Athletic Health Care Research Articles

Applications of AI in martial arts: A survey

Artificial intelligence (AI) has become an interdisciplinary subject that integrates digital image processing, machine learning, and computer science, etc. A lot of work in martial arts benefits from AI technology. In this paper, we highlight and summarize the applications of AI in martial arts and indicate the main progress of related studies. Through the investigation of martial arts styles, tasks, data acquisition methods, and algorithm improvements, a paradigm that represents a possible technological process for an intelligent martial arts training system was summarized. These applications bring more scientific training and more effective technical analysis to martial arts. Furthermore, this paper delves into specific AI applications in areas such as action recognition, pose estimation, action evaluation, elite athlete support, sports betting, health care, animation generation, and competition field segmentation. By exploring these areas, the research prospects of AI applications in martial arts are comprehensively discussed. This paper inspires further research on martial arts by using AI, which includes helping researchers expand their research ideas and research methods, identify frontier issues, and innovate based on existing research.

Assessment of Perceived Diversity and Inclusivity of Athletic Training Textbooks

Context Adopting diverse perspectives is increasingly important for athletic trainers (ATs) to provide care that fosters inclusion for all patients. Despite the NATA’s commitment to diversity, NATA membership remains approximately 80% White. Additionally, although ATs work with people from ethnically diverse backgrounds with unique body expression and body-size characteristics, it is unknown whether athletic training textbooks represent this diversity. Objective To investigate diversity characteristics of images including patients and clinicians within athletic training textbooks. Design Cross-sectional study. Patients or Other Participants Twenty percent (n = 15) of athletic training and health care textbooks included on the Board of Certification reference list were selected. Twenty percent of chapters from those textbooks were then randomly selected for inclusion. Main Outcome Measure(s) Descriptive statistics were calculated for person (athlete, nonathlete, clinician), setting (athletic venue, clinic, physician office, other), and demographic categories (perceived skin tone, race/ethnicity, age, gender, body size, body expression). Chi-square tests of goodness of fit were performed to determine significant differences between categories, and χ2 tests of independence were performed to determine differences across person type and category and across textbook domain and category. Results One thousand six hundred sixty-seven people were assessed from 1190 images. Images depicted statistically more persons with light skin tone (86%) assumed to be White (86%), young adults (75%) of average weight (95%), with no body expression diversity (95%). There were no major differences in subject characteristic majorities across person type or textbook domain. Conclusions Like other health care professions, a lack of image diversity was demonstrated within athletic training textbooks. To better recruit diverse students to the athletic training profession, and to prepare professional students to provide culturally competent and patient-centered care, these resources should better represent the diversity of ATs and their patients.

Relationship Between Athletic Trainer Access, Socioeconomic Status, and Race and Ethnicity in United States Secondary Schools.

Extensive research has exposed healthcare disparities regarding socioeconomic status (SES) and race/ethnicity demographics. Previous research has shown significant differences in access to athletic training services (AT access) in the secondary school setting based on SES, but with limited samples. This study investigated differences in AT access based on race/ethnicity and SES on a national scale. Cross-sectional study. Database study using secondary analysis. Data were collected from the National Center for Education Statistics (NCES), Athletic Training Location and Services (ATLAS) database, and US Census Bureau. 10,983 public schools. Descriptive data was summarized by measures of central tendency. A one-way ANOVA determined differences between school characteristics: median household income (MHI), percent of students eligible for free and reduced lunch (%FRL), percent white students, and percent non-white students based on AT access: Full-time (FT-AT), part-time (PT-AT), and no athletic trainer (no-AT). A Bonferroni pairwise comparison was used for variables with significant main effects. Across all schools included in the study, 43.8% had no-AT (n=4,812), 23.5% had PT-AT access (n=2,581), and 32.7% had FT-AT access (n=3,590). There were significant effects between AT access and MHI (p<.001), %FLR (p<.001), percent white (p<.001), and percent non-white (p<.001). FT-AT schools had a higher SES when compared to PT-AT and no-AT schools. Significant differences existed between AT access groups and race/ethnicity of schools. Schools with FT-AT had a significantly lower percent of non-white students (31.3%) compared to schools with no-AT (46.0%) (p<.001). No significant differences between FT-AT and PT-AT based on race/ethnicity demographics presented (p≥.13). Schools with higher SES had greater AT access; whereas, schools with a higher percentage of non-white students were more likely to have no AT access, demonstrating the disparities in healthcare extends to athletic healthcare as well. To increase AT access, future initiatives should address the inequities where larger minority populations and counties of lower SES exist.

Fuzzy Evaluation Model for Products with Multifunctional Quality Characteristics: Case Study on Eco-Friendly Yarn

Numerous advanced industrial countries emphasize green environmental protection alongside athletic healthcare. Many world-renowned sports brands are actively developing highly functional, environmentally friendly, and aesthetically pleasing products. For example, in the production of sports shoes, the eco-friendly yarn process is one of the important processes. This process involves multiple crucial larger-the-better quality characteristics closely tied to the functionality of sports shoes. Facing green environmental regulations and external competitors, it is evidently an imperative issue for enterprises to consider how to improve the quality of newly developed products, increase product value, and lower rates of both rework and scrap to accomplish the goals of saving energy and minimizing waste. Aiming to solve this problem, this study proposed a fuzzy evaluation model for products with multifunctional quality characteristics to assist the sporting goods manufacturing industry in evaluating whether all functional quality characteristics of its products meet the required quality level. This study first utilized the larger-the-better Six Sigma quality index concerning environmental protection for evaluation and then proposed product evaluation indicators for the eco-friendly yarn. Since the parameters of these indicators have not yet been determined, sample data need to be used for estimation. Enterprises require rapid response, so that the sample size is relatively small. Sampling error will increase the risk of misjudgment. Therefore, taking suggestions from previous studies, this study constructed the fuzzy evaluation model based on confidence intervals of quality indicators for the eco-friendly yarn. This method incorporated previous experience with data, thereby enhancing assessment accuracy.

Shared decision-making with athletes: a survey study of healthcare professionals’ perspectives

ObjectivesShared decision-making (SDM) is a trending topic in athlete health care; however, little is known about its use in a sports context. This study aimed to measure knowledge and self-perceived...

Athletic Trainers' Familiarity, Comfort, Knowledge, and Recognition of Social Determinants of Health.

Social determinants of health (SDOH)-education, transportation, housing, employment, health systems and services, economic status, and physical and social environments-influence patient outcomes; therefore, athletic trainers (ATs) need to understand and address these factors. However, little is known about how ATs perceive SDOH or how knowledgeable they are about social factors that contribute to patient health and well-being. To evaluate ATs' familiarity and comfort with SDOH and their perceived knowledge and recognition of SDOH. Cross-sectional study. Online survey. Our survey was distributed to 17 000 ATs; 1829 accessed it (access rate = 10.8%), and 1694 completed it (completion rate = 92.6%, AT experience = 15.2 ± 10.6 years, age = 36.6 ± 10.8 years). The survey included multipart questions that evaluated ATs' perceptions of their familiarity, comfort, and knowledge about SDOH. Data were summarized using descriptive statistics. Few respondents (4.1%, 70/1691) reported being extremely familiar with SDOH. Most indicated being moderately familiar (45.0%, 761/1691), minimally familiar (34.7%, 587/1691), or not familiar at all (16.1%, 273/1691). For questions about comfort, few described being extremely comfortable (3.5%, 59/1691) with SDOH, and most reported being moderately comfortable (35.4%, 598/1691), minimally comfortable (41.1%, 695/1691), or not comfortable at all (18.6%, 314/1691). For questions about knowledge, few indicated being extremely knowledgeable (2.7%, 46/1686) about SDOH, and the majority described being moderately (36.8%, 622/1686), minimally (41.8%, 704/1686), or not knowledgeable at all (18.6%, 314/1686). Over half of ATs accurately categorized 8 of the 9 SDOH listed in the survey, and 22% endorsed more correct than incorrect items. A majority of ATs perceived their familiarity, comfort, and knowledge about SDOH to be moderate to low, which may reflect the relatively recent emphasis on SDOH in athletic health care. Because SDOH can have a major effect on patient health and well-being, strategies should be developed for educating ATs about SDOH. Developing strategies to increase comfort with SDOH in patient care is critical to ensure that those factors that can be addressed at the patient level are identified and managed.

Secondary School Athletic Trainers' Perceptions of the Influence of Social Determinants of Health and Socioeconomic Status on Clinical Management Decisions.

Evidence suggests that lower socioeconomic status (SES) and negative social determinants of health (SDOH) contribute to health care disparities. Due to their accessibility in the high school setting, secondary school athletic trainers (SSATs) may encounter patients who are historically underserved in health care, such as patients with low SES. However, a significant gap in knowledge exists regarding how SDOH and SES may influence SSATs' clinical management decisions. To describe SSATs' perceptions of how patient SDOH and SES influence clinical management decisions and to identify barriers to athletic health care. Cross-sectional study. Online survey. National Athletic Trainers' Association SSATs (6.7% response rate). Secondary school athletic trainers were asked about their perceptions of patient SDOH and SES (content validity index = 0.83 for relevancy). The levels of relevance and agreement were answered on a 4-point Likert scale. Data were summarized using means and SDs, frequencies and proportions (%), and median scores. A total of 380 SSATs participated (mean years of experience = 14.9 ± 11.7 years). When providing care, most (71.3%) SSATs believed their patients' health or health care access to be the most relevant of the 5 SDOH, whereas the other 4 SDOH were less than 60% relevant. Most SSATs agreed or strongly agreed that patient SES affected both referral (67.4%) and the reliance on conservative treatment before referral (71.2%). Secondary school athletic trainers identified patient or guardian compliance (70.2%) and type of health insurance (61.5%) as barriers to providing care to patients with low SES. Secondary school athletic trainers perceived health or health care access as the most relevant social determinant when providing care to patients with low SES. When SSATs further considered the SES of patients, they identified all SDOH as barriers that they were ill equipped to navigate as they delivered care and engaged in patient referral.

The Social Determinants of Health and Athletic Trainer Availability in Indiana Secondary Schools.

The social determinants of health (SDOH) are circumstances under which individuals are born, work, and live that influence health outcomes. Previous researchers have examined 1 determinant of economic stability and found disparities in socioeconomic status and athletic trainer (AT) availability. To examine the SDOH characteristics of Indiana secondary schools and AT availability. Cross-sectional study. Database secondary analysis. A total of 426 secondary schools. All data were collected from publicly available databases. The independent variable was AT availability, and schools were classified as having a full-time AT, a part-time AT only, or no AT. The SDOH variables were gathered for each school (at the school and county levels). Data were summarized using measures of central tendencies, 1-way analysis of variance, and Kruskal-Wallis tests. School enrollment was larger in schools with greater AT availability (P< .001). The proportion of non-White students was greater in schools with more AT availability (P= .002). Greater AT availability was present in counties with higher graduation rates (P= .03). Post hoc comparisons revealed differences in graduation rates between schools with a part-time AT and those with no AT (P= .04). Schools with less AT availability were located in counties with a slightly higher percentage of the population uninsured (P= .02). Schools with greater AT availability were located in counties with a higher ratio of population to primary care physicians (P= .03). Schools with less AT availability were located in counties with a higher population experiencing severe housing problems (P= .02). No differences were found in AT availability based on the 3 social and community context variables (P> .05). Differences were noted in AT availability and SDOH characteristics at the secondary school level. We observed less AT availability where high school graduation rates and the population of primary care providers were lower. Strategies should be implemented to improve access to athletic health care in underresourced communities.

Name, Image, and Likeness and the Health of the Young Athlete: A Call to Action for Sports Medicine Providers and the Athletic Healthcare Network.

In June 2021, the National Collegiate Athletic Association (NCAA) adopted a new policy allowing NCAA athletes the opportunity to benefit and profit from their name, image, and likeness (NIL). Several state high-school associations have established policies to guide their members and students through the new era of NIL. While the potential benefits cannot be ignored, NIL presents novel responsibilities and stressors to athletes. This paper will review the paucity of literature on the effect of NIL on youth athletes and bring attention to mental health, well-being, or academic performance impacted by NIL. Articles were identified through Google and PubMed search starting from NIL policy approval (June 30, 2021). Search terms included "name, image and likeness" and "NIL." Clinical commentary. Level 5. Although 1 article was identified through PubMed search and numerous articles were identified through Google search, no articles directly evaluated the effects of NIL on the mental health, well-being, or academic performance of youth athletes. It is critical for sports medicine providers and other members of the athletic healthcare network to familiarize themselves with these emerging topics to best serve their patients and communities. The athletic healthcare network must be prepared to address possible NIL-related health ramifications for our patients and their families and help them navigate a confusing and predatory landscape. We must provide resources to youth athletes to minimize the risks associated with NIL involvement and related activities, and to ensure that athletes with NIL contracts are able to balance their academic and athletic responsibilities. Fostering strong relationships between stakeholders and sports medicine staff is paramount to creating an environment that permits honest discussions about NIL and the health of athletes from youth to adulthood. N/A.

The effect of patient-led goal setting approach combined with pain neuroscience education or manual therapy in patients with chronic low back pain: protocol for a parallel-group randomized controlled trial

BackgroundLow back pain (LBP) is a multifactorial disorder associated with a high range of physical and psychological burden on the society. Patient-led goal-setting approach has shown potential effects for improving chronic LBP. However, there are few studies investigating its benefits when combined with a supplementary intervention. This paper, therefore, presents a protocol for a randomized control trial (RCT) to study the effect of a patient-led goal-setting approach combined with pain neuroscience education (PNE) or manual therapy (MT) among patients with chronic LBP.MethodsA total of 105 patients suffering from chronic LBP will be recruited via flyers displayed in hospitals and universities, and those meeting the study’s criteria will randomly be allocated into a patient-led goal-setting approach with the PNE group, and/or with the MT program group, and/or a control group. The primary outcomes will be the pain intensity and disability. Secondary outcomes include quality of life, depression, anxiety and stress, fear avoidance beliefs, kinesophobia, pain self-efficacy, catastrophic pain, neurophysiology of pain, and central sensitivity. All the outcomes will be recorded at 2 months after receiving the treatment as post-test sessions and after 4 and 12 months as follow-up sessions. The Ethics Committee in Research at Sport Sciences Research Institute of Iran approved the protocol of this trial (IR.SSRC.REC.1400.084). Written, informed consent to participate will be obtained from all participants. All methods will be conducted in accordance with the ethical standards of the Declaration of Helsinki and in accordance with relevant guidelines and regulations. We will disseminate the findings through peer-reviewed publications and conference presentations and send them to the participants.DiscussionThis trial will demonstrate which supplementary intervention can better improve the impact of a patient-led goal-setting approach to treat LBP. If successful, the results will potentially have implications for athletic trainers, physiotherapists, and health care practitioners.Trial registrationIRCT Iranian Registry of Clinical Trials IRCT20210927052616N1. Registered on November 03, 2021.

Clinical Role of the Sports Dentist in the Athlete Health Care Team

Clinical Role of the Sports Dentist in the Athlete Health Care Team

Clinical tissue engineering approach and biotechnological advances to improve athlete healthcare

Sports activities have continued for centuries and have become essential to daily life. Professional athletes participating in various sports competitions have many advantages, such as a promising career and high income. On the other hand, being a professional athlete also has some disadvantages. The most dramatic one is the risk of injury. Even though injuries are a part of sports, they have become a significant problem today due to the long recovery period which in turn overshadows sports competitions. In addition, the performance loss is an extra handicap for the athletes compared to the pre-injury levels. In this case, biomedical and biotechnological sciences are a glimmer of hope for shortening the treatment process and minimizing performance loss in returning to professional sports life. Combinations of scaffolds, biological factors, and cells are utilized based on mentioned approaches to treat such injuries, which are frequently seen nowadays and have become the nightmare of professional athletes. This review discusses various regenerative medicine and biotechnology-based therapeutic methods used in the treatment of spinal cord, cartilage, tendon, and musculoskeletal injuries in athletes. Additionally, wearable technologies, which are used to evaluate physiological signals, monitor health, prevent possible injuries, and create personalized training programs are mentioned, as well.

Interprofessional Interviewing in Intraprofessional Athletic Training Student Pairs: A Multi-Institutional Educational Technique

Context The Commission on Accreditation of Athletic Training Education 2020 Standards for Professional Programs highlight the need to further incorporate interprofessional education components into the curricula for athletic training programs. Interprofessional education can be a challenging component to integrate into the curriculum on an ongoing and routine basis, especially when access, quantity, and quality of interprofessional education resources are limited at individual universities. Objective To promote professional socialization between athletic training students of different universities while also promoting teamwork and collaboration values and skills through the use of shared interprofessional resources. Background This educational technique was developed as a means to address the lack of access to interprofessional resources faced by 3 professional athletic training programs in order to help meet compliance with 2020 Commission on Accreditation of Athletic Training Education standards 8, 57, and 79. Description Athletic training students from 3 professional athletic training programs were paired with one athletic training student from another institution to research a nonorthopaedic, general medical condition. They were assigned a 3-part project: (1) review the existing literature for peer-reviewed articles on their assigned pathology, (2) interview a non–athletic trainer health care provider who has worked with the pathology, and (3) create an education infographic of the information to use as an educational tool for patients. The project helped to promote collaborative and team-based skills critical to interprofessional and intraprofessional success as a health care provider. Clinical Advantage(s) Students learned with, from, and about how non–athletic trainer health care professionals manage their assigned nonorthopaedic, general medical pathologies in clinical practice. Conclusion(s) This collaborative project allowed athletic training students to develop intraprofessional and interprofessional skills by working with both athletic training students and non–athletic training health care professionals. Informative feedback on how the students perceived their interactions was received at the conclusion of the assignments.

Gender Diversity in Sports Medicine: Current Trends

As the sports medicine field has grown, the need for a more diverse workforce has become more evident. Given the growing athlete diversity that exists at all recreational and competitive levels of organized sports, it is important to better understand the current state of athletic health care diversity. This review assesses the current state of diversity in sports medicine from the perspective of the medical and athletic training professions. Men and women currently display nearly equivalent participation levels; however, the distribution of female team physicians and athletic trainers could better match the teams that they serve. Although progress has been made, much more needs to be done to bring more female athletic trainers and team physicians into athletic health care leadership roles. Early mentoring programs have shown efficacy for increasing the number of female candidates who might become the foundation of future athletic health care and academic program leaders. Level of EvidenceV, expert opinion.

Athletic Trainers' Perceptions of and Experience with Social Determinants of Health.

The role that social determinants of health (SDHs) play in athletic healthcare is gaining attention, yet little is known about athletic trainers' (ATs) perceptions of and encounters with the impact of SDHs. The purpose of this study was to evaluate ATs' perceptions of various SDHs and their experience treating patients whose health and well-being were influenced by SDHs. This was a cross-sectional, web-based survey completed by 1694 ATs (completion rate = 92.6%; 61.1% female; age = 36.6 ± 10.8 years). The survey consisted of several multipart questions focusing on specific SDHs. Descriptive statistics were used to report frequencies and percentages. Results indicated widespread agreement that SDHs matter to patient health and are of concern in athletic healthcare. The SDHs that ATs most commonly reported encountering included lifestyle choices (n = 1306/1406; 93.0%), social support (n = 1185/1427; 83.0%), income (n = 1167/1502; 77.7%), and access to quality and timely healthcare (n = 1093/1420, 77.0%). The SDHs that ATs least commonly reported having experience with was governmental policy (n = 684/1411; 48%). The perceived importance of SDHs among ATs and their commonly reported experiences managing patient cases in which SDHs negatively influence patients' health and healthcare suggest that efforts to assess these factors are needed so that strategies to address their influence on athletic healthcare can be identified.

Athletic Trainer’s Varying Levels of Awareness and Use of Disablement Model Frameworks: A Qualitative Study

In healthcare, disablement model frameworks aim to improve the delivery of patient-centered care through the recognition of patient factors beyond impairments, restrictions, and limitations, which include personal, environmental, and societal factors. Such benefits translate directly to athletic healthcare providing a mechanism for athletic trainers (ATs), as well as other healthcare professionals, to ensure that all aspects of the patient are managed prior to returning to work or sport. The purpose of this study was to investigate ATs recognition and use of disablement frameworks in current clinical practice. We used criterion sampling to identify ATs who were currently practicing from a random sample of ATs that participated in a related cross-sectional survey. A total of 13 participants engaged in an online, audio-only, semi-structured interview that was audio-recorded and transcribed verbatim. A consensual qualitative research (CQR) approach was used to analyze the data. A coding team of three individuals used a multi-phase process to construct a consensus codebook that identified common domains and categories among the participants' responses. Four domains emerged regarding ATs' experiences and recognition of disablement model frameworks. The first three domains were related to the application of disablement model frameworks: (1) patient-centered care, (2) limitations and impairments, and (3) environment and support. Participants described varying degrees of competence and consciousness regarding these domains. The fourth domain related to participants' exposure to disablement model frameworks through formal or informal experiences. Findings suggest that ATs largely demonstrate unconscious incompetence regarding the use of disablement frameworks in clinical practice.

The effect of the COVID-19 pandemic on the mental status of health workers at sports clubs

Objective: COVID-19 pandemic has affected many people as well as athletes and healthcare professionals mentally. Although there are many studies examining the effect of the pandemic on the mental status of athletes and hospital staff, its effect on the psychological status of professionals providing athlete health care is unknown. This study investigates the effect of the pandemic on the mental health status of health workers of employed in sports clubs. Method: A total of 192 physicians, physiotherapists and masseurs employed in four different sports branches (football, basketball, volleyball, handball) participated in this survey study, which was conducted one year after the outbreak of the pandemic. Three questionnaires, including Depression Anxiety Stress Scale-21 (DASS-21), Coronavirus Anxiety Scale, and Coronavirus Fear Scale were administered to evaluate the mental status of the participants. Results: Physiotherapists' DASS-21 total and stress subgroup scores were found to be higher than those of masseurs (p=0.013, p=0.016, respectively). When compared by sports branches, the measurement results of healthcare professionals were similar (p&gt;0.05). The DASS-21 anxiety subgroup scores were found to be higher in those who had COVID-19 infection than in those who did not (p=0.004). Nevertheless, the mean scores of the participants were in the normal range. Conclusion: In this study, which was conducted about a year after the beginning of the pandemic, the COVID-19 pandemic and the coronavirus infection did not have a significant effect on the mental state of the sports health workers. This can be attributed to the fact that healthcare professionals have adapted to the pandemic process.

How collaborative mental health care for competitive and high-performance athletes is implemented: A novel interdisciplinary case study.

Collaborative care is considered a best practice in mental health care delivery and has recently been applied in high-performance sport to address athletes' mental health needs. However, how the collaborative process unfolds in practice in the sport setting has not yet been well documented. The purpose of this illustrative case study was to investigate a novel interdisciplinary approach used within the Canadian Centre for Mental Health and Sport (CCMHS) to provide mental health care to clients. Focusing on 'how' the approach was implemented, the aim of the study was to provide insight into the collaboration that occurred between mental performance and mental health practitioners to provide care to a high-performance athlete over an 11-month period, as well as factors facilitating and impeding the team's collaboration. The case involved three practitioners and a 16-year-old female athlete experiencing chronic pain, low mood, and elevated anxiety. In the first phase of the data collection process, each practitioner engaged in guided reflective journaling to describe the case and reflect on their practice and outcomes. During the second phase, practitioners co-created a case timeline to describe the collaborative process using clinical documents. Lastly, practitioners participated in collaborative reflection to collectively reflect more broadly on collaboration practice occurring within the CCMHS and Canadian sport system. The data depict a complex care process in which the necessity and intensity of collaboration was primarily driven by the client's symptoms and needs. A content analysis showed that collaboration was facilitated by the CCMHS' secure online platform and tools, as well as individual practitioner and team characteristics. Collaboration was, however, hindered by logistical challenges, overlapping scopes of practice, and client characteristics. Overall, there were more perceived benefits than drawbacks to providing collaborative care. While flexibility was required during the process, deliberate and systematic planning helped to ensure success. Factors such as interdependence of collaborative practice, complementarity of practice within care teams, compensation for collaboration, in-person versus virtual delivery, and intricacies of care coordination should be further examined in the future to optimize collaborative mental health care in sport.

Hybrid effectiveness-implementation study designs in sports injury prevention research.

Despite vast evidence supporting the effectiveness of lower extremity injury prevention programs in a variety of sport settings, age groups, and levels of competition, there is limited evidence on implementation strategies that positively impact the feasibility, scale-up and sustainability of such programs. Sport-related injury prevention is affected by the research-to-practice gap, a pervasive issue in healthcare, where high-quality experimental research is not used in routine clinical practice. An intervention shown to be efficacious in a controlled environment, such as a lab or in a field-study conducted by scientists, will demonstrate a decline in benefit when implemented in the intended clinical setting. Real-world considerations, such as foundational knowledge and training, time constraints, or end user motivation, influence the quality and consistency of implementation. Acknowledging and addressing implementation barriers in a systematic way is essential to promote effective program dissemination. Study design methods that measure both clinical effectiveness and implementation strategies need to be identified. Hybrid effectiveness-implementation designs simultaneously measure both an intervention's effect on clinical outcomes as well as critical information related to implementation strategy; however these study designs are not frequently utilized. The purpose of this mini-review is to describe: the basics of hybrid designs, rationale for using hybrid designs, and examples of how these designs could be used in athletic healthcare injury prevention research.

Characterizing athletic healthcare: A perspective on methodological challenges, lessons learned, and paths forward.

Recently, there has been an emphasis on collecting large datasets in the field of sports medicine. While there have been great advances in areas of sport performance and sport epidemiology, there have been fewer efforts dedicated to understanding the effectiveness and impact of athletic healthcare, including injury prevention programs and rehabilitation interventions provided at the point-of-care. In 2009, the Athletic Training Practice-Based Research Network (AT-PBRN) was launched to address this need, with the mission of improving the quality of care provided by athletic trainers. Unlike other research efforts in sports and medicine, such as sport epidemiology, there are fewer methodological best practices specifically related to clinical data in athletic healthcare. As a result, the AT-PBRN has encountered several methodological challenges during its tenure and has established guidelines based on various sources within the fields of sports and medicine to address these challenges. Therefore, the purpose of this perspective is to identify the challenges and describe strategies to address these challenges related to characterizing athletic healthcare using a large database. Specifically, challenges related to data entry (data quality and reliability) and data extraction and processing (data variability and missing data) will be discussed. Sharing challenges and perspectives on solutions for collecting and reporting on athletic healthcare data may facilitate a greater consistency in the approach used to collect, analyze, and report on clinical data in athletic healthcare, with the goal of improving patient outcomes and the quality of care provided by athletic trainers.