individualized feedback on functional performance 3) demonstration and participation in the 11+. Attitudes towards injury prevention were compared using the subscales of the HBMS and TPBS at all three time points. Functional performance was compared at the pre-measure and follow-up measure. RESULTS: Significant improvements with large effect sizes were detected in individual self-efficacy from pre-test (0.73±4.48) to post-test (2.93±4.30; P=0.05; ƞ2=0.18) and pre-test to follow-up (3.20±3.49; P=0.04; ƞ2=0.20) and community led self-efficacy from pre-test (4.40±2.75) to post-test (6.07±3.43; P=0.02; ƞ2=0.24) and pre-test to follow-up (7.07±2.05; P=0.001; ƞ2=0.44). Additionally, significant improvements were found in the LESS-RT following the intervention. CONCLUSIONS: The intervention based on the HBM led to improvements in individual and community led self-efficacy indicating an enhancement in the participants' confidence in their ability to participate in an ERIPP. Future research should investigate the effectiveness of individualized interventions to improve attitudes towards and adherence to ERIPPs.

Comparison of the Y-Balance Test and Star Excursion Balance Test: Utilization of a Discrete Event Simulation.

CONTEXT: The Y-Balance Test (YBT) and Star Excursion Balance Test (SEBT) are commonly used to detect deficits in dynamic postural control. There is a lack of literature on the differences in reach distances and efficiency of the tests. OBJECTIVE: To compare the reach distances of the YBT and SEBT. An additional aim was to compare the time necessary to administer the 2 tests and utilize a discrete event simulation to determine the number of participants who could be screened within different scenarios. DESIGN: Cross-sectional. Laboratory Patients: Twenty-four physically active individuals between the ages of 18-35 years volunteered to participate in this study (M/F: 11/13; age 22.78 [2.63] y, height 68.22 [4.32] cm, mass 173.27 [10.96] kg). INTERVENTION: The participants reported to the laboratory on one occasion and performed the YBT and SEBT. The anterior, posteromedial, and posterolateral reach distances were recorded for each test. In addition, the time to administer each test was recorded in seconds. MAIN OUTCOME MEASURES: The average reach distances and time for each test were used for analysis. Paired t tests were utilized to compare the reach distances and time to administer the 2 tests. A discrete event simulation was used to determine how many participants could be screened using each test. RESULTS: The anterior reach for the SEBT (64.52% [6.07%]) was significantly greater than the YBT (61.66% [6.37%]; P < .01). The administration time for the YBT (512.42 [123.97] s) was significantly longer than the administration time for the SEBT (364.96 [69.46] s; P < .01). The discrete event simulation revealed more participants could be screened using the SEBT when compared with the YBT for every situation. CONCLUSION: Scores on the anterior reach of the SEBT are larger when compared with the YBT. The discrete event simulation can successfully be used to determine how many participants could be screened with a certain amount of resources given the use of a specific test.

THE RELIABILITY OF THE STAR EXCURSION BALANCE TEST AND LOWER QUARTER Y-BALANCE TEST IN HEALTHY ADULTS: A SYSTEMATIC REVIEW.

BACKGROUND: Dynamic balance is often an important criterion used during lower extremity musculoskeletal injury prediction, prevention, and rehabilitation processes. Methods to assess lower extremity dynamic balance include the Star Excursion Balance Test (SEBT) and Lower Quarter Y-Balance Test (YBT). Due to the importance of dynamic balance it is imperative to establish reliable quantification techniques. PURPOSE: To conduct a systematic review to assess the reliability and responsiveness of the SEBT/YBT. STUDY DESIGN: Systematic Review. METHODS: Electronic databases (PubMed, MEDLINE, CINAHL, and SPORTDiscus) were searched from inception to August 2018. Included studies examined the intra- and inter-rater reliability of the SEBT/YBT in healthy adults. Two investigators independently assessed methodological quality, level of evidence and strength of recommendation with the Qualtiy Appraisal of Reliability Studies (QAREL) scale. Relative intra and inter-rater reliability was examined through intraclass correlation coefficients (ICC) and responsiveness was evaluated through minimal detectable change (MDC). Data was analyzed based on reach direction (Anterior, Posteromedial, and Posterolateral) and normalization (normalized and non-normalized). Additionally, data were then synthesized using the strength of recommendation taxonomy to provide a grade of recommendation. RESULTS: A total of nine studies were included in this review. Six studies examined the inter-rater reliability and seven assessed intra-rater reliability. The included studies had a median QAREL score of 66.89% (range = 55.56% to 75.00%) and 59.03% (range = 33.33 to 66.67%) for inter and intra-rater reliability respectively. Median ICC values for inter-rater reliability were 0.88 (Range = 0.83 - 0.96), 0.87 (range = 0.80 - 1.00), and 0.88 (range = 0.73 - 1.00) for the anterior, posteromedial, and posterolateral directions respectively. Median ICC values for intra-rater reliability were 0.88 (Range = 0.84 - 0.93), 0.88 (Range = 0.85 - 0.94), and 0.90 (Range = 0.68 - 0.94) for the anterior, posteromedial, and posterolateral directions, respectively. CONCLUSIONS: There is grade A evidence to support that the SEBT/YBT have excellent inter and intra-rater reliability when used in healthy adults. Furthermore, minimal detectable change values have been provided that can be used in practice to aid clinical decision making. Future research is needed to assess the reliability, responsiveness, and validity of the SEBT/YBT in pathologic populations. LEVEL OF EVIDENCE: 1a.

Use of Social or Behavioral Theories in Exercise-Related Injury Prevention Program Research: A Systematic Review.

BACKGROUND: The use of social or behavioral theories within exercise-related injury prevention program (ERIPP) research may lead to a better understanding of why adherence to the programs is low and inform the development of interventions to improve program adherence. There is a need to determine which theories have been used within the literature and at what level theory was used to further the field. OBJECTIVE: To determine which social or behavioral science theories have been incorporated within ERIPP research and assess the level at which the theories were used. The key question guiding the search was "What social or behavioral theories have been used within ERIPP research?" METHODS: A systematic review of the literature was completed with an appraisal of bias risk using a custom critical appraisal tool. An electronic search of EBSCOhost (Academic Search Complete, CINAHL, Medline, Psychology and Behavioral Sciences Collection) and PubMed was completed from inception to October 2018. Studies investigating attitudes towards ERIPP participation with the use of a social or behavioral theoretical model or framework were eligible for inclusion. RESULTS: The electronic search returned 7482 results and two articles were identified though a hand search, which resulted in ten articles meeting inclusion criteria. Four different behavioral or social theoretical models or frameworks were identified including the health action process approach model, health belief model, self-determination theory, and theory of planned behavior. Six studies utilized the theory at a B level meaning a theoretical construct was measured while four utilized the theory at the C level meaning the theory was tested. The mean critical appraisal score was 78%, indicating a majority of the studies were higher quality. CONCLUSION: There has been an increase in the use of theory within literature that is specific to ERIPP participation. Additionally, the use of theory has shifted from guiding program design to the measurement of theoretical constructs and testing of the theoretical models.

Health Belief Model Scale and Theory of Planned Behavior Scale to assess attitudes and perceptions of injury prevention program participation: An exploratory factor analysis.

OBJECTIVES: To examine the psychometric properties of the Health Belief Model Scale (HBMS) and Theory of Planned Behavior Scale (TPBS), and determine construct validity by evaluating which subscales were most associated with intention to participate in an Exercise-related Injury Prevention Program (ERIPP) within physically active adults. DESIGN: Cross-sectional. METHODS: Two hundred and eighty-four physically active individuals volunteered to participate in this study and completed the HBMS and TPBS on one occasion. The HBMS consisted of 39 items and the TPBS consisted of 22 items. Both scales aimed to assess attitudes and perceptions of ERIPP participation. Exploratory factor analysis evaluated the loading factors of the HBMS and TPBS. Linear regression determined if the HBMS and TPBS subscales were predictors of intention to participate in an ERIPP. RESULTS: Nine factors were identified within the HBMS and five factors were identified within the TPBS. The subscales of the HBMS and TPBS had acceptable internal consistencies. Perceived benefits, social norms, and social influence from the TPBS and perceived benefits, individual self-efficacy, and general health cues from the HBMS were positively and significantly associated with intention to participate while perceived barriers had a negative association. CONCLUSIONS: The HBMS and TPBS demonstrated strong psychometric properties to assess behavioral determinants of ERIPP participation within physically active adults. The social influence, social norm, and individual self-efficacy subscales were the best predictors of intention to participate followed by benefits, general health cues, and barriers.