Digital Health Literacy and Social Determinants of Health Affecting Telehealth Use by Athletic Trainers.

CONTEXT: While increasing telehealth use throughout sports medicine has improved patients' access to health care, some communities may not have the same opportunities to connect with a provider. Barriers to telehealth implementation can be influenced by internal (eg, provider's digital health literacy and resources) and external (eg, community's social determinants of health or "SDOH") factors. This study aimed to assess the impact of internal and external factors on telehealth use by athletic trainers (ATs). DESIGN: Cross-sectional survey. METHODS: In total, 767 ATs participated in the study. Participants (age = 39 [13] y) completed a survey containing the electronic health literacy scale and digital health literacy instrument, reported professional use of telehealth as a provider (yes/no), provided resources at their clinical site, and provided the zip code for the community they served. After data collection, the researchers extracted SDOH information using the zip code data from 2 US databases, including population density, median household income, poverty index, education level, and technology access. Chi-square or independent samples t tests were conducted to compare telehealth use by each SDOH factor. RESULTS: In total, 62.3% (n = 478/767) of ATs reported using telehealth, and 81.6% of ATs (n = 626) had a dedicated facility to offer health care services. We identified a significant difference in digital health literacy scores between users and nonusers of telehealth (P = .013). We did not identify any significant differences between telehealth users by community type (P = .957), population density (P = .053), income (P = .462), poverty index (P = .073), and computer (P = .211) or broadband internet access (P = .295). CONCLUSIONS: Our data suggest that internal factors such as digital health literacy and clinical site resources may have contributed to an AT's previous telehealth use in clinical practice. However, the SDOH data extracted from the community zip code where the AT provided clinical services were similar for those with and without previous telehealth use.

Attitudes and Beliefs of Wildland Firefighters Toward Occupational Health Services.

CONTEXT: Wildland firefighters (WLFFs) are at an increased risk of health conditions, injuries, and illnesses related to sustained levels of intense physical activity. The purpose of this study was to identify and explore the current attitudes and beliefs of WLFFs regarding health services. Methods: We used consensual qualitative research design for this study. Participants engaged in an online, semistructured interview. Results: We identified four domains: (1) risk mitigation strategies, (2) culture of fire services, (3) access to health care services, and 4) identification of health care gap. Conclusions: Access to occupational health services for WLFFs is readily available in the form of emergency medical care. However, a lack of regular access to physical medicine and the continuation of care beyond acute treatment was apparent.

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. 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.

Differences in Access to Athletic Trainers in Public Secondary Schools Based on Socioeconomic Status.

CONTEXT: Significant health care disparities exist in the United States based on socioeconomic status (SES), but the role SES has in secondary school athletes' access to athletic training services has not been examined on a national scale. OBJECTIVE: To identify differences in access to athletic training services in public secondary schools based on school SES. DESIGN: Cross-sectional study. SETTING: Database secondary analysis. PATIENTS OR OTHER PARTICIPANTS: Data for 3482 public high schools. MAIN OUTCOME MEASURE(S): Data were gathered from the Athletic Training Locations and Services (ATLAS) database, US Census Bureau, and National Center for Education Statistics. We included schools from 5 states with the highest, middle, and lowest poverty percentages (15 states total) and collected county median household income, percentage of students eligible for free or reduced-price lunch, race and ethnicity demographics, and access to athletic training services (full-time athletic trainer [AT], part-time AT only, no AT) for each school. Data were summarized in means, SDs, medians, interquartile ranges (IQRs), frequencies and proportions, 1-way analyses of variance, and Kruskal-Wallis tests. RESULTS: Differences were present in school SES between schools with full-time, part-time-only, and no athletic training services. Schools with greater access to athletic training services had fewer students eligible for free or reduced-price lunch (full time: 41.1% ± 22.3%, part time only: 45.8% ± 24.3%, no AT: 52.9% ± 24.9; P < .001). Similarly, county median household income was higher in schools with increased access to athletic training services (full time median [IQR]: $56 026 [$49 085-$64 557], part time only: $52 719 [$45 355-$62 105], and no AT: $49 584 [$41 094-$57 688]; P < .001). CONCLUSIONS: Disparities in SES were seen in access to athletic training services among a national sample of public secondary schools. Access to ATs positively influences student-athletes' health care across several measures. Pilot programs or government funds have been used previously to fund athletic training services and should be considered to ensure equitable access, regardless of school SES.

Core and Whole-Body Vibration Exercise Improve Military Foot March Performance in Novice Trainees: A Randomized Controlled Trial.

INTRODUCTION: The purpose of the present study was to investigate core exercise training and whole-body vibration (WBV) as a training method to improve performance and recovery from an 8-km military foot march in novice trainees. MATERIALS AND METHODS: A 3 × 5 repeated measures randomized control trial was used to evaluate the effects of core exercise training and WBV on performance and recovery from an 8-km foot march. Thirty-nine participants were randomized into three groups: core exercise (Ex), WBV with core exercise (WBVEx), and control. Each participant completed two 8-km foot marches (FM1 and FM2) with a 35 pound rucksack, separated by 4 weeks. Participants in the Ex and WBVEx groups completed 3 weeks of core exercise training, three times per week in between FM1 and FM2. Performance time, creatine kinase (CK), and interleukin-6 (IL-6) were measured. The Auburn University Institutional Review Board approved all aspects of this study (protocol number: 19-211 MR 1907). RESULTS: Performance time (P < .001) and CK (P = .005) were significantly improved during FM2 as compared to FM1. The Ex (d = -0.295) and WBVEx (d = -0.645) treatments had a large effect on performance time. CK (P < .001) and IL-6 (P < .001) were significantly elevated at the completion of the foot march regardless of group. Only CK remained elevated for 2 days (P < .001) following the foot march. CONCLUSIONS: Core exercise training with or without WBV improved 8-km foot march performance time by 5-6 minutes. The improvements are likely because of an increase in trunk stability. Additionally, this study showed that completing two identical foot marches a month apart increases performance and improves recovery.

Experiences of Athletic Trainers in Tactical Athlete Settings When Managing Patients With Mental Health Conditions.

CONTEXT: Researchers have demonstrated that job demands impair tactical athletes' mental health. Mental health stigmas in this population and limited resources may prevent individuals from receiving care. Athletic trainers (ATs) are often the first, and sometimes the only, contact for mental health concerns. Previous literature indicated that ATs desired more psychosocial training and experience. OBJECTIVE: To investigate ATs' preparedness and experiences managing patients with mental health conditions in the tactical athlete setting. DESIGN: Consensual qualitative research study. SETTING: One-on-one, semistructured interviews. PATIENTS OR OTHER PARTICIPANTS: Fifteen ATs (men = 7, women = 8; age = 36 ± 10 years; experience in tactical athlete setting = 4 years [range, 6 months-20 years]; military = 12, law enforcement = 2; fire service = 1). MAIN OUTCOME MEASURE(S): Interviews followed a 9-question protocol focused on job setting preparation, mental health training, and perceived role managing patients with mental health concerns. Interviews were audio recorded and transcribed verbatim. A 3-person coding team convened for data analysis following the consensual qualitative research tradition. Credibility and trustworthiness were established using a stability check, member checking, and multianalyst triangulation. RESULTS: Four domains emerged surrounding ATs' mental health management experiences with tactical athletes: (1) population norms, (2) provider preparation, (3) provider context, and (4) structure of job responsibilities. Most ATs felt their educational experiences lacked comprehensive mental health training. Some participants described formal employer resources that were optional or mandatory for their job, whereas others engaged in self-education to feel prepared for this setting. Participants shared that unfamiliar experiences, such as divorce and deployment, influenced their context as providers. Most ATs had no policy related to mental health care and referral, indicating it was outside their responsibilities or they were unsure of role delineation. CONCLUSIONS: For ATs working with tactical athletes, our respondents suggested that additional mental health education and training are necessary. They also indicated that improvement is needed in job structure regarding role delineation and the establishment of policies regarding behavioral health.

Psychological Ownership in Athletic Training.

CONTEXT: Psychological ownership (PO) is a state in which an individual feels possession over an object, organization, or entity (eg, PO over the organization where one works, PO over the profession one serves). Understanding PO could provide insight into the "vitality of the profession" as defined in the Prioritized Research Agenda for the Athletic Training Profession. OBJECTIVE: To explore athletic trainers' (ATs') PO over their employing organizations and the athletic training profession. DESIGN: Cross-sectional study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: Clinically practicing ATs who were active members of the National Athletic Trainers' Association. MAIN OUTCOME MEASURE(S): Demographic variables, Psychological Ownership Questionnaire (POQ) scores, and Psychological Ownership Questionnaire for athletic training (POQ-AT) scores were the primary outcomes measured. Descriptive statistics were calculated for the demographic variables, POQ and POQ-AT overall scores, form scores, and dimension scores. Nonparametric tests were used to investigate differences between the POQ and POQ-AT by demographic characteristics. RESULTS: The ATs indicated greater PO over the athletic training profession (Z = -3.45, P = .001) than over their employing organizations. They displayed greater belongingness (Z = -9.51, P < .001) and self-identity (Z = -8.71, P < .001) and less territoriality (Z = -5.52, P < .001) and accountability (Z = -5.33, P < .001) over their profession than their organization. Those ATs who supervised others had higher overall POQ (Mann-Whitney U test = 34 372, P < .001) and overall POQ-AT (U = 36 624, P = .014) scores than ATs who did not supervise others. A difference was evident in overall POQ (Kruskal-Wallis statistical analysis H4 = 20.47, P < .001) and overall POQ-AT (H4 = 21.34, P < .001) scores by years of experience. CONCLUSIONS: Respondents indicated greater PO over their profession than their employing organizations. They demonstrated greater self-identity and belongingness and less territoriality and accountability over the athletic training profession than over their employing organization, suggesting that they were connecting aspirations and accomplishments with the profession but connecting duty and responsibility with their organizations. Years of experience and supervisor status may play roles in the level of organizational PO.

Core and Whole Body Vibration Exercise Influences Muscle Sensitivity and Posture during a Military Foot March.

Military foot marches account for 17-22% of Army musculoskeletal injuries (MSI), with low back pain (LBP) being a common complaint. Core-exercise and whole-body vibration (WBV) have been shown to decrease LBP in patients with chronic low back MSI. This study investigated if WBV and/or core-exercise influenced LBP or posture associated with a military ruck march. A randomized control trial with three groups: (1) WBV and core-exercise (WBVEx); (2) core-exercise alone (Ex); and (3) control evaluated the effects of core-exercise and WBV on LBP during/after a two 8 K foot marches with a 35 lb rucksack. The intervention groups completed three weeks of core-exercise training with/without WBV. Outcome measurements included visual analog scale (VAS), algometer, posture and electromyography (EMG). LBP, pressure threshold, and posture were elevated throughout the foot march regardless of group. LBP remained elevated for 48 h post foot march (p = 0.044). WBVEx and Ex did not have a significant effect on LBP. WBVEx and Ex both decreased muscle sensitivity and increased trunk flexion (p < 0.001) during the second foot march (FM2). The 8 K foot marches significantly increased LBP. Core-exercise training with/without WBV decreases low back muscle sensitivity. WBV and core-exercise increases trunk flexion which may help improve performance and may influence LBP.

The promotion of injury and illness prevention and reporting in the fire service.

BACKGROUND: Injury prevention interventions are limited in the fire service due to a lack of widespread implementation and underreporting. This creates a significant challenge to improving occupational health. OBJECTIVE: To determine how fire chiefs are promoting reporting and the prevention of physical and mental injuries and illnesses. METHODS: We used an open-ended, qualitative instrument to assess the presence of prevention programs and actions to promote injury and illness reporting in the fire service. The instrument contained six content validated items related to the promotion of prevention interventions and reporting. RESULTS: A total of 54 fire chiefs (age = 51±8y; females = 4, males = 50, years of experience as fire chief = 7±6y) responded to the instrument. A majority (n = 37/54, 68.5%) of the fire chiefs indicated their department had an established health and wellness program. Most fire chiefs reported using established guidelines, education, and a supportive culture to promote prevention and reporting. The cultural stigma of being a firefighter and fear of repercussions were barriers to the promotion of reporting of illness and injury. Fire chiefs stated that they struggled to find ways to effectively promote reporting and prevention strategies. CONCLUSIONS: The success of a fire chief's promotional efforts was greater in instances where multiple factors were addressed.

Athletic Trainers' Job Tasks and Status During the COVID-19 Pandemic: A Preliminary Analysis.

CONTEXT: In December 2019, severe acute respiratory syndrome coronavirus 2, also known as the novel coronavirus disease 2019 (COVID-19), became a global public health crisis. Government officials in the United States subsequently responded by issuing lockdown orders that closed schools, terminated sports, and resulted in many people transitioning to working from home, immediately affecting the ability of athletic trainers (ATs) to practice clinically. OBJECTIVE: To describe the job status, job duties, telemedicine use, and resiliency of ATs during the COVID-19 pandemic. DESIGN: Cross-sectional study. SETTING: Mixed-methods survey. PATIENTS OR OTHER PARTICIPANTS: A total of 611 ATs (age = 32 ± 13 years). MAIN OUTCOME MEASURE(S): The survey consisted of 6 demographic questions, a job status assessment (3 questions, 1 open-ended prompt), a telemedicine use assessment (5 questions, 2 open-ended prompts), and the 6-item Brief Resilience Scale. Qualitative analyses were completed using Text iQ technology and descriptive statistics, and cross-tabulations were conducted using follow-up χ2 comparisons of resiliency with job setting and telemedicine use. RESULTS: Most ATs continued to work in some capacity throughout the COVID-19 pandemic and expressed optimism about the likelihood that their job status and setting would return. However, participants shared financial and mental health concerns because of reduced pay, stress, and uncertainty about the future. We also identified versatility within the profession, as ATs were serving in new roles related to COVID-19 or adopting telemedicine (n = 251, 41.1%). Athletic trainers were implementing all domains of clinical practice using telemedicine, yet most did not consult legal counsel on or have formal training in the delivery method before implementation. Finally, most ATs exhibited normal resilience that was not affected by job setting (χ2 = 26.901, P = .68) or the use of virtual health care (χ2 = 2.597, P = .27). CONCLUSIONS: The COVID-19 pandemic has affected ATs' jobs, and in many cases, the ATs have demonstrated adaptability and value in assuming various roles in the larger health care system.

Telemedicine Experiences of Athletic Trainers and Orthopaedic Physicians for Patients With Musculoskeletal Conditions.

CONTEXT: Telemedicine is the delivery of medical care from a distance using technology. The integration of telemedicine as a supplement to musculoskeletal-based patient encounters may be feasible in sports medicine. OBJECTIVE: To investigate health care professionals' perceptions of and experiences with telemedicine. DESIGN: Cross-sectional explanatory sequential mixed-methods study. PATIENTS OR OTHER PARTICIPANTS: A purposeful sample of 17 athletic trainers from a National Collegiate Athletic Association Division I institution and 5 orthopaedic physicians from a sports medicine clinic located 92 miles from the campus. INTERVENTION(S): Participants were trained on the telemedicine platform and used it over 5 months for initial, follow-up, and discharge patient encounters. MAIN OUTCOME MEASURE(S): Participants completed a preintervention survey containing the Theory of Planned Behavior and Technology Acceptance Model tool. Responses were analyzed using descriptive statistics and an independent-samples t test. After the intervention period, participants completed individual semistructured interviews that we coded using the consensual qualitative research tradition. RESULTS: From the interviews, the clinicians were characterized as telemedicine adopters (n = 14) or nonadopters (n = 8). The adopters reported higher levels of agreement on the Theory of Planned Behavior and Technology Acceptance Model tool as compared with nonadopters for all constructs. When comparing adoption status, we identified a difference (P < .01), with nonadopters reporting a low level of agreement for the subjective norm construct. The interviews revealed 5 domains: integration challenges, integration opportunities, collaborative practice, anticipatory socialization to future use, and benefits of integration. The participants indicated that integration challenges centered on "buy in," whereas opportunities aligned with the patient's condition and technology ease of use. They reflected that the telemedicine encounters required more preparation and yet allowed for cooperative behaviors between clinicians. The benefits of telemedicine included convenience and scheduling preferences that encouraged future use. CONCLUSIONS: The integration of telemedicine in sports medicine brought about both challenges and opportunities for collaboration among athletic trainers and physicians that were heavily predetermined by the social pressures of colleagues.

Sequential Pulse Compression's Effect on Blood Flow in the Lower-Extremity.

CONTEXT: Several interventions are available to reduce the intensity and duration of the unwanted effects (eg, muscle soreness) associated with physical activity, such as massage, compression garments, and sequential pulse compression (SPC). Such interventions aim to increase blood flow to alleviate symptoms. However, there is a lack of evidence to support the use of SPC to alter total hemoglobin concentration (THb) in active individuals. OBJECTIVE: To examine the acute effects of a single session of SPC on hemoglobin concentration compared with a control condition. DESIGN: Single cohort, crossover design. PARTICIPANTS: Thirty-four physically active and healthy participants (females = 12 and males = 22) completed the study. INTERVENTIONS: The authors randomly assigned participants to first receive the experimental (SPC) or control condition. Measures were recorded precondition and postcondition. Participants returned to the laboratory to complete the second condition ≥24 hours after the first condition. MAIN OUTCOME MEASURES: Relative changes in THb, deoxygenated hemoglobin, and oxygenated hemoglobin measures were recorded using near-infrared spectroscopy placed on the muscle belly of the medial gastrocnemius of the dominant limb. RESULTS: SPC significantly increased THb (P < .001, d = 0.505) and oxygenated hemoglobin (P < .001, d = 0.745) change scores compared with the control condition. No statistical difference in deoxygenated hemoglobin change scores was found between the SPC and control conditions, but a medium effect size suggests potential biological significance (P = .06, d = 0.339). CONCLUSIONS: Overall, SPC increases THb to the lower-extremity and may be a viable option in the management of muscle soreness related to physical activity.

Functional Performance of Firefighters After Exposure to Environmental Conditions and Exercise.

CONTEXT: Slips, trips, and falls are leading causes of musculoskeletal injuries in firefighters. Researchers have hypothesized that heat stress is the major contributing factor to these fireground injuries. OBJECTIVE: To examine the effect of environmental conditions, including hot and ambient temperatures, and exercise on functional and physiological outcome measures, including balance, rectal temperature, and perceived exertion. DESIGN: Randomized controlled clinical trial. SETTING: Laboratory environmental chamber. PATIENTS OR OTHER PARTICIPANTS: A total of 13 healthy, active career firefighters (age = 26 ± 6 years [range = 19-35 years], height = 178.61 ± 4.93 cm, mass = 86.56 ± 16.13 kg). INTERVENTION(S): Independent variables consisted of 3 conditions (exercise in heat [37.41°C], standing in heat [37.56°C], and exercise in ambient temperature [14.24°C]) and 3 data-collection times (preintervention, postintervention, and postrecovery). Each condition was separated from the others by at least 1 week and lasted a maximum of 40 minutes or until the participant reached volitional fatigue or a rectal temperature of 40.0°C. MAIN OUTCOME MEASURE(S): Firefighting-specific functional balance performance index, rectal temperature, and rating of perceived exertion. RESULTS: Exercise in the heat decreased functional balance, increased rectal temperature, and altered the perception of exertion compared with the other intervention conditions. CONCLUSIONS: A bout of exercise in a hot, humid environment increased rectal temperature in a similar way to that reported in the physically active population and negatively affected measures of functional balance. Rather than independently affecting balance, the factors of exercise and heat stress appeared to combine, leading to an increased likelihood of slips, trips, and falls.

Triple Hop for Distance as a Predictor of Lower Extremity Performance in Firefighter Equipment.

The objective of this study was to examine the predictive value of the Triple Hop for Distance (THD) physical performance test to assess lower extremity (LE) strength and power in individuals donning firefighter personal protective equipment (PPE). Thirty-one healthy participants completed the THD in firefighter PPE on both the dominant and non-dominant limb. Dependent variables included LE power (vertical jump height [cm]) on a jump mat, and LE strength of the quadriceps and hamstrings (peak torque [Nm]) on an isokinetic dynamometer. THD was a strong predictor of LE power on the dominant (p<0.01) and non-dominant (p<0.01) limbs. THD was also a moderate predictor of LE strength on both the dominant limb (Ham60 [p<0.01]), Quad60 [p<0.01]), and the non-dominant limb (Ham60 [p<0.01]), (Quad60 [p<0.01]). The THD was found to be a strong and valid predictor for clinical measures of LE power and strength in firefighter PPE.

The effect of structural firefighter protective clothing systems on single-legged functional hop test scores.

BACKGROUND: Firefighters must complete a physical ability test to assess work readiness. There is a lack of understanding of how personal protective clothing (PPC) affects functional performance tests for work readiness, e.g. Triple Hop for Distance (THD) and Triple Hop for Work (THW). OBJECTIVE: To examine firefighter PPC's effect on the THD and THW measures. METHODS: Thirty-one healthy, untrained participants (male = 20, female = 11; age = 23±3 years; height = 175.30± 11.12 cm; mass = 77.94±14.24 kg; mass in PPC = 89.14±14.68 kg) completed three successful trials of the THD on their dominant and non-dominant leg, with and without PPC. The main outcome measures included maximum and mean distances on the THD with and without PPC and THW. RESULTS: We identified a significant decrease in THD measures (mean difference = 97.83 cm; p <  0.001) and THW measures (mean difference = -326.61J; p <  0.001) when donning PPC in the dominant leg. We identified a significant decrease in THD (mean difference = 121.48 cm; p <  0.001) and THW (mean difference = 493.15J; p <  0.001) for females, and a significant difference for THD (mean difference = 84.83 cm; p <  0.001) for males when donning PPC. CONCLUSIONS: The addition of PPC decreased the THD and THW measures. The additional mass of the PPC required the more energy to move the same distance without the PPC.

Personal protective ensembles' effect on dynamic balance in firefighters.

BACKGROUND: Firefighting specific personal protective ensembles (PPE) have decreased the number of injuries and illnesses related to exposure to fire products; however nearly half of fire related injuries are musculoskeletal in nature. The external load of the PPE may contribute to balance deficits; placing firefighters at an increased risk of injury. OBJECTIVE: To determine the effects of PPE on dynamic balance in firefighters. METHODS: Forty male firefighters (age = 37.1±8.2y; height = 182.7±8.5 cm; mass = 98.9±14.4 kg; years of experience = 11.0±6.2y) completed this study. Participants completed the dynamic balance tasks in station attire (- PPE) and while donning firefighting specific PPE (+PPE) (mass of PPE = 23.8±2.1 kg). We measured dynamic balance using the lower quarter Y Balance Test with average measures of three trials in the anterior, posteromedial, and posterolateral reach for each limb. RESULTS: We found significant negative alterations in dynamic balance with the addition of PPE for the right anterior (mean difference = - 3.4±3.1 cm; p <  0.001), left anterior (mean difference = - 3.9±3.6 cm; p <  0.001), right posterolateral (mean difference = - 6.9±6.1 cm; p <  0.001), left posterolateral (mean difference = - 5.3±5.5 cm; p <  0.001), right posteromedial (mean difference = - 4.3±6.8 cm; p <  0.001), and left posteromedial (mean difference = - 4.0±6.8 cm; p <  0.001) reach directions. CONCLUSIONS: Firefighting PPE negatively influences dynamic balance. Proactive injury reduction strategies should be utilized in firefighters to mitigate the influence of PPE during work-related tasks.

Lesbian, Gay, Bisexual, Transgender, and Queer Patients: Collegiate Athletic Trainers' Perceptions.

CONTEXT: Research suggests that patients who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) are at risk for certain conditions and denied equal access to health care in physician offices compared with their heterosexual counterparts. However, little evidence exists regarding the treatment of LGBTQ student-athlete patients in the athletic training clinic and the role the athletic trainer (AT) plays in these health care experiences. OBJECTIVE: To explore the perceptions of ATs treating LGBTQ student-athlete patients. DESIGN: Cross-sectional study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: A total of 1077 collegiate and university ATs completed the survey (5685 e-mails distributed, 1214 surveys started, access rate = 21.4%, completion rate = 88.7%). MAIN OUTCOME MEASURE(S): Demographic information and level of agreement in 3 areas (approach, quality of care, and comfort) were obtained on a 5-point Likert scale. We asked ATs their likeliness of providing guidance to student-athletes about navigating their sexuality generally and as it related to athletic participation, if they thought they provided equal health care to a student-athlete who identified as LGBTQ, how comfortable they were treating LGBTQ student-athlete patients, and how comfortable they thought student-athlete patients would be seeking care from them or from providers in their clinic. RESULTS: Overall, we found differences among groups for sexual orientation, gender, religion, and the existence of interpersonal contact with LGBTQ friends or family for approach, quality of care, and comfort. We also identified 2 main themes indicating ATs' desire for more training and education, specifically in caring for transgender student-athletes and providing patient-centered care with professionalism, regardless of gender identity or sexual orientation. CONCLUSIONS: Although differences existed among demographic groups, ATs had a generally positive view of treating LGBTQ student-athlete patients and wanted more training and education on the specific needs of this population.

The Use of Patient-Reported Outcome Measures: Secondary School Athletic Trainers' Perceptions, Practices, and Barriers.

CONTEXT: Incorporating patient-reported outcomes (PROs) into daily routine is essential for patient-centered clinical practice. Secondary school athletic trainers (ATs) may encounter unique barriers that limit their willingness to use PROs. OBJECTIVE: To explore how secondary school ATs who were using PROs perceived their application, benefits, and problems compared with those who did not. DESIGN: Cross-sectional study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: A total of 2984 secondary school ATs received an e-mail invitation, and 322 completed the survey (response rate = 10.8%). Respondents were 43 ± 10 years old, with most indicating at least 11 years as a Board of Certification-certified AT (n = 276, 85.7%). MAIN OUTCOME MEASURE(S): The ATs were invited to complete a Web-based survey regarding the uses and benefits of and problems with PROs. Those using PROs in clinical practice were asked their criteria for selecting the measures, whereas those not using PROs were asked their reasons for not using them. Dependent variables were endorsements of uses and benefits of and problems with PROs. RESULTS: The most commonly cited uses of PROs were determining treatment effectiveness (193/264, 73%) and demonstrating effectiveness to administration (174/264, 66%). Improving communication with the patient (267/296, 90%) and helping to direct the plan of care (256/297, 86%) were the most frequently endorsed benefits of PROs. Time to score and analyze (152/284, 53%) and time for patients to complete (134/284, 47%) PROs were the problems encountered most often. For ATs not using PROs (223/262, 85%), the most frequent reason was the lack of a support structure (102/219, 46%). For ATs using PROs (39/262, 15%), quick completion times (32/39, 82%) was the most common criterion used to select individual measures. CONCLUSIONS: A majority of secondary school ATs recognized the benefits of PROs and yet did not use them in clinical practice due to setting-specific barriers.

Lesbian, Gay, Bisexual, Transgender, and Queer Athletic Trainers: Collegiate Student-Athletes' Perceptions.

CONTEXT: Lesbian, gay, bisexual, transgender, and queer (LGBTQ) athletic trainers (ATs) face uncertain acceptance in the workplace. OBJECTIVE: To examine the perceptions of National Collegiate Athletic Association (NCAA) student-athletes toward ATs who identified as LGBTQ. DESIGN: Cross-sectional design. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: A total of 623 (males = 212, females = 403, other = 8; age = 19.7 ± 1.4 years) NCAA student-athletes completed the survey. MAIN OUTCOME MEASURE(S): Participants completed a 19-item survey to assess their perceptions about the appropriateness of, quality of care from, and comfort with ATs who identified as LGBTQ. We asked 10 demographic questions and 2 questions regarding the student-athlete's exposure to individuals who identified as LGBTQ. Five matrix questions had 5 stems each to represent LGBTQ individuals on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree) and 2 open-ended questions elicited qualitative data. We analyzed characteristics of central tendency to evaluate the level of appropriateness, quality of care, and level of comfort perceived by student-athletes of ATs who identified as LGBTQ. We used Mann-Whitney U and Kruskal-Wallis tests for post hoc analyses where appropriate. We used grounded theory to identify themes in the answers to the open-ended questions. RESULTS: Participants indicated they would seek health care and would feel comfortable approaching an AT who identified as LGBTQ. Participants agreed it was appropriate for an LGBTQ AT to work with both male and female sports and did not agree that health care provided by heterosexual and LGBTQ ATs differed. The open-ended responses revealed 4 themes: professionalism, upbringing, situational concerns, and concerns about specific populations that affected their perceptions. CONCLUSIONS: In general, the NCAA student-athletes had positive perceptions of ATs who identified as LGBTQ.

Local Pressure Application Effects on Neurological and Circulatory Function.

BACKGROUND: Pain and discomfort reported during sitting is a significant problem for aviators during prolonged missions. Previous work has determined that areas of local pressure exist during prolonged sitting in UH-60 seat systems; however, no work has examined the effects of this local pressure on measures of neurological and circulatory function. METHODS: A total of 30 healthy subjects completed the study in which focal pressure was applied in three conditions (no pressure, pressure to the ischial tuberosity, and pressure to the posterior thigh). We applied pressure using a purpose-built pressure application system allowing subjects to sit in a position mimicking the sitting position in a UH-60 Black Hawk helicopter and measurements were taken before, during, and after pressure application. We measured neurological function with the soleus Hoffmann reflex and sural nerve conduction velocity, and circulatory function with dynamic infrared thermography. RESULTS: We found a decrease in soleus Hoffmann reflex by 0.87 V and 0.52 V during pressure application at the posterior thigh and ischial tuberosity, respectively. No changes in nerve conduction velocity were found among the conditions during or after pressure application. Limb temperature increased 0.42-0.44°C during pressure application, but began to return to baseline once pressure was removed. DISCUSSION: This study examined the development of neurological and circulatory alterations due to local pressure application in an aviation specific functional position. These results may be used in the development of future interventions to mitigate the negative effects of localized pressure in military aviators.Games KE, Lakin JM, Quindry JC, Weimar WH, Sefton JM. Local pressure application effects on neurological and circulatory function. Aerosp Med Hum Perform. 2018; 89(8):693-699.