Secondary School Athletic Trainers' Clinical Management Decisions of Low Socioeconomic Status Patients.

CONTEXT: Evidence suggests that negative social determinants of health (SDOH) and lower socioeconomic status (SES) contribute to health care disparities. Due to their accessibility in the high school setting, secondary school athletic trainers (SSATs) may encounter patients that are historically underserved in health care such as low SES patients. However, there is a significant gap in knowledge regarding how SES and SDOH may influence SSATs' clinical management decisions. OBJECTIVE: The purpose of this study was to describe SSATs' perceptions of how patient SDOH and SES influence clinical management decisions and to identify barriers to athletic healthcare. DESIGN: Cross-sectional study. SETTING: Online survey. PARTICIPANTS: NATA SSATs (6.7% response rate). MAIN OUTCOME MEASURE(S): SSATs were asked about their perceptions of patient SES and the SDOH (CVI = 0.83 for relevancy). Questions were ranked on a 4-point Liker scale on level of relevance and agreement. Data were summarized by means and standard deviations (SD), frequencies and proportions (%), and median scores. RESULTS: A total of 380 SSATs participated (years of experience mean=14.9±11.7 years). When providing care, most (71.3%) SSATs believed that their patient's health/health care access SDOH to be the most relevant of the 5 SDOH whereas the other 4 SDOH were less than 60% relevant. Most SSATs agreed/strongly agreed that patient SES impacts referral (67.4%) and the reliance on conservative treatment before referral (71.2%). SSATs identified patient/guardian compliance (70.2%) and type of health insurance (61.5%) as barriers to providing care to low SES patients. CONCLUSIONS: SSATs perceived health/health care access as the most relevant SDOH when providing care to low SES patients. When SSATs further considered the SES of patients, they identified all SDOHs as barriers to providing health care they were ill equipped to navigate as they delivered care and engaged in patient referral.

Creatine supplementation in high school football players.

OBJECTIVE: To describe creatine supplementation patterns and behaviors associated with creatine supplementation in high school football players. DESIGN: A cross-sectional, multisite, anonymous, descriptive survey was conducted between October 1999 and February 2000. SETTING: 37 public high schools in Wisconsin. SUBJECTS: A total of 1,349 high school football players, grades 9-12. MAIN OUTCOME MEASURES: Self-reported prevalence of creatine use, as well as perceived benefits and risks. In addition, sources of information and influence regarding creatine supplementation were assessed. RESULTS: 30% of the respondents reported using creatine. Creatine use was lowest in the 9th grade (10.4%) and highest in the 12th grade (50.5%). 41% of the players at small schools stated they used creatine compared with 29% of the players in large schools. Enhanced recovery following a workout was the most likely perceived benefit of creatine supplementation, while dehydration was cited most often as a risk of creatine use. Users were encouraged to take creatine most often by their friends while their parents discouraged creatine use. CONCLUSIONS: Creatine use is widespread in high school football players. High school football players who use creatine may not be aware of the risks and benefits associated with creatine supplementation. Sports medicine professionals who work with this population need to educate athletes, coaches, and parents about the use of creatine as a performance-enhancing supplement.

Balance as a predictor of ankle injuries in high school basketball players.

OBJECTIVE: The purpose of this study was to determine if a preseason measurement of balance while in a unilateral stance could predict susceptibility to ankle injury in a cohort of high school basketball players. Predicting risk for ankle injury could be important in helping to reduce the risk of these injuries and furthermore save health care costs. DESIGN: Cohort study. SETTING: Data were collected at five high schools during the first 2 weeks of the 1997-1998 and 1998-1999 basketball seasons. SUBJECTS: 210 (119 male, age = 16.1 +/- 1.1 yr; height = 182.98 +/- 7.4 cm; weight = 76.4 +/- 10.9 kg; and 91 female, age = 16.3 +/- 1.3 yr; height = 170.9 +/- 7.8 cm; weight = 63.4 +/- 8.4 kg) high school basketball players who did not sustain a time loss ankle or knee injury within the previous 12 months served as subjects. Subjects did not use prophylactic ankle taping or bracing during the season. ASSESSMENT OF RISK FACTORS: Balance was quantified from postural sway scores measured while subjects performed unilateral balance tests with eyes both open and closed. Logistic regression analysis was carried out to determine if gender, dominant leg, and balance scores were related to ankle sprain injuries. In addition, Fischer's exact test was used to determine if the rate of ankle injuries was the same whether the subject had poor, average, or good balance. Balance was assessed by measuring postural sway with the NeuroCom New Balance Master version 6.0 (NeuroCom International, Clackamas, OR, U.S.A.). Testing to determine postural sway consisted of having subjects stand on one leg for three trials of 10 seconds with their eyes open, then repeated with their eyes closed. Subjects then underwent the same assessment while standing on the other leg. Postural sway was defined as the average degrees of sway per second (degrees S/S) for the 12 trials producing a compilation (COMP) score. OUTCOME MEASURES: Ankle injury resulting in missed participation. RESULTS: Subjects who sustained ankle sprains had a preseason COMP score of 2.01 +/- 0.32 (Mean +/- SD), while athletes who did not sustain ankle injuries had a score of 1.74 +/- 0.31. Higher postural sway scores corresponded to increased ankle sprain injury rates (p = 0.001). Subjects who demonstrated poor balance (high sway scores) had nearly seven times as many ankle sprains as subjects who had good balance (low sway scores) (p = 0.0002.) CONCLUSION: In this cohort of high school basketball players, pre-season balance measurement (postural sway) served as a predictor of ankle sprain susceptibility.

Anthropometric and performance measures for high school basketball players.

OBJECTIVE: To determine possible anthropometric and performance sex differences in a population of high school basketball players. DESIGN AND SETTING: Measurements were collected during the first week of basketball practice before the 1995-1996 season. Varsity basketball players from 4 high schools were tested on a battery of measures chosen to detect possible anthropometric and performance sex differences. SUBJECTS: Fifty-four female and sixty-one male subjects, from varsity basketball teams at high schools enrolled in the athletic training outreach program at the University of Wisconsin Hospital Sports Medicine Center in Madison, WI, volunteered to take part in this study. MEASUREMENTS: We took anthropometric measurements on each of the 115 subjects. These included height, weight, body composition, ankle range of motion, and medial longitudinal arch type in weightbearing. Performance measures included the vertical jump, 22.86-m (25-yd) shuttle run, 18.29-m (20-yd) sprint, and single-limb balance time. RESULTS: We compared anthropometric and performance characteristics using a 2-sample t test. The only exception to this was for medial longitudinal arch type, where the 2 groups were compared using a 2-tailed Fisher's exact test. The male subjects were significantly taller and heavier, while the females had a significantly higher percentage of body fat. There were no significant differences found for ankle plantar flexion and dorsiflexion, but the females had significantly more inversion and eversion range of motion. Analysis of medial longitudinal arch type found females to have a higher percentage of pronated arches and males to have a higher percentage of supinated arches. Performance testing revealed that the males were able to jump significantly higher and run the 22.86-m (25-yard) shuttle run and 18.29-m (20-yard) sprint significantly faster than the female subjects. There was no significant difference between the groups for single-limb balance time. CONCLUSIONS: We found significant anthropometric and performance sex differences in a cohort of high school basketball players. Further study of these measures is necessary to determine if these differences can predict the risk for ankle injuries in this particular population.