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

CONTEXT: Addressing social determinants of health (SDH) in all populations improves patient outcomes, leading to better patient-centered care. Despite known influences of SDH, little is known about the ability of athletic trainers (ATs) to observe SDH in practice. OBJECTIVE: To explore ATs' observations of SDH and describe actions taken at the point-of-care in college/university settings. DESIGN: Descriptive via an observational card study. SETTING: Athletic training facilities. PARTICIPANTS: ATs (23 participants across 20 institutions) employed in the college/university setting. DATA COLLECTION AND ANALYSIS: ATs used a modified observation card to document observations of SDH during patient encounters in the college/university setting. Cards contained instructions for completion and a table with 4 columns: (1) a list of 19 predetermined SDH, (2) checkbox for observed SDH, (3) checkbox for perceived negative influence of observed SDH on patient health, and (4) open box to write in what actions, if any, were taken to address the observed SDH. RESULTS: Overall, 424 cards were collected. Of 725 observed SDH, 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 16.4%), and transportation issues (32/281, 11.4%) were most common. For the 23.0% (166/725) of SDH acted on, 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 SDH, they can promote better patient-centered care and improve patient outcomes. Our results suggested many SDH observed by ATs in the college/university setting had a negative influence on patient health. Better support for patients with behavioral health issues and academic stressors is important because these SDH were commonly perceived to negatively influence health and well-being.

Negotiation Practices of Athletic Trainers Employed in the Clinical Setting.

CONTEXT: Athletic trainers (ATs) are comparatively underpaid relative to peer health care professionals. Whereas many factors contribute to the salary and benefits of a given employment position, negotiation is a factor of the final salary and benefits package that is achieved. It is unclear to what extent ATs negotiate salary or other terms of employment during the hiring process. OBJECTIVE: To explore the negotiation practices of ATs during the hiring process. DESIGN: Cross-sectional study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: A total of 587 ATs employed in the clinical setting who previously held at least 1 full-time employment position. MAIN OUTCOME MEASURE(S): Independent variables were several demographic factors as well as the current salary range. Dependent variables were participants' responses to various survey items focused on experiences with salary and terms-of-employment negotiation. Summary statistics were used to characterize all variables and multiple χ2 analyses (P < .05) were performed to determine the significant influences of independent variables on negotiation practices. RESULTS: More than half of ATs (57.6%) did not attempt to negotiate their salary, and almost three-quarters of ATs (70.5%) did not negotiate their terms of employment during the hiring process. The most successfully negotiated terms were moving expenses (72.3%) and continuing education funding and reimbursement (62.7%). The influence of demographic factors on negotiation and negotiation success varied, with significant findings for the number of previous full-time employment positions, gender, marital status, salary range, and number of dependents. CONCLUSIONS: It is alarming that more than half of ATs did not negotiate salary or terms of employment during the hiring process. Whereas widespread training on negotiation practices is warranted, our findings suggest it would be most beneficial for early-career and female ATs. All ATs must become comfortable with negotiating salary and terms of employment to effect change in the average salary and employment status of those in the profession.

Content Validation of the Athletic Training Milestones: A Report from the Association for Athletic Training Education Research Network.

The Athletic Training Milestones were developed as a comprehensive framework to assess athletic trainers' knowledge, skill, and behavior acquisition across the continuum of athletic training practice. However, without established content validity, it is unclear whether the Athletic Training Milestones can be used effectively as a clinical evaluation and research tool to evaluate competence and performance across multiple users and sites. We conducted a highly conservative content validity index (CVI) with data from 12 content experts. Our findings revealed an extremely high overall scale CVI of 0.99, and CVI scores of the 28 individual subcompetency items assessed ranged from 0.83 to 1.00. For the athletic training profession to truly embrace competency-based evaluation and performance assessments, we need a highly valid and comprehensive instrument, such as the Athletic Training Milestones.

Point-of-Care Clinical Trials in Sports Medicine Research: Identifying Effective Treatment Interventions Through Comparative Effectiveness Research.

CONTEXT: Recently, calls to conduct comparative effectiveness research (CER) in athletic training to better support patient care decisions have been circulated. Traditional research methods (eg, randomized controlled trials [RCTs], observational studies) may be ill suited for CER. Thus, innovative research methods are needed to support CER efforts. OBJECTIVES: To discuss the limitations of traditional research designs in CER studies, describe a novel methodologic approach called the point-of-care clinical trial (POC-CT), and highlight components of the POC-CT (eg, incorporation of an electronic medical record [EMR], Bayesian adaptive feature) that allow investigators to conduct scientifically rigorous studies at the point of care. DESCRIPTION: Practical concerns (eg, high costs and limited generalizability of RCTs, the inability to control for bias in observational studies) may stall CER efforts in athletic training. In short, the aim of the POC-CT is to embed a randomized pragmatic trial into routine care; thus, patients are randomized to minimize potential bias, but the study is conducted at the point of care to limit cost and improve the generalizability of the findings. Furthermore, the POC-CT uses an EMR to replace much of the infrastructure associated with a traditional RCT (eg, research team, patient and clinician reminders) and a Bayesian adaptive feature to help limit the number of patients needed for the study. Together, the EMR and Bayesian adaptive feature can improve the overall feasibility of the study and preserve the typical clinical experiences of the patient and clinician. CLINICAL ADVANTAGES: The POC-CT includes the basic tenets of practice-based research because studies are conducted at the point of care, in real-life settings, and during routine clinical practice. If implemented effectively, the POC-CT can be seamlessly integrated into daily clinical practice, allowing investigators to establish patient-reported evidence that may be quickly applied to patient care decisions. This design appears to be a promising approach for CER investigations and may help establish a "learning health care system" in the sports medicine community.

Athletic Trainers' Practice Patterns Regarding Medical Documentation.

CONTEXT: Medical documentation is a required component of patient care in all health care professions. OBJECTIVE: To evaluate athletic trainers' perceived behaviors toward, barriers to, and confidence in their medical documentation. DESIGN: Cross-sectional study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: We purchased a list of randomly selected e-mails from the National Athletic Trainers' Association. Of the 9578 participants, 1150 accessed our questionnaire (12.0% access rate), 1053 completed at least 1 portion, and 904 completed the questionnaire in its entirety (85.8% completion rate). Of the participants, 60.1% (n = 569/947) were female, 66.6% (n = 632/949) held a master's degree, 39.3% (n = 414/1053) worked in a collegiate or university setting, and 36.1% (n = 381/1053) worked in a secondary school setting. MAIN OUTCOME MEASURE(S): We used a 31-item questionnaire with demographics (12 items), medical documentation behaviors (16 items), barriers (2 items), and perceptions (1 multipart item) sections. The questionnaire explored athletic trainers' behaviors as well as confidence in, comfort with, and concerns about their documentation practices (Cronbach α = 0.887). We used descriptive statistics to identify characteristics of central tendency (mean, standard deviation, mode, frequency). RESULTS: Participants always (45.7%, n = 478/1046) or very frequently (39.0%, n = 408/1046) used a double documentation system consisting of electronic and paper records (50.4%, n = 523/1038). They most often documented to provide legal protection (86.8%, n = 914/1053), because it is a legal obligation (79.1%, n = 833/1053), or to track patient progress (83.9%, n = 883/1053). The most frequently cited barriers to medical documentation were time (76.5%, n = 806/1053), managing too many patients (51.9%, n = 547/1053), technological concerns (17.2%, n = 181/1053), and software limitations (17.2%, n = 181/1053). Respondents believed they were competent, comfortable, and confident in their documentation practices. CONCLUSIONS: We were able to evaluate the generalizability of previous research while adding to the understanding of the behaviors toward, barriers to, and perceptions about medical documentation. We confirmed that time and patient load affected the ability to perform high-quality medical documentation.

Implementation Science: Lessons Learned From Evaluating Practice Recommendations for the Care of Patients With Spine Injuries.

Health care providers are encouraged to provide care according to practice recommendations because these suggestions should improve patient care and promote optimal patient outcomes. The goals of these practice recommendations are to improve patient care and promote optimal patient outcomes. However, without integration into clinical practice, the value of practice recommendations in supporting patient care is lost. Unfortunately, little is known about the success of integrating practice recommendations into clinical practice, and targeted efforts to promote integration are likely needed. Implementation research is a broad area of study that focuses on how guidelines, programs, or interventions are put into practice and delivered. The Translating Research Into Injury Prevention Practice (TRIPP) framework consists of 6 stages that support implementation science, and the framework has been used to assist in integrating injury-prevention programs into patient care. The structure of the TRIPP framework makes it applicable to other programs that would benefit from implementation science, including practice recommendations. Stages 5 and 6 of the TRIPP framework emphasize the need to explore the implementation context and factors related to uptake of a program by end users. This commentary highlights our efforts to use methods for implementation research to evaluate stage 5 of the TRIPP framework as it relates to acute care for patients with suspected spine injuries and provides 6 lessons learned that may assist in future efforts to better implement practice recommendations in patient care. Targeted efforts to assist clinicians in implementing practice recommendations may promote their use and ultimately enhance the care provided for patients with a variety of health conditions. An essential component of any implementation effort is understanding end users via stages 5 and 6 of the TRIPP framework, and this understanding may maximize knowledge translation and encourage practice change and advancement.

Future Strategies to Enhance Patient Care Documentation Among Athletic Trainers: A Report From the Athletic Training Practice-Based Research Network.

CONTEXT: High-quality patient care documentation is an essential component of any health care professional's daily practice. Whereas athletic trainers (ATs) recognize the importance of patient care documentation, several barriers may prevent them from producing high-quality patient care documentation. OBJECTIVE: To explore beneficial strategies and techniques that ATs perceived would enhance the quality of patient care documentation in the secondary school setting. DESIGN: Qualitative study. SETTING: Individual telephone interviews. PATIENTS OR OTHER PARTICIPANTS: Ten ATs who were members of the Athletic Training Practice-Based Research Network and employed in the secondary school setting were interviewed (4 men, 6 women with 7.1 ± 7.8 years of athletic training experience). DATA COLLECTION AND ANALYSIS: An individual telephone interview was conducted with each participant. Once transcribed, data were analyzed into common themes and categories per the consensual qualitative research tradition. Trustworthiness of the data was achieved through triangulation strategies: (1) the inclusion of multiple researchers to ensure accuracy and representativeness of the data and (2) participant member checking. RESULTS: Participants identified several documentation strategies they perceived would be helpful to improve the quality of patient care documentation, including mode and consistency of documentation and the need for a standardized process as well as the need for system standardization. In addition, participants discussed the need for more education on patient care documentation. Specifically, they identified ways of learning and strategies for future education to enhance patient care documentation across the profession. CONCLUSIONS: As athletic training continues to evolve, it is crucial that ATs are well educated on how to produce high-quality patient care documentation as a part of routine practice. Continuing professional development opportunities are needed to promote lifelong learning in the area of patient care documentation.

Disablement Model and Health-Related Quality of Life Classification for Patient-Reported Outcomes Measurement Information System (PROMIS) Instruments.

CONTEXT: The National Institutes of Health created a medical research road map that included the development of the Patient-Reported Outcomes Measurement Information System (PROMIS). A key feature of PROMIS was the development of patient-reported outcome measures (PROs) addressing various aspects of health. Understanding disablement dimensions and health-related quality-of-life (HRQOL) domains captured through PROMIS measures will help with instrument selection. OBJECTIVE: To evaluate the pediatric PROMIS PROs and determine the areas of disablement and HRQOL captured within each instrument. DESIGN: Descriptive laboratory study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty-two pediatric PROMIS instruments (19 short forms and 3 profiles). MAIN OUTCOME MEASURE(S): Three raters independently reviewed the PROMIS instruments and categorized each question on each instrument according to the World Health Organization's International Classification of Functioning, Disability, and Health disablement model domains (body functions and structures, activity, participation, environmental factors, personal factors) and HRQOL (psychological, physical, social, spiritual, economic) dimensions. A consensus process determined the final question category. The frequencies of disablement model domains and HRQOL dimensions captured by questions on PROMIS instruments were reported. RESULTS: The most frequently reported disablement model domain was body function and structure, which was captured by questions in 16/22 (73%) pediatric PROMIS instruments, followed by activity (13/22 [59%] pediatric PROMIS instruments) and participation (9/22 [41%] pediatric PROMIS instruments). The most frequently captured HRQOL dimensions were physical and psychological health, both evaluated in 13/22 (59%) of the pediatric PROMIS instruments. The social dimension of HRQOL was assessed in 9/22 (41%) of the pediatric PROMIS instruments. CONCLUSIONS: Pediatric PROMIS fixed-length instruments captured a variety of disablement domains and health dimensions, but, like most PRO instruments, no single PROMIS instrument captured them all. Clinicians and researchers must consider their goals when selecting PRO instruments, which may require implementing multiple instruments and those beyond PROMIS.

Lived Experiences of Adolescent Athletes Following Sport-Related Concussion.

BACKGROUND: Previous studies have identified the effect of sport-related concussion on health-related quality of life through the use of patient-reported outcome measures. However, there has been little research exploring the underlying mechanisms that influence these perceptions of health-related quality of life among adolescent athletes who have sustained a sport-related concussion. PURPOSE: To explore the psychosocial aspects of concussion among adolescent athletes. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 12 interscholastic athletes (4 girls, 8 boys; mean ± SD age, 15.7 ± 1.7 years; grade level, 10.2 ± 1.4) were interviewed via a semistructured interview protocol between 15 and 30 days postinjury. Data analysis was guided by the consensual qualitative research tradition. Themes and categories emerged through consensus by a 3-person research team, and bias was minimized through the use of multiple-analyst triangulation. RESULTS: Participants identified numerous postconcussion symptoms that resulted in increasing difficulty with emotions (eg, irritable, easily frustrated), roles at school (eg, concentration difficulties, fatigue), and roles in their social environment (eg, letting the team down, not being able to contribute to sport). As a result, participants expressed how they tried to minimize or mask symptoms to decrease the potential of being viewed differently by their peers. CONCLUSION: Adolescent athletes perceived a significant effect of sport-related concussion on numerous areas of psychosocial and emotional health and well-being. Anticipatory guidance-with education regarding the possible signs and symptoms, risk factors, and recovery expectations following a concussion-is important to include in postinjury management. A better understanding of sport-related concussion and expected recovery could help to improve perceptions of this injury among interscholastic athletes. Additionally, best practices should be identified to assist health care professionals and school personnel in the development of temporary adjustments or formal academic adjustment policies in the secondary school setting, therefore ensuring that the patients receive the support that they need to maintain their roles as students.

Athletic Trainers' Roles and Responsibilities Regarding Academic Adjustments as Part of the Concussion-Management Process in the Secondary School Setting.

CONTEXT: Athletic trainers (ATs) play a vital role in managing the care of student-athletes after a sport-related concussion, yet little is known about their specific involvement in the implementation of academic adjustments as part of the concussion-management plan. OBJECTIVE: To explore ATs' perceived roles and responsibilities regarding the implementation of academic adjustments for concussed student-athletes. DESIGN: Qualitative study. SETTING: Individual telephone interviews. PATIENTS OR OTHER PARTICIPANTS: Sixteen ATs employed in the secondary school setting (8 women, 8 men; age = 39.6 ± 7.9 years; athletic training experience = 15.1 ± 5.6 years), representing 12 states, were interviewed. DATA COLLECTION AND ANALYSIS: One telephone interview was conducted with each participant. After the interviews were transcribed, the data were analyzed and coded into themes and categories, which were determined via consensus of a 4-person research team. To decrease researcher bias, triangulation occurred through participant member checking, the inclusion of multiple researchers, and an internal auditor. RESULTS: Several categories related to participants' perceptions regarding their roles and responsibilities within the academic-adjustments process emerged from data analysis: (1) understanding of academic adjustments, (2) perceptions of their roles in academic adjustments, (3) initiation of academic adjustments, (4) facilitation of academic adjustments, and (5) lack of a role in the academic-adjustments process. Although most ATs perceived that they had a role in the initiation and facilitation of academic adjustments for concussed student-athletes, some reported they did not want a role in the process. Regardless, participants frequently suggested the need for further education. CONCLUSIONS: These findings highlight that ATs either wanted to be involved in the implementation of academic adjustments but felt further education was needed or they did not want to be involved because they felt that it was not in their area of expertise. To create a cohesive concussion-management team, it is vital that ATs understand their individual and collaborative roles in the secondary school setting.

Athletic Trainers' Reasons for and Mechanics of Documenting Patient Care: A Report From the Athletic Training Practice-Based Research Network.

CONTEXT: Documenting patient care is an important responsibility of athletic trainers (ATs). However, little is known about ATs' reasons for documenting patient care and the mechanics of completing documentation tasks. OBJECTIVE: To understand ATs' perceptions about reasons for and the mechanics of patient care documentation. DESIGN: Qualitative study. SETTING: Individual telephone interviews with Athletic Training Practice-Based Research Network members. PATIENTS OR OTHER PARTICIPANTS: Ten ATs employed in the secondary school setting (age = 32.6 ± 11.4 years, athletic training experience = 7.1 ± 7.8 years) were recruited using a criterion-based sampling technique. Participants were Athletic Training Practice-Based Research Network members who used the Clinical Outcomes Research Education for Athletic Trainers electronic medical record system and practiced in 6 states. DATA COLLECTION AND ANALYSIS: We used the consensual qualitative research tradition. One investigator conducted individual telephone interviews with each participant. Data collection was considered complete after the research team determined that data saturation was reached. Interviews were transcribed verbatim and independently analyzed by 4 research team members following the process of open, axial, and selective coding. After independently categorizing interview responses into categories and themes, the members of the research team developed a consensus codebook, reanalyzed all interviews, and came to a final agreement on the findings. Trustworthiness was established through multiple-analyst triangulation and member checking. RESULTS: Participants identified 3 reasons for documenting patient care: communication, monitoring patient care, and legal implications. Four subcategories emerged from the mechanics-of-documentation theme: location, time of day, length of time, and criteria for documenting. The ATs described different criteria for documenting patient care, ranging from documenting every injury in the same manner to documenting time-loss and follow-up injuries differently. CONCLUSIONS: Whereas ATs recognized individual mechanisms that enabled them to document patient care, they may need more guidance on the appropriate criteria for documenting various patient care encounters and strategies to help them document more effectively.

Athletic Trainers' Perceptions of and Barriers to Patient Care Documentation: A Report From the Athletic Training Practice-Based Research Network.

CONTEXT: For the practice characteristics of the services athletic trainers (ATs) provide to be identified, all ATs must complete high-quality patient care documentation. However, little is known about ATs' perceptions of patient care documentation or the potential barriers they may encounter while trying to ensure high-quality documentation. OBJECTIVE: To explore ATs' perceptions of and barriers to patient care documentation via the Clinical Outcomes Research Education for Athletic Trainers (CORE-AT) electronic medical record system in the secondary school setting. DESIGN: Qualitative study. SETTING: Individual telephone interviews. PATIENTS OR OTHER PARTICIPANTS: We interviewed 10 ATs (4 men, 6 women; age = 32.6 ± 11.4 years, athletic training experience = 7.1 ± 7.8 years) who were members of the Athletic Training Practice-Based Research Network (AT-PBRN) and employed in the secondary school setting. DATA COLLECTION AND ANALYSIS: We conducted an individual interview with each participant. After transcription of the interviews, the data were analyzed into common themes and categories following the consensual qualitative research tradition. Data triangulation occurred through member checking and multiple researchers to ensure accuracy during data analysis. RESULTS: Participants revealed several perceptions of patient care documentation, consisting of quality, expectations and accountability, priority, incentive, and culture of the secondary school setting. In addition, we identified barriers to quality patient care documentation: lack of time, lack of accountability for documenting patient care, inadequate facility resources, and lack of personnel. Participants discussed the volume of patients as a unique challenge in the secondary school setting. CONCLUSIONS: Whereas ATs perceived patient care documentation as important, several practical barriers may inhibit their ability to complete high-quality documentation of the services they provide. Effective strategies to improve the quality of patient care documentation among ATs are needed to ensure that their value, particularly in the secondary school setting, is accurately characterized.

Rest and Return to Activity After Sport-Related Concussion: A Systematic Review of the Literature.

OBJECTIVE: To systematically review the literature regarding rest and return to activity after sport-related concussion. DATA SOURCES: The search was conducted in the Cochrane Central Register of Controlled Trials, CINAHL, SPORTDiscus, Educational Resources Information Center, Ovid MEDLINE, and PubMed using terms related to concussion, mild traumatic brain injury, physical and cognitive rest, and return to activity. STUDY SELECTION: Studies were included if they were published in English; were original research; and evaluated the use of, compliance with, or effectiveness of physical or cognitive rest or provided empirical evidence supporting the graded return-to-activity progression. DATA EXTRACTION: The study design, patient or participant sample, interventions used, outcome measures, main results, and conclusions were extracted, as appropriate, from each article. DATA SYNTHESIS: Articles were categorized into groups based on their ability to address one of the primary clinical questions of interest: use of rest, rest effectiveness, compliance with recommendations, or outcome after graded return-to-activity progression. A qualitative synthesis of the results was provided, along with summary tables. CONCLUSIONS: Our main findings suggest that rest is underused by health care providers, recommendations for rest are broad and not specific to individual patients, an initial period of moderate physical and cognitive rest (eg, limited physical activity and light mental activity) may improve outcomes during the acute postinjury phase, significant variability in the use of assessment tools and compliance with recommended return-to-activity guidelines exists, and additional research is needed to empirically evaluate the effectiveness of graded return-to-activity progressions. Furthermore, there is a significant need to translate knowledge of best practices in concussion management to primary care providers.

The Diagnostic Accuracy of Clinical Diagnostic Tests for Thoracic Outlet Syndrome.

Clinical Scenario: Thoracic outlet syndrome is quite challenging to diagnose. Currently, there are myriad diagnostic procedures used in the diagnosis of all types of thoracic outlet syndrome. However, controversy exists over which diagnostic procedures produce accurate findings. CLINICAL QUESTION: Can clinical diagnostic tests accurately diagnose patients presenting with symptoms of thoracic outlet syndrome? Summary of Key Findings: A thorough literature search returned 6 possible studies; 3 studies met the inclusion criteria and were included. Two studies supported the use of clinical diagnostic tests for the diagnosis of thoracic outlet syndrome. One study reported high false-positive rates among clinical diagnostic tests for thoracic outlet syndrome. One study reported that clinical diagnostic test findings correlate to provocative positioned magnetic resonance imaging findings. Clinical Bottom Line: There is moderate evidence to support the use of the Halstead maneuver (also known as the costoclavicular maneuver or exaggerated military brace test), Wright's test, Cyriax Release test, and supraclavicular pressure test to have good diagnostic accuracy for the provocation of symptoms in patients presenting with upper extremity pathology. However, these clinical diagnostic tests do not appear to allow for the differential diagnosis of thoracic outlet syndrome exclusively. The use of the Adson's test and Roos test should be discontinued for the differential diagnosis of thoracic outlet syndrome. Strength of Recommendation: Grade B evidence exists to support the accuracy of the Halstead maneuver, Wright's test, Cyriax Release test, and supraclavicular pressure test for the diagnosis of upper extremity pathology in general. Grade C evidence exists for the use of these clinical diagnostic tests to exclusively diagnose thoracic outlet syndrome.

The Effect of Cognitive Rest as Part of Postconcussion Management for Adolescent Athletes: A Critically Appraised Topic.

Clinical Scenario: It is hypothesized that cognitive activity following a concussion may potentially hinder patient recovery. While the recommendation of cognitive rest is often maintained and rationalized, a causal relationship between cognitive activity and symptom duration has yet to be established. CLINICAL QUESTION: Does the implementation of cognitive rest as part of the postconcussion management plan reduce the number of days until the concussed adolescent patient is symptom free compared to a postconcussion management plan that does not incorporate cognitive rest? Summary of Key Findings: A thorough literature search returned 7 possible studies; 5 studies met the inclusion criteria and were included. Three studies indicated that increased cognitive activity is associated with longer recovery from a concussion, and, therefore, supported the use of cognitive rest. One study indicated that the recommendation for cognitive rest was not significantly associated with time to concussion symptom resolution. One study indicated that strict rest, defined as 5 days of no school, work, or physical activity; might prolong symptom duration. Clinical Bottom Line: There is moderate evidence to support the prescription of moderate cognitive rest for concussed patients. Clinicians who intend on implementing cognitive rest in their concussion protocols should be aware of inconsistencies and be open-minded to alternative treatment progressions while taking into consideration each individual patient and maintaining adequate patient-centered care principles. Strength of Recommendation: Grade B evidence exists that prescription of moderate cognitive rest for concussed patients may be beneficial as a supplement to physical rest as treatment for symptom reduction in adolescents.

The Diagnostic Accuracy of Screening Tools to Detect Eating Disorders in Female Athletes.

Clinical Scenario: Eating disorders in female athletes are a commonly underdiagnosed condition. Better screening tools for eating disorders in athletic females could help increase diagnosis and help athletes get the treatment they need. Focused Clinical Question: Should screening tools be used to detect eating disorders in female athletes? Summary of Key Findings: The literature was searched for studies that included information regarding the sensitivity and specificity of screening tools for eating disorders in female athletes. The search returned 5 possible articles related to the clinical question; 3 studies met the inclusion criteria (2 cross-sectional studies, 1 cohort study) and were included. All 3 studies reported sensitivity and specificity for the Athletic Milieu Direct Questionnaire version 2, the Brief Eating Disorder in Athletes Questionnaire version 2, and the Physiologic Screening Test to Detect Eating Disorders Among Female Athletes. All 3 studies found that the respective screening tool was able to accurately identify female athletes with eating disorders; however, the screening tools varied in sensitivity and specificity values. Clinical Bottom Line: There is strong evidence to support the use of screening tools to detect eating disorders in female athletes. Screening tools with higher sensitivity and specificity have demonstrated a successful outcome of determining athletes with eating disorders or at risk for developing an eating disorder. Strength of Recommendation: There is grade A evidence available to demonstrate that screening tools accurately detect female athletes at risk for eating disorders.