World Federation of Athletic Training and Therapy World Congress 2022 Peer-Reviewed Track Abstracts, May 5–7, 2022, Winnipeg, Manitoba, Canada

Abstract

Context: Recent research has highlighted changes in neurocognitive and central nervous system function among some of the most common injuries, particularly in those with chronic ankle instability (CAI). Functional performance tests (FPT) like the side-hop test (SHT) are often used to assess physical performance, however, minimally stress a patient's neurocognitive function. On the contrary, dual-tasking is often used to assess the interplay between physical and neurocognitive performance, however, these traditional laboratory tasks are minimally challenging on higher-level athletes. Modifying and adding a reactive component to an already proven FPT may provide clinicians with increased insight into neurocognitive performance. Therefore, the purpose of this study was two-fold, to validate a choice-reaction hop test (CRHT) by assessing differences in timing versus the SHT, and to determine the CRHT's test-retest reliability. We hypothesized that the CRHT would take longer to complete than the SHT and it would demonstrate good test-retest reliability.Methods: Fourteen physically active (>90 minutes of physical activity/week) participants (5 female/9 male, 24.5±3.6 years old, 174.2±9.3 cm, 74.4±16.3 kg) with a range of ankle injury history completed the study. Participants were initially screened and completed injury history questionnaires followed by two hop tests in a randomized order. For the SHT, participants performed 20 hops on a single limb medially and laterally over a 30-cm distance as quickly as possible. For the CRHT participants similarly hopped on an instrumented mat 20 times on a single limb medially and laterally over a 30-cm distance, however, participants had to react to one of two squares on each side randomly indicated by flashing lights on a computer screen. Participants completed 3 trials of each hop test in a counterbalanced order. Participants returned one-week later to repeat the CRHT. To validate the CRHTs neurocognitive component, a paired t-test between the SHT and the CRHT was conducted. To assess the test-retest reliability of the CRHT, an ICC using a 2-way, random effects model for consistency of average measures was computed between day 1 and 2.Results: Participants took significantly longer to complete the CRHT (22.1±3.8s) compared to the traditional SHT (10.4±2.0s, p<0.001). The CRHT demonstrated good-excellent test-retest reliability across testing days (r=0.873, p<0.001).Conclusions: Compared to the SHT, the CRHT took significantly longer to complete indicating its ability to stress neurocognitive function during an FPT. The CRHT also demonstrated adequate test-retest reliability, which may allow it to be a useful measure in serial evaluations such as during rehabilitation benchmarking. The CRHT may be an effective FPT to assess combined physical and neurocognitive function to assist clinicians in evidence-based decision making. Future research needs to assess differences in the CRHT in those with CAI versus healthy control participants to further validate its clinical utility.Context: The biopsychosocial model (BPS) has allowed healthcare professionals like Athletic Therapists/Trainers to holistically examine patients, through the integration of biological, psychological, and social factors, addressing the complexity of pain and disability during musculoskeletal injury. Despite clinician's knowledge on the importance of the BPS model, especially in chronic pain, a biomedical approach to overall Athletic Training and Therapy education and clinical practice still exists.Objective: to establish what Graduate Certified Athletic Therapists perceptions are on the importance of the Biopsychosocial Model in overall patient management within clinical practice? Secondly, examining what are Graduate Certified Athletic Therapists views on the Biopsychosocial Model in their undergraduate educational curriculum in Athletic Therapy?Study Design: Cross-sectional study using an online survey was implemented.Patients or Other Participants: 133 Athletic Therapists/Trainers completed the survey (completion rate = 89%).Main Outcome Measure(s): Participants completed demographic, Biopsychosocial Model in Practice and Biopsychosocial Model in College/University Curriculum questions. The 14-item survey used a combination of multiple choice and Likert scale questions. Descriptive statistics characterised the participants; reliability/internal consistency was assessed using Cronbach's α, Chi Squared tests explored the relationships between BPS model and patient care and education. Spearman's Correlation assessed the relationships between Athletic Therapists/Trainers perceptions of BPS and patient care. Mann Whitney U identified the differences between BPS, sex, and education.Results: There was a very strong positive correlation between implementation and the importance of the BPS model in patient management (r= 0.729, n=133, p<0.000). A positive correlation was found between confidence levels and implementation of the BPS model in patient management (r= 0.364, n=133, p<0.000). A weaker but positive correlation was found between confidence levels and effectiveness in incorporating the BPS model on patient outcomes (r= 0.264, n=133, p<0.002). Descriptive statistics showed 82.7% of participants viewed BPS as very important, 71.4% reported very strong implementation with patients, while 56.4% of participants were very confident in their knowledge of the BPS model. A significant difference was found in the understanding of BPS model based on third level education in Athletic Therapists/Trainers and the transferrable skills of the BPS in clinical practice, U = 1208.000, z= -4.425, p = 0.00, r = 0.383. Descriptive statistics showed 61.7% of participants viewed having inadequate transferable skills of the BPS model to a clinical setting, where 27.8% of participants agreed that knowledge of the BPS model was important to ATs and that their educational curriculum was adequate. The survey was assessed for reliability, Cronbach's α score of 0.729.Conclusion: Graduate Athletic Therapists positively view the importance of Biopsychosocial model in patient management, which will enhance clinical practice and patient outcome measures. However, the transferability of BPS from educational curriculum into clinical practice could be further enhanced and developed. Shifting educational curriculum from biomedical focus to a Biopsychosocial model is needed across all Athletic Therapy/ Training programs.Context: All Canadian based members of the Canadian Athletic Therapists Association (CATA) are required to be members of a regional association (RA). The CATA Board of Directors presented a bylaw change eliminating this requirement. This announcement was unexpected by many members, resulting in varied opinions. The Bylaw change has many implications, such as the role of the CATA and RA, membership fee changes, and questioning the value of memberships. The purpose of this research was to explore these issues, and gauge membership opinions of the value of the CATA and RAs.Methods: An online-based survey was targeted to members of the CATA through RAs in Canada, social media, and snowball sampling. Reminders were sent through the same channels, and the survey was open for 1 month. The survey consisted of 50 questions including demographic data detailing membership status, RA affiliation, and membership length. We included questions about membership value and knowledge about association work. Data were tabulated and analysed for national and regional trends and differences. Primary analysis suggested examining Ontario members' opinions as a unique group.Results: Of 682 who started, 61% (N=416) participants completed the survey, and incomplete surveys were deleted. Certified participants were as follows: ATABC (36), AATA (44), SATA (1), MATA (40), OATA (204), CTSQ (69), APATA (6). Provisional[ly] certified, retired, and associate members (N=5) were counted in the certified groups. The remaining participants were certification candidates (3.8%). Over half (57%) of ATs felt the CATA provided 70-100% of national advocacy for the profession. Less than half (44%) of the membership felt the RA provided 70-100% local advocacy, but that value increased to 57% when the OATA group was removed. Just under half (48%) of members credit the RA 70-100%, on advocating for regulation, but 24% were unsure. Removing the OATA group resulted RA regulation advocacy increasing to 63%. Eighty-three percent (83%) of OATA members value the CATA, but only 45% of other RA members share this value. Thirteen percent (13%) of OATA members value their RA, while this percent rises to 74% for other RA members.Conclusion: In general, there is value associated with CATA and RA membership, but there is a strong divide between members of the OATA and other RA members. Regulation, an important issue for many members, is inconsistently viewed by members across the RAs. Most believe regulation is the responsibility of the RA. The dissatisfaction of OATA members skews the opinions of the national membership. . This survey was completed with the goal of understanding membership knowledge and values to better inform all members of the CATA and RAs. The information obtained is of value beyond the bylaw change. A membership survey asking similar questions should be completed every five years.Context: Recent estimates from Alberta, Canada suggests that one in four high school students will have sustained at least one sport-related concussion by the time they graduate and annual prevalence is one in nine. Sustaining a concussion likely increases an adolescent's risk of subsequent injury, yet few studies have quantified this risk across different populations. This study aimed to examine the prevalence of sustaining any subsequent injury and specifically a recurrent concussion following sport-related concussion in the same season among male and female youth ice hockey players ages 11-17 years.Methods: These data are from a 5-year prospective cohort study including youth ice hockey players (n=4420) from British Columbia and Alberta (2013-2014 to 2017-18). We used validated injury surveillance methodology that included a preseason demographic and medical questionnaire, baseline evaluation of symptoms, cognitive function, and balance using the Sport Concussion Assessment Tool (v.3 or v.5), weekly hockey participation hours, and a standardized injury report form validated by a study clinician. All ice hockey injuries requiring medical attention, the inability to complete a session, or time loss from hockey were identified. All players with a suspected concussion were referred to a sport medicine physician and concussion diagnosis was based on the most current International Consensus Statement on Concussion in Sport. We identified participants with a suspected hockey-related concussion that returned to sport within the ice hockey season and reported 1) the estimated prevalence [95% confidence intervals (CI) adjusting for cluster by team] of players with a subsequent injury (including concussion) or recurrent concussion in the same season, and 2) the median (range) number of days to subsequent injury. Prevalence ratios (PR) to assess differences between males and females were estimated using robust Poisson regression adjusted for clustering by team.Results: Of the 384 males and 64 females concussed in this sample, 72 males (18.8%, 95%CI: 15.1%-30.0%) and 7 females (10.9%, 95%CI: 0.4%-23.2%) sustained a subsequent injury before the end of their season. The median (range) days to subsequent injury was 101 (11-181) for males and 75 (7-123) for females. In total, 50 males (13.0%, 95%CI: 9.9%-17.1%) and 4 females (6.3%, 95%CI: 1.7-22.6%) sustained a recurrent concussion, specifically. The median (range) days to recurrent concussion was 96 (11-164) for males and 39 (12-75) for females. Males and females did not differ in the risk of sustaining a subsequent injury (PR=0.58, 95%CI: 0.21-1.60) or recurrent concussion (PR: 0.48, 95%CI: 0.13-1.76).Conclusions: An estimated 1 in 5 male and 1 in 10 female hockey players sustained a subsequent injury within the same season following a sport-related concussion. While no significant differences were identified between males and females, results should be interpreted with caution due to the low number of females in this sample.Context: Neuropsychological assessments are routinely used in the evaluation of concussion. . Ideally, every athlete would have a baseline neuropsychological assessment for comparison in the event of a concussion, however many factors make it challenging to have these assessments on each athlete. Further, the datasets currently available do not stratify by concussion history which is known to cause changes in neuropsychological performance. The purpose of this study is to provide a large normative dataset as a reference for interscholastic athletes, stratified by concussion history.Methods: 36,360 interscholastic athletes (males n= 21,696, females n= 14,664) between the ages of 10-18 years old participated in preseason baseline concussion testing which included Immediate Post-concussion Assessment and Cognitive Test (ImPACT). ImPACT testing was conducted in groups prior to the start of sport participation by an ATC trained in ImPACT test administration. Outcome data obtained for Verbal (VEM) and Visual (VIM) Memory, Visual Motor Speed (VMS), Reaction Time (RT) and Impulse Control (IC) was stratified by number of previous concussions.Results: Descriptive data are as follows; VEM (84.25 ± 10.263), VIM (73.69 ± 13.115), VMS (35.31 ± 7.102), RT (0.65 ± 0.101) and IC (6.31 ± 4.465). . A one-way ANOVA compared the IMPACT outcomes based upon the number of reported concussions. A significant difference was noted for VIM (F(9,36351) = 1.91, p<0.05), VMS (F(9,36352) = 13.73, p<0.05), RT (F(9,36352) = 7.39, p<0.05), and IC (F(9,36352) = 8.73,p<0.05). No significant differences were found for VEM based upon number of concussions. . Post-hoc testing revealed significant differences between athletes who sustained 0, 1, 2, and 3 concussions. No differences were noted for number of concussions greater than 3.Conclusions: The outcomes support the use of stratified norms for concussion history in interscholastic athletes. Further, healthcare professionals should use caution when comparing post-injury data to standard normative data as concussion history is not taken into account and may impact the outcome. Future research should evaluate ImPACT data in athletes who have sustained more than 3 concussions. The current dataset, while robust, was limited to mostly athletes who had sustained 3 or fewer concussions.Context: Concussions in interscholastic athletes pose a challenge for athletic trainers as the brain of adolescents is growing and developing, which can make the diagnosis and management of those injuries increasingly difficult for healthcare providers. While having a baseline measure for each athlete is recommended, the time and resources required to administer baseline tests for all athletes is not always feasible. Therefore, having access to a large baseline dataset will provide healthcare professionals a reference point to compare when individuals sustain a concussion. . The purpose of this study is to provide ImPACT normative data as a reference for athletes of different ages and genders.Methods: More than 36,000 interscholastic athletes (males n= 21,696, females n= 14,664) between the ages of 10-18 years old participated in pre-season baseline concussion testing. Traditional computer based Immediate Post-concussion Assessment and Cognitive Test (ImPACT), was utilized as a measure of neuropsychological assessment. Athletes were tested in a group environment prior to the start of sport participation. All testing was supervised by an Athletic Trainer trained in ImPACT test administration. Outcome data obtained for Verbal (VEM) and Visual (VIM) Memory, Visual Motor Speed (VMS), Reaction Time (RT) and Impulse Control (IC) was stratified by age and gender.Results: Outcomes for all participants are as follows; VEM (84.25 ± 10.26), VIM (73.69 ± 13.12), VMS (35.31 ± 7.10), RT (0.65 ± 0.10) and IC (6.31 ± 4.47). A one-way ANOVA was used to determine difference in outcomes based upon age. Significant differences were found for: VEM (P(8,36307) = 82.77, p<0.05), VIM (P(8,44177) = 71.00, p<0.05), VMS (P(8,44178) = 776.66, p<0.05) RT (P(8,44178) = 360.26, p<0.05), and IC (P(8,44178) = 68.99, p<0.05). Tukey's HSD was used to determine the nature of the differences between ages, multiple significant differences were noted between each age for each outcome. An independent t-test found significant differences between gender for; VEM (t(44245) = 23.79, p<0.05), VMS (t(44246) = 20.83, p<0.05), RT (t(44246) = 7.33, p<0.05), IC (t(44246) = 13.33, P<0.05).Conclusions: While standard ImPACT baseline norms do stratify by age, gender stratifications are not currently published. It is important that healthcare professionals use the appropriate stratifications to compare post-concussion data in interscholastic athletes, as there are differences between gender and between age groups.Context: Alterations in scapular position and motion (scapular dyskinesis [SD]) are a prevalent clinical finding in symptomatic and healthy individuals that increases the risk of shoulder pain and pathology. Given the multi-directional muscle fibres of the trapezius, differences in excitation within a region likely influence scapular position and motion. The purpose of the study was to examine muscle excitation in the three regions of the trapezius in those with and without SD during shoulder flexion to determine if differences in the mean location of excitation (i.e. barycentre) exist.Methods: Fifty-six healthy right-handed participants were assessed for SD using the SD test: 28 had normal scapular motion (CON: 15 Female, 27±9 years) and 28 had dyskinesis (DYS: 22 Female, 24±7 years). Participants completed five repetitions of weighted shoulder flexion. Kinematics of the upper extremity were collected to determine glenohumeral angle, while high-density surface electromyography of the upper [UT], middle [MT], and lower [LT] trapezius was collected using 3, 32-electrode grids. Barycentre within 30-degree ranges (30°-60°, 60°-90°, 90°-120°) was extracted during elevation [UP] and lowering [DOWN] phases for each grid. A two-way ANOVA was conducted for each grid in each range, resulting in six ANOVAs to examine the interaction of group and angle.Results: Barycentre location is expressed as a percentage of grid position from 0% (most cranial) to 100% (most caudal). A significant interaction was found for LT-UP (p = .025, η2p = .079). Barycentre was located more cranially in DYS at each range, with differences of 4.6% (CON=35.2±6.6%, DYS=30.6±7.9%, p = .022) for 30°-60°, 5.0% (CON=35.1±6.7%, DYS=30.1±8.2%, p = .015) for 60°-90°, and 5.8% (CON=35.7±7.3%, DYS=29.9±8.4%, p = .008) for 90°-120°. Simple main effect of angle was significant for DYS (p = .042, η2p = .132) but not CON. A significant interaction was found for LT-DOWN, (p = .041, η2p = .073). Barycentre was located more cranially in DYS at 120°-90° and 90°-60°, with differences of 5.9% (CON=36.3±6.9%, DYS=30.4±8.5%, p = .006) and 4.5% (CON=36.1±6.2%, DYS=31.6±7.9%, p = .021), respectively. Simple main effect of angle was significant for CON (p = .030, η2p = .157) and DYS (p < .001, η2p = .404). No significant interactions were found for UT or MT during UP or DOWN phases.Conclusion: Mean location of excitation in the LT was more cranial in DYS at various angles of shoulder flexion compared to CON, which may contribute to alterations in scapular kinematics observed in individuals with SD. Future research is needed to determine if selective excitation of sub-regions of the trapezius is associated with deviations in scapular kinematics, and whether the location of excitation within a muscle can be altered, both acutely and chronically, by targeted rehabilitation strategies to improve scapular kinematics and reduce the risk of shoulder pathology.Context: Shoulder conditions are among the most common reason for visiting primary point of care services such as family physicians and allied health professionals (i.e. athletic therapists, physiotherapists), resulting in an overwhelming high demand for services. The current system, however, is plagued with variations in patient care, inappropriate or unnecessary treatment, inaccurate diagnoses, and greater use of healthcare resources. For instance, there is a lack of consistency and awareness with respect to appropriate imaging criteria by ordering physicians. This results in a high volume of magnetic resonance imaging (MRI) that continues to be ordered at the primary care level when not indicated. . Standardized clinical decision-making tools improve patient access and quality of care. Standardized care pathways provide guidance on best practice and aim to decrease variance in practice across the continuum of care, while reducing unnecessary wait times and healthcare expenditures.Methods: Development of the tool underwent: 1) completion of a rapid review; 2) selection of experts, and 3) implementation of a modified Delphi voting process.Results: The rapid review initially yielded 6,451 articles after duplicates were removed. After title, abstract, and full-text review, 88 articles provided evidence and generated 271 voting statements. Fifty-five experts were selected to participate in three rounds of Delphi voting. Experts were chosen to represent different health disciplines and geographical locations across Alberta. Rounds 1 and 2 voting occurred via email using Research Electronic Data Capture (REDCap) survey distribution tools; Round 3 voting occurred “face-to-face” using the video-conferencing web-based platform, Zoom Video Communications (version 5.1.0). Consensus was reached for a standardized primary care decision-making tool for the following shoulder conditions: rotator cuff disease, biceps pathology, superior labral tear, instability, adhesive capsulitis, and osteoarthritis of the glenohumeral and acromioclavicular joints.Conclusion: This tool is intended to provide a province-wide standardized approach for managing shoulder conditions in primary care. This tool consists of a clinical examination algorithm for assessing, diagnosis, and managing shoulder pain; recommendations for history-taking and identification of red flags or additional concerns; recommendations for physical examination and neurological screening; and stepwise approaches for clinical decision-making. Development of this tool was an Alberta Health Services' Bone and Joint Health Strategic Clinical Network (BJH SCN) initiative of the Musculoskeletal Transformation (MSK-T) Program. The MSK-T Program is a province-wide initiative aimed to improve quality of care; standardize MSK care across Alberta; and support innovating models that shift the burden of care and dollars from downstream management (i.e. surgery) towards prevention, early detection, and appropriate community management. This initiative is also supported by the Alberta Bone and Joint Health Institute.Context: The Canada Games (summer and winter) have been held since 1967. Injury and health surveillance systems are important for understanding the burden, causes, and potential prevention opportunities of injuries and illnesses during major sporting events. This study aimed to examine sport-related injury and illness rates during the 2019 Canada Games and determine potential improvements for future injury surveillance.Methods: This is a retrospective cohort study using data extracted from registration information and incident reports by medical staff from the 2019 winter Canada Games. All medical reports were independently coded by two researchers with sports medicine backgrounds, based on the Orchard Sports Injury and Illness Classification System (OSIICS) and the International Olympic Committee (IOC) consensus statement on methods for recording and reporting of epidemiological data on injury and illness in sport. Conflicts were discussed with the research team. All registered athletes (ages 12-30) were included in this analysis. Injury incidence proportions (IP) per 100 registered athletes with 95% confidence intervals (CI) were calculated for male and female by sport based on injuries classified as index injuries directly or non-directly related to sport during the Canada Games. The incidence proportion of all illnesses are also reported.Results: In total, 2,346 unique athletes (1,110 males, 1,235 females, 1 non-disclosed) participated in 2019. There were 2,249 medical incident reports, of which 562 were identified as index injuries either directly or non-directly related to sport during the games [IP: 23.9 injuries (95% CI 22.0-26.0) per 100 athletes] and 97 illnesses [IP: 4.1 illnesses (95% CI 3.4-5.0) per 100 athletes]. The sporting events with the highest incidence of injuries included, men's and women's freestyle skiing [IP: 62.8 injuries (95% CI 41.4-91.4) per 100 athletes and IP: 56.0 injuries (95% CI 30.6-94.0) per 100 athletes respectively], men's boxing [IP: 46.3 injuries (95% CI 27.0-72.4) per 100 athletes], women's snowboarding [IP: 44.1 injuries (95% CI 24.7-72.8) per 100 athletes], women's biathlon [IP: 40.5 injuries (95% CI 22.7-66.9) per 100 athletes] and men's gymnastics [IP: 36.1 injuries (95% CI 23.6-52.9) per 100 athletes]. Despite standardized coding procedures, many of the medical reports lacked sufficient detail, resulting in many cases requiring discussion prior to coding (e.g. 23% of injury pathology type cases, 40% of OSIICS injury diagnoses).Conclusion: Approximately 1 in 5 athletes sustained at least one injury requiring medical attention during the 2019 Canada Games. The IOC consensus statement on methods for recording and reporting of epidemiological data provides sport organizers with guidelines and best practices on how to collect and report injury rates, but these strategies have yet to be implemented. Implementing more standardized reporting can improve the reliability of monitoring injury and illness burden and inform prevention strategies at future Canada Games.Context: The Children Focused Injury Risk Screening Tool (ChildFIRST) was developed to identify children who present poor movement competence and may have increased risk of lower limb injury. The correlation of movement competence and physical activity levels has been widely studied; however, the correlation between physical activity levels and a tool that evaluates movement competence and injury risk has not been explored. The purpose was to evaluate the correlation between the ChildFIRST scores and physical activity levels in 8–12-year-old children.Methods: We conducted a cross-sectional study to evaluate apparently healthy, injury free, 8-12-year-old children. After conducting a power analysis, we used convenience sampling to recruit participants from local schools and sport academies. We evaluated movement competence using the ChildFIRST which is a valid and reliable tool that consists of ten movement skills (i.e., bodyweight squat, vertical jump, horizontal jump, walking lunge, running, leaping, single-leg hop, single-leg sideways hop and hold, two to one hop and hold, and 90-degree hop and hold) each with four evaluation criteria for a total score of 40 points. Demographic data, self-reported physical activity, and ChildFIRST scores analyzed in this study were collected as part of the continued validation ChildFIRST study using 3-dimensional motion analysis. We computed a Pearson correlation coefficient (r) with 95% confidence intervals (CI) and an alpha level of 0.05 to study the correlation between the ChildFIRST and physical activity levels. We determined the physical activity levels by adding the number of physical activity sessions (excluding physical education classes) and sport practices per week.Results: Seventeen (17) children completed the tests (82.35% male, years = 10.46 ±1.33, BMI = 17.13 ±1.58). The children participated in 4.53 ±1.59 physical activity sessions and 2.88 ±1.87 sports practices for a total of 7.41 ±2.47 sessions per week. These sessions lasted less than 30 minutes for 12.50% of the participants, between 30 and 60 minutes for 56.25% of the participants, and more that 60 minutes for 31.25% of the participants. The mean of ChildFIRST scores was 30.18 ±4.96, and the correlation between physical activity and ChildFIRST scores was positive (r = 0.49; 95%CI [0.02, 0.79]) and significant (p = 0.044).Conclusion: Consistent with the literature, there is a moderate positive correlation between ChildFIRST scores and physical activity levels. Including an injury prevention approach to movement competence assessment is congruous to promoting safe physical activity. Focusing on the development of movement skills should continue to be advocated by practitioners working with pediatric populations. Improved movement competence may lead to increased motivation and confidence that may lead to increased physical activity levels. The ChildFIRST can provide information to assist stakeholders in designing individualized movement-based interventions associated with long term physical activity levels.Context: Special Operations Forces (SOF) combat Soldiers endure various occupational exposures including blunt and blast head trauma. These exposures may result in occupational injuries, which may negatively affect human performance. Vision contributes to human performance, and existing data support two premises: 1) concussions adversely affect vision, and 2) visual deficits are associated with increased head impact frequency and severity, and decreased impact anticipation. These premises affect athletes and Sol