The Delphi Method: An Approach for Facilitating Evidence Based Practice in Athletic Training

The shift to a culture of evidence-based practice (EBP) in athletic training is a necessary step in both the optimization of patient care and the advancement of athletic trainers (ATs) as health care professionals. Whereas individuals have gained knowledge in this area, most ATs still are not practicing in an evidence-based manner. Exploring perceived strategies to enhance the use of EBP will help to determine the best approaches to assist ATs in applying EBP concepts to practice to improve patient care. To explore beneficial strategies and techniques ATs perceived would promote successful implementation of EBP within athletic training education and clinical practice. Qualitative study. Individual telephone interviews. Twenty-five ATs (12 educators, 13 clinicians; athletic training experience = 16.00 ± 9.41 years) were interviewed. One phone interview was conducted with each participant. After the interview was transcribed, the data were analyzed and coded into common themes and categories. Triangulation of the data occurred via the use of multiple researchers and member checking to confirm the accuracy of the data. Participants identified several components they perceived as essential for enhancing the use of EBP within the athletic training profession. These components included the need for more EBP resources, more processed information, focused workshops, peer discussion and mentorship, and continual repetition and exposure. Participants also indicated that ATs need to accept their professional responsibilities to foster EBP in their daily practices. The proper shift to a culture of EBP in athletic training will take both time and a persistent commitment by ATs to create strategies that will enhance the implementation of EBP across the profession. Researchers should focus on continuing to identify effective educational interventions for ATs and to determine successful strategies to implement EBP into didactic curricula and clinical practice. Additional focus should be given to which strategies most effectively produce changes in clinical practice.

The paradigm of evidence-based practice (EBP) is well established among the health care professions, but perspectives on the best methods for acquiring, analyzing, appraising, and using research evidence are evolving. The EBP paradigm has shifted away from a hierarchy of research-evidence quality to recognize that multiple research methods can yield evidence to guide clinicians and patients through a decision-making process. Whereas the "frequentist" approach to data interpretation through hypothesis testing has been the dominant analytical method used by and taught to athletic training students and scholars, this approach is not optimal for integrating evidence into routine clinical practice. Moreover, the dichotomy of rejecting, or failing to reject, a null hypothesis is inconsistent with the Bayesian-like clinical decision-making process that skilled health care providers intuitively use. We propose that data derived from multiple research methods can be best interpreted by reporting a credible lower limit that represents the smallest treatment effect at a specified level of certainty, which should be judged in relation to the smallest effect considered to be clinically meaningful. Such an approach can provide a quantifiable estimate of certainty that an individual patient needs follow-up attention to prevent an adverse outcome or that a meaningful level of therapeutic benefit will be derived from a given intervention. The practice of athletic training will be influenced by the evolution of the EBP paradigm. Contemporary practice will require clinicians to expand their critical-appraisal skills to effectively integrate the results derived from clinical research into the care of individual patients. Proper interpretation of a credible lower limit value for a magnitude ratio has the potential to increase the likelihood of favorable patient outcomes, thereby advancing the practice of evidence-based athletic training.

To present and discuss disablement models and the benefits of using these models as a framework to assess clinical outcomes in athletic training. Conceptual schemes that form the basic architecture for clinical practice, scholarly activities, and health care policy, disablement models have been in use by health care professions since the 1960s. Disablement models are also the foundation for clinical outcomes assessment. Clinical outcomes assessment serves as the measurement tool for patient-oriented evidence and is a necessary component for evidence-based practice. Disablement models provide benefits to health professions through organization of clinical practice and research activities; creation of a common language among health care professionals; facilitation of the delivery of patient-centered, whole-person health care; and justification of interventions based on a comprehensive assessment of the effect of illness or injury on a person's overall health-related quality of life. Currently, the predominant conceptual frameworks of disability in health care are those of the National Center for Medical Rehabilitation Research and the World Health Organization. Disablement models need to be understood, used, and studied by certified athletic trainers to promote patient-centered care and clinical outcomes assessment for the development of evidence-based practice in athletic training. CLINICAL AND RESEARCH ADVANTAGES: For clinicians and researchers to determine effective athletic training treatments, prevention programs, and practices, they must understand what is important to patients by collecting patient-oriented evidence. Patient-oriented evidence is the most essential form of outcomes evidence and necessitates an appreciation of all dimensions of health, as outlined by disablement models. The use of disablement models will allow the athletic training profession to communicate, measure, and prioritize the health care needs of patients, which will facilitate organized efforts aimed at assessing the quality of athletic training services and practices and ultimately promote successful evidence-based athletic training practice.

Environmental sustainability is a critical concern in health care. Similar to other professions, the practice of athletic training necessitates the use of a large quantity of natural and manufactured resources. To examine the perceptions of the waste produced by the practice of athletic training and the green practices currently used by athletic trainers (ATs) to combat this waste. Mixed-methods study. Field setting. A total of 442 ATs completed the study. Sixteen individuals participated in the qualitative portion. Data from sections 2 and 3 of the Athletic Training Environmental Impact Survey were analyzed. Focus groups and individual interviews were used to determine participants' views of waste and the efforts used to combat waste. Descriptive statistics were used to examine types of waste. Independent t tests, χ2 tests, and 1-way analyses of variance were calculated to identify any differences between the knowledge and use of green techniques. Interviews and focus groups were transcribed verbatim and analyzed inductively. Participants reported moderate knowledge of green techniques (3.18 ± 0.53 on a 5-point Likert scale). Fifty-eight percent (n = 260) of survey participants perceived that a substantial amount of waste was produced by the practice of athletic training. Ninety-two percent (n = 408) admitted they thought about the waste produced in their daily practice. The types of waste reported most frequently were plastics (n = 111, 29%), water (n = 88, 23%), and paper for administrative use (n = 81, 21%). Fifty-two percent (n = 234) agreed this waste directly affected the environment. The qualitative aspect of the study reinforced recognition of the large amount of waste produced by the practice of athletic training. Types of conservation practices used by ATs were also explored. Participants reported concern regarding the waste produced by athletic training. The amount of waste varies depending on practice size and setting. Future researchers should use direct measures to determine the amount of waste created by the practice of athletic training.

Mini-Editorial Compilation for Special Section

Evidence-based practice (EBP) involves a healthcare professional using his or her own knowledge, the current research published, and the needs of the patient to make the best clinical decision. This has been a hot topic in many different branches of healthcare and recently athletic trainers have begun to embrace its importance. In December of 2015, athletic trainers (ATs) will need to have completed 10 of their 50 continuing education units (CEUs) in EBP to maintain certification. While ATs recognize the significance of implementing EBP into clinical decision making, there are many barriers slowing the change. This chapter includes information about how EBP is currently being used by athletic training clinicians and educators, the barriers ATs perceive to using EBP, the importance of using EBP, and managing the transition needed to successfully adopt the use of EBP. Online learning will be reviewed as the primary method of diffusing EBP into the profession of athletic training.

Evidence-based practice (EBP) involves a health care professional using his or her own knowledge, the current research published, and the needs of the patient to make the best clinical decision. This has been a hot topic in many different branches of healthcare and recently athletic trainers have begun to embrace its importance. In December of 2015, athletic trainers (ATs) will need to have completed ten of their fifty continuing education units (CEUs) in EBP to maintain certification. While ATs recognize the significance of implementing EBP into clinical decision making, there are many barriers slowing the change. This chapter includes information about how EBP is currently being used by athletic training clinicians and educators, the barriers ATs perceive to using EBP, the importance of using EBP, and managing the transition needed to successfully adopt the use of EBP. Online learning will be reviewed as the primary method of diffusing EBP into the profession of Athletic Training.

Sports Injury Epidemiology: Foundation of Evidence of, by, and for Athletic Trainers.

In this issue of the Journal, 2 papers are devoted to the assessment of treatment outcomes. The first, ‘‘Using Disablement Models and Clinical Outcomes Assessment to Enable Evidence-Based Athletic Training Practice, Part I: Disablement Models,’’ addresses the theoretic foundations on which contemporary outcomes assessments are built. The second, ‘‘Using Disablement Models and Clinical Outcomes Assessment to Enable Evidence-Based Athletic Training Practice, Part II: Clinical Outcomes Assessment,’’ describes the links between disablement models and outcomes assessment. The authors discuss the need for and development of instruments used to capture the effects of injury, illness, and treatment responses from the patient’s perspective. In the accompanying commentary, the links between evidence-based athletic training practice and outcomes assessment are further highlighted. This discussion is followed by a series of recommendations that the authors believe are necessary for the further development of athletic training and recognition of the field as a health care profession. I applaud all the authors of these papers for their hard work and contributions to the Journal and the profession. I agree wholeheartedly with the recommendations they make, and I believe these papers are ‘‘must reading’’ for all those concerned about the future of the athletic training profession. Outcomes assessment and evidence-based practice are complex and multifaceted issues. Certainly athletic training is not alone in its struggles to embrace a paradigm of evidence-based medicine, described by Akai1(p731) as ‘‘equal in enormity to the human genome project.’’ There are political, educational, and research implications of a paradigm of evidence-based practice. What is sometimes overlooked when the implications of evidence-based athletic training are discussed is the fundamental need for this new paradigm. As pointed out by Snyder and colleagues, cliniciangenerated assessments cannot capture the full effects of injury or treatment on the patient’s life. Without a full evaluation of the effects of injury, illness, and treatments on impairments and functional and performance limitations, as well as on the patient’s quality of life, a true critical appraisal of health care interventions is not possible. Capturing this information is challenging and is an evolving science. However, these efforts focus on what really matters in health care: the experience of the patient. We are in an era that requires more from clinicians than simply believing that what they are doing or recommending is what is best for the patient. To the greatest extent possible, the clinician should be able to offer evidence that the recommendations made and the interventions provided are the most likely to achieve the outcomes the patient desires. Thus, as we collectively ponder the continuing evolution of evidence-based athletic training and the implications for educational programming, status as a profession, and governmental recognition, let us not forget the genesis behind the dominant paradigm shift in health care over the past 20 years: the need to apply what we learn through research to improve patient care. When the needs of and care for the patient come first, the collective effort in developing a strong foundation for the practice of evidence-based athletic training is easily recognized as time and money well spent. Moreover, recognizing athletic trainers as important members of a massive and interconnected health care team brings with it the obligation that they practice to the fullest extent of their training. By placing the patient first, everyone wins.

Evidence-based practice (EBP) involves a health care professional using his or her own knowledge, the current research published, and the needs of the patient to make the best clinical decision. This has been a hot topic in many different branches of healthcare and recently athletic trainers have begun to embrace its importance. In December of 2015, athletic trainers (ATs) will need to have completed ten of their fifty continuing education units (CEUs) in EBP to maintain certification. While ATs recognize the significance of implementing EBP into clinical decision making, there are many barriers slowing the change. This chapter includes information about how EBP is currently being used by athletic training clinicians and educators, the barriers ATs perceive to using EBP, the importance of using EBP, and managing the transition needed to successfully adopt the use of EBP.

Context Advanced clinical practice is inherent in contemporary athletic training education, such as residency programs and Doctor of Athletic Training programs; however, as a concept, advanced clinical practice in athletic training has been poorly studied to date. Objective To explore athletic trainers' perceptions of advanced clinical practice. Design Cross-sectional. Setting Online survey with open-ended questions. Patients or Other Participants Three hundred fifty of 1992 athletic trainers accessed the survey (17.6% access rate); 321 respondents completed at least 1 open-ended question; and 196 completed the survey in its entirety (61.1% completion rate). Intervention(s) We used a 13-item survey including demographic items (9 items) and open-ended response questions (4 items). Main Outcome Measure(s) Guided by the consensual qualitative research approach, a 3-person data analysis team coded the open-ended responses. Each member coded 50 responses and a consensus codebook was developed. Two members of the team coded the remaining responses, which were confirmed by the third member. Emergent data were organized into themes and categories, and frequency counts were determined for each category. Results Athletic trainers' definitions of advanced clinical practice were categorized into 4 emergent categories: (1) formal training and education; (2) informal training and education; (3) knowledge, skills, and behaviors; and (4) experience and uncertainty. Conclusions The categories of formal and informal training and education focused on athletic trainers acquiring additional knowledge and skills through mechanisms such as postprofessional degree programs, residency programs, or other areas of study. The knowledge, skills, and behaviors category included areas related to specialized skills and the core competencies. These 3 categories aligned with one another to provide both the types of knowledge, skills, and behaviors that define advanced clinical practice, and the specific mechanisms through which an athletic trainer can achieve advanced clinical practice.

The field of health care needs to change in order to address challenges such as rising health care costs, aging populations and the need to treat increasing numbers of people with chronic health conditions. All of this must be accomplished while reducing costs and maintaining quality of care. Health care professionals are being tasked with facilitating this change. Like many other health care professions, athletic training has turned to evidence-based practice to assure that athletic trainers are trained to deliver the highest quality of care in the most efficient way to their patients. The transition to integrating evidence-based practice will be challenging and will require a massive diffusion of innovation throughout the field of athletic training.

Context: The purpose of this review is to assess leadership education and practice in athletic training. Leadership is a critical component of athletic training and health care. Leadership research in athletic training is dramatically behind other health care professions. Objective: To develop a model for integrating leadership behavior and education into clinical practice and athletic training education that is based on review of leadership literature within athletic training and to introduce a conceptual framework from which to base future dialogue and by which to describe and assess the demonstration of leadership within athletic training. Data Source: PubMed and CINAHL served as the data sources for the allied health fields and were limited to athletic training and nursing. Other data sources included EBSCO Business Source Complete, ERIC, and leadership and management texts. Data Synthesis: The role and presence of leadership behaviors and skills in athletic training journals were reviewed and summarized. A general overview of the various leadership theories is presented. Conclusions: Leadership behavior can facilitate the transfer of professional behavior and performance from classroom to clinical practice; however, leadership may be perceived to be less important than clinical skills. A model for integrating leadership into athletic training is presented with implications for practice. As athletic training continues to evolve, the need to formalize leadership development for athletic trainers may be warranted. Focusing on the structure and function of leadership behaviors and content may help advance athletic training and align it with other health professions relative to leadership research.

Celebrating the Culture of Interprofessional Collaboration in Athletic Training

1 Copyright © by Indiana State University Clinical Practice in Athletic Training All rights reserved. ISSN Online 2577-8188 Volume 1 – Issue 1 – June 2018 Welcome to Clinical Practice in Athletic Training: Letter from the Editor-in-Chief