National Athletic Trainers Research Articles

Caffeine can affect student‐athlete health, performance

Many student‐athletes consume caffeine in some form on a regular basis but lack an accurate understanding of how it can impact their performance and health, not to mention the regulatory factors involved. That's why Matthew S. Ganio, Ph.D., Professor and Head of the Department of Health, Human Performance and Recreation at the University of Arkansas, spoke about this topic at the National Athletic Trainers’ Association virtual convention. He said athletic trainers and other staff can play a key role in raising awareness among student‐athletes.

Modifications Of Exertional Heat Illness Policies In Us High School Athletics Over An Academic Year

PURPOSE: To evaluate the modifications of Exertional Heat Illness (EHI) policies in United States (US) high schools over a period of one academic year (Fall to Spring) as reported by athletic trainers (ATs). METHODS: An 11-item pre-validated questionnaire was developed using the National Athletic Trainers’ Association Position Statement on EHI. ATs at high schools throughout the US were invited (via email or social media platforms) to complete an online questionnaire related to their school’s written EHI policies (yes/no written policy) at two time points (Fall 2018 and Spring 2019). A total of 105 ATs (female = 59.6%) employed at high schools (with a majority located in Southeast = 37.1%, school size = 1133 ± 935 students) completed the questionnaire at both time points. Data were aggregated and summarized using frequencies. Differences in modifications between time points were assessed using McNemar’s tests (P < 0.05). RESULTS: The proportion of ATs reporting the existence of a policy for the prevention and management of EHI was significantly higher in the Spring (75.7%) than in the preceding Fall (66.0%, p = 0.033). Further, the proportion of schools reporting the component “requires a cold-water immersion tub to be set up (including: filled with water, ice chests nearby) during warm weather activities)” was significantly higher in the Spring (72.6%) compared to the Fall (58.1%, p = 0.039). No other modifications in EHI policies were observed (p > 0.05, Table 1). CONCLUSION: Findings indicate that written EHI policies are not comprehensively and uniformly adopted at the start of the school year and adaptations appear to be marginal through the year. Intervention efforts targeted at improving written policies during the summer break may be warranted as EHI rates are highest in pre-season (i.e., Fall) practices.

Athletic Trainer-Reported Prevalence of Mental Health, Substance Use, and Barriers to Health in Secondary Schools.

Where a person lives can have a significant effect on health. Limited access to health care, food insecurity, lack of affordable housing, and violence increase a person's likelihood of poor health. Athletic trainers (ATs) can contribute to identifying and improving the determinants of health that affect student-athletes. (1) What were the current perceptions ATs had about the health behaviors (specifically mental health and substance use) of high school student-athletes? (2) What were the barriers that ATs experienced when providing health services to high school student-athletes? (3) How did the developed environment affect the health behaviors and barriers that ATs observed? Qualitative study. Online survey. Certified National Athletic Trainers' Association members employed in the secondary school setting. Demographics of ATs were collected, and the ATs' perceptions of the health of student-athletes across developed environments, prevalence of mental health issues, tobacco and substance use, barriers to health care services, and housing and food insecurities among student-athletes were surveyed. Descriptive statistics for the outcome measures were reported. A total of 7600 electronic surveys were distributed to the ATs and 911 responded (females = 62%, average age = 36 years, average experience = 12.5 years). The school setting was identified by 82.5% as public and the environment as suburban by 43.7%, rural by 30.1%, and urban by 26.1%. Participants perceived a high average prevalence of mental health concerns (32%), e-cigarette use (31.7%), and marijuana use (26.9%) among student-athletes. Significant perceived barriers to health included limited access to transportation, poverty, and housing and food insecurities. This study highlights the health disparities and barriers ATs observed when addressing the health care needs of student-athletes. Understanding the determinants of health in order to identify the causes of health disparities may better prepare ATs to manage the health needs of underserved student-athletes.

The Influence of Education and Environment on Patient-Reported Outcome Use in Athletic Training Clinical Practice

Context There have been multiple education reforms aimed at incorporating patient-reported outcome measures (PROMs) into routine clinical care. However, many factors can impact PROM use, including employment setting/policies or access to literature. Objective To explore the influence of educational background and employment setting/policies on athletic trainer (AT) attitudes and practices related to PROM use in the secondary and collegiate settings. Design Cross-sectional survey. Setting Secondary schools; National Collegiate Athletic Association Division I, II, and III; National Association of Intercollegiate Athletics; and junior colleges. Patients or Other Participants Five hundred and seven ATs working in secondary and collegiate settings. Data Collection and Analysis An established scale evaluating attitudes toward PROMs was distributed to a purposeful sample of 4000 ATs. Also included were questions concerning use of PROMs, employer policies related to PROMs, access to non–National Athletic Trainers' Association (NATA) journals, and educational background. Scores on each scale were compared based on educational background, employment setting/policies, and access to non-NATA scientific journals using Kruskal-Wallis tests with a Bonferroni correction. Frequency of PROM use was evaluated using chi-square tests (α = .05). Results PROMs were viewed positively across all participants, with more positive attitudes toward PROMs observed among those with clinical doctorates (P = .029) compared to those with master's or bachelor's degrees and by those with an athletic training-–related postprofessional master's degree (P = .030) compared to a non–athletic training master's degree. There were no differences in attitudes based on timing of professional degree completion. There were no differences in the usage of PROMs based on educational background or employment setting, with only 10% of respondents reporting routine PROM use. However, access to non-NATA scientific journals (P = .016) and employer policies related to the use of PROMs were associated with increased use of PROMs (P &amp;lt; .001). Conclusion Educational reforms have enhanced the attitudes of practicing ATs toward PROMs; however, environmental facilitators, such as expanded access to scientific literature and policies regarding the use of PROMs, are necessary to increase the use of PROMs.

Pediatric HEALTHCARE Provider Awareness, Confidence, and Use of Sports Specialization Recommendations and Application towards Youth Athlete Counseling

Background:Sport specialization is increasingly common in many youth sports and has been linked to increased injury, overtraining, and burnout. Several organizations have developed safe sport recommendations in an effort to mitigate injury risk. Healthcare providers (HCPs) can be a source of education for parents and athletes on safe sports practices, but the awareness, confidence, and use of these recommendations among HCPs who work with youth athletes is limited. Hypothesis/Purpose: To evaluate the awareness, confidence, and use of sports specialization and safe sport recommendations of HCPs who work with pediatric athletes.Methods:A cross-sectional online survey was developed to assess pediatric HCP awareness of, confidence in, and clinical use of sports specialization recommendations. The survey included 1) personal demographics, 2) professional demographics, 3) knowledge and perceptions of sport specialization, 4) awareness, confidence, and use of recommendations, and 5) HCP program training and professional development background specific to sports specialization. Survey links were sent by email to 5000 secondary school athletic trainers and 297 PRiSM members during October 2019-January 2020. The survey was open for 4 weeks, with a reminder email sent after 2 weeks. Data was analyzed with descriptive statistics.Results:The survey was accessed by 620 HCPs (access rate=11.7%) and completed by 508 HCPs (completion rate=81.9%). Respondents (279 females, 228 males; age=37.2±10.5 years) included athletic trainers (74.5%, n=379), physicians (16.9%, n=86, physical therapists (6.7%, n=35), nurse practitioners (1.0%, n=5), and physician assistants (0.1%, n=4) with 11.2±9.1 years of experience providing care to pediatric athletes. Three-fourths of respondents (n=373) were aware of recommendations from the National Athletic Trainers’ Association, but fewer were aware of those from the American Academic of Pediatrics (42.3%, n=212), American Medical Society for Sports Medicine (40.3%, n=200), American Orthopaedic Society for Sports Medicine (45.2%, n=225), International Olympic Committee (14.2%, n=69), Major League Baseball (30.6%, n=151), USA Hockey (13.6%, n=66), and National Basketball League (9.3%, n=45). The percentage of respondents who were confident in knowledge of (Table 1) and used (Table 2) each organization’s recommendation are provided in the tables. Table 3 presents the degree to which various reasons limit the use of sports specialization recommendations.Conclusion:Healthcare providers are aware of sport specialization recommendations and believe they are associated with decreased risk of injury. However, barriers to applying the recommendations most cited were the inability of parents and children to change specialization behaviors. Future research should focus on implementation of recommendations to enact behavior change.Tables

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

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

Mechanical Percussion Devices: A Survey of Practice Patterns Among Healthcare Professionals.

BackgroundMechanical percussion devices have become popular among sports medicine professionals. These devices provide a similar effect as manual percussion or tapotement used in therapeutic massage. To date, there are few published studies or evidence-based guidelines for these devices. There is a need to understand what professionals believe about this technology and how they use these devices in clinical practice.PurposeTo survey and document the knowledge, clinical application methods, and use of mechanical percussion devices among healthcare professionals in the United States.DesignCross-sectional survey study.MethodsA 25 question online survey was emailed to members of the National Athletic Trainers Association, Academy of Orthopedic Physical Therapy, and American Academy of Sports Physical Therapy.ResultsFour hundred twenty-five professionals completed the survey. Most professionals (92%, n=391) used devices from two manufacturers: Hyperice® and Theragun®. Seventy-seven percent directed clients to manufacturer and generic websites (n=329) to purchase devices. Most respondents used a medium and low device speed setting for pre- and post-exercise (62%, n=185), pain modulation (59%, n=253), and myofascial mobility (52%, n=222). A large proportion of respondents preferred a total treatment time between 30 seconds and three minutes (36-48%, n=153-204) or three to five minutes (18-22%, n=76-93). Most respondents (54-69%, n=229-293) believed that mechanical percussion increases local blood flow, modulates pain, enhances myofascial mobility, and reduces myofascial restrictions. Most respondents (72%, n=305) were influenced by other colleagues to use these devices. Sixty-six percent used patient reported outcomes (n=280) to document treatment efficacy. Live instruction was the most common mode of education (79%, n=334).ConclusionThese results are a starting point for future research and provide insight into how professionals use mechanical percussion devices. This survey also highlights the existing gap between research and practice. Future research should examine the efficacy of this technology and determine consensus-based guidelines.Level of Evidence3

Kinesiology Tape: A Descriptive Survey of Healthcare Professionals in the United States.

BackgroundThe existing body of kinesiology tape (KT) research reveals inconsistent results which challenges the efficacy of the intervention. Understanding professional beliefs and KT clinical application might provide insight for future research and development of evidence-based guidelines.PurposeThe purpose of this study was to survey and document the beliefs and clinical application methods of KT among healthcare professionals in the United States.DesignCross-sectional survey study.MethodsA 30-question online survey was emailed to members of the National Athletic Trainers Association, Academy of Orthopedic Physical Therapy, and American Academy of Sports Physical Therapy. Professionals were also informed through a recruitment post in different private healthcare Facebook groups.ResultsOne thousand and eighty-three respondents completed the survey. Most respondents used KT for post-injury treatment (74%), pain modulation (67%), and neuro-sensory feedback (60%). Most believed that KT stimulates skin mechanoreceptors (77%), improve local circulation (69%), and modulates pain (60%). Some respondents believed KT only created a placebo effect (40%) and use it for such therapeutic purposes (58%). Most used a standard uncut roll (67%) in black (71%) or beige (66%). Most respondents did not use any specialty pre-cut tape (83%), infused tape (99.54%), or a topical analgesic with tape (65%). The most common tape tension lengths used by respondents were 50% tension (47%) and 25% (25%) tension. Patient reported outcomes (80%) were the most common clinical measures. Most respondents provided skin prep (64%) and tape removal (77%) instructions. Some did not provide any skin prep (36%) or tape removal (23%) instruction. The average recommended times to wear KT were two to three days (60%). The maximum times ranged from two to five days (81%).ConclusionThis survey provides insight into how professionals use KT and highlights the gap between research and practice. Future research should address these gaps to better determine evidence-based guidelines.Level of Evidence3

Work-Life Balance Research in Athletic Training: Perspectives on Future Directions.

Work-Life Balance Research in Athletic Training: Perspectives on Future Directions.

High Schools' Adoption of Evidence-Based Practices for the Management of Exertional Heat Stroke.

Exertional heat stroke (EHS) deaths can be prevented by adhering to best practices. To investigate high schools' adoption of policies and procedures for recognizing and treating patients with EHS and the factors influencing the adoption of a comprehensive policy. Cross-sectional study. Online questionnaire. Athletic trainers (ATs) practicing in the high school (HS) setting. Using the National Athletic Trainers' Association position statement on exertional heat illness, we developed an online questionnaire and distributed it to ATs to ascertain their schools' current written policies for using rectal temperature and cold-water immersion. The precaution adoption process model allowed for responses to be presented across the various health behavior stages (unaware if have the policy, unaware of the need for the policy, unengaged, undecided, decided not to act, decided to act, acting, and maintaining). Additional questions addressed perceptions of facilitators and barriers. Data are presented as proportions. A total of 531 ATs completed the questionnaire. Overall, 16.9% (n = 62) reported adoption of all components for the proper recognition and treatment of EHS. The component with the highest adoption level was "cool first, transport second"; 74.1% (n = 110) of ATs described acting on or maintaining the policy. The most variability in the precaution adoption process model responses was for a rectal temperature policy; 28.7% (n = 103) of ATs stated they decided not to act and 20.1% (n = 72) stated they maintained the policy. The most frequently cited facilitator of and barrier to obtaining rectal temperature were a mandate from the state HS athletics association (n = 274, 51.5%) and resistance to or apprehension of parents or legal guardians (n = 311, 58.5%), respectively. Athletic trainers in the HS setting appeared to be struggling to adopt a comprehensive EHS strategy, with rectal temperature continuing as the biggest challenge. Tailored strategies based on health behavior, facilitators, and barriers may aid in changing this paradigm.

Responding in Crisis: Considerations for Administrators and Faculty

Responding in Crisis: Considerations for Administrators and Faculty

Program Directors' Perception of the Importance of Soft Skills in Athletic Training

Context Soft skills have been reported to be a necessary aspect of athletic training education and clinical practice. However, almost no empirical research has explored the level of importance of soft skills or the frequency with which they are evaluated within athletic training education. Objective To delineate the perceived importance of soft skills within athletic training education and describe the frequency with which those soft skills are evaluated within athletic training programs. Patients or Other Participants Four hundred eight program directors (PDs) of Commission on Accreditation of Athletic Training Education–accredited athletic training programs were invited to patriciate; 122 responded and 108 of those responses (88.5%) were usable (64% PDs of baccalaureate programs, 28% PDs of professional masters, 8% did not disclose), yielding a 26.5% response rate. All 10 National Athletic Trainers' Association districts were represented, with the highest representation (26%) from District 4. A majority of respondents were female (57%). Most respondents (79%) had 11 or more years of experience (33% of those ≥21 years) as an athletic training educator, and 98% of respondents identified as white/non-Hispanic. Main Outcome Measure(s) Importance and frequency of soft-skill evaluation were measured using the Athletic Training Soft-Skills Assessment Instrument (ATSSAI). Data of perceived importance and frequency of evaluation were organized by various demographic variables and between scale dimensions. Results The ATSSAI psychometric analysis yielded satisfactory internal consistency and validity (α = .84 to .93). Paired-samples t test indicated significant differences between the ATSSAI Perceived Importance and Frequency of Evaluation scales (mean = 1.65 ± .47 versus mean = 3.29 ± 1.17, P = .000; Cohen d = 1.83). Pearson r correlation showed a positive relationship between perceived importance and frequency of evaluation, r = 0.81. Independent-samples t tests revealed female PDs perceived 2 soft skills (18%; observant and exact and prepared and adaptable) as more important (t99 = 2.12 and 2.18, P = .31 and .37) than did male PDs and evaluated 3 (27%; decisive and confident, prepared and adaptable, and observant and exact) more frequently (t99 = 2.35–2.50, P = .14–.21) than did male PDs. Conclusions All soft skills identified as necessary for inclusion in athletic training education were perceived to be very or extremely important by PDs. However, those same soft skills were not evaluated as often as their importance might suggest. Dependability and responsibility was the most important and most frequently evaluated soft skill (mean = 1.31 ± .51 and 2.21 ± 1.30, respectively). Female PDs generally perceived soft skills as more important and reported evaluating them more frequently. Soft-skill development is a tacit-based phenomenon that contributes to leadership effectiveness and clinical preparedness.

Athletic Trainers' Perceptions of Treating and Managing Patients With Ankle Sprains.

Ankle sprains are common occurrences in athletic and general populations. High volumes of ankle sprains elevate the clinical burden on athletic trainers (ATs). The National Athletic Trainers' Association (NATA) published a position statement regarding the treatment and management of ankle sprains, but certain factors might affect an AT's ability to effectively implement the recommendations. To evaluate ATs' current understanding, perceptions, and difficulties regarding the treatment, management, and long-term effects of ankle sprains. Cross-sectional study. Online survey instrument. A total of 796 ATs (years certified = 12.1 ± 9.2) across all athletic training job settings. Participants completed a 38-question survey that addressed their demographic characteristics, as well as their perceptions and knowledge of the epidemiology, treatment, and management of ankle sprains. The survey was also used to document participants' patient education practices and attitudes toward the NATA position statement regarding ankle sprains, along with the challenges of and pressures against implementation. Descriptive statistics, correlations, and analyses of variance were used to analyze the data and evaluate group differences and relationships. Of the participants, 83% demonstrated a moderate understanding of fundamental ankle sprain epidemiology. Group differences regarding patient education were seen by education levels, years certified, and job setting. Overall, 38.1% of ATs were either unsure or unaware of the NATA position statement, but those who were aware rated its usefulness at 3.89 on a scale of 1 to 5, with 1 being not useful at all; 3, neutral; and 5, very useful. On average, 1.9 ± 0.88 challenges to implementing effective treatment practices were documented, and 2.0 ± 0.95 pressures to return athletes to play after ankle sprain were reported. Nearly 40% of the ATs were either unaware or unsure of the current recommendations regarding how patients with ankle sprains are treated, which could affect how care is delivered.

Barriers and Facilitators Faced by Athletic Trainers Implementing National Athletic Trainers' Association Inter-Association Task Force Preseason Heat-Acclimatization Guidelines in US High School Football Players.

The aim of the National Athletic Trainers' Association Inter-Association Task Force (NATA-IATF) preseason heat-acclimatization guidelines was to acclimatize high school athletes to the environment during the first 2 weeks of the preseason and reduce the risk of exertional heat illness. To identify barriers and facilitators that high school athletic trainers (ATs) encountered when implementing the NATA-IATF guidelines. Qualitative study. Individual phone interviews with all participants. Thirty-three ATs (16 men, 17 women; age = 36.0 ± 12.0 years, athletic training experience = 12.9 ± 10.5 years) representing 19 states (4 with state mandates) were interviewed before data saturation was achieved. Participants were purposefully sampled from a larger investigation based on stratification of US Census region and preidentified high school compliance with the NATA-IATF guidelines. A cross-sectional, semistructured phone interview (6 steps) was conducted with each participant and then transcribed verbatim. A 7-person research team (5 coders, 2 auditors) coded the data into themes and categories, focusing on consensus of data placement to reduce bias and ensure accuracy. Facilitators and barriers that influenced successful guideline implementation were (1) perceived stakeholder access, (2) perceived stakeholder role, (3) capability and capacity, (4) school culture, (5) logistical support, (6) resources, (7) physical environment, and (8) consistency of the guidelines. Overall, participants discussed facilitators and barriers within each category based on their experiences and circumstances. Athletic trainers faced numerous concerns regarding compliance with the NATA-IATF preseason heat-acclimatization guidelines. Multiple levels of influence should be targeted to improve implementation. These include intrapersonal factors by giving ATs the education and self-efficacy to support advocacy for implementation, interpersonal components by establishing strong collaborative networks for change, community and environmental factors by optimizing school culture and community resources for implementation, and policy aspects by establishing consistent guidelines across all bodies.

Adoption of Lightning Safety Best-Practices Policies in the Secondary School Setting.

Lightning-related injuries are among the top 10 causes of sport-related death at all levels of sport, including the nearly 8 million athletes participating in US secondary school sports. To investigate the adoption of lightning safety policies and the factors that influence the development of comprehensive lightning safety policies in United States secondary schools. Cross-sectional study. Secondary school. Athletic trainers (ATs). An online questionnaire was developed based on the "National Athletic Trainers' Association Position Statement: Lightning Safety for Athletics and Recreation" using a health behavior model, the precaution adoption process model, along with facilitators of and barriers to the current adoption of lightning-related policies and factors that influence the adoption of lightning policies. Precaution adoption process model stage (unaware for need, unaware if have, unengaged, undecided, decided not to act, decided to act, acting, maintaining) responses are presented as frequencies. Chi-square tests of associations and prevalence ratios with 95% CIs were calculated to compare respondents in higher and lower vulnerability states, based on data regarding lightning-related deaths. The response rate for this questionnaire was 13.43% (n = 365), with additional questionnaires completed via social media (n = 56). A majority of ATs reported maintaining (69%, n = 287) and acting (6.5%, n = 27) a comprehensive lightning safety policy. Approximately 1 in 4 ATs (25.1%, n = 106) described using flash to bang as an evacuation criterion. Athletic trainers practicing in more vulnerable states were more likely to adopt a lightning policy than those in less vulnerable states (57.4% versus 42.6%, prevalence ratio [95% CI] = 1.16 [1.03, 1.30]; P = .009). The most commonly cited facilitator and barrier were a requirement from a state high school athletics association and financial limitations, respectively. A majority of ATs related adopting (eg, maintaining and acting) the best practices for lightning safety. However, many ATs also indicated continued use of outdated methods (eg, flash to bang).

Wet Bulb Globe Temperature Use in National Collegiate Athletic Association Football Bowl Subdivision Athletic Training Staffs

Heat illnesses present a risk for athletes, especially football players. The National Athletic Trainers’ Association established recommendations to prevent heat illnesses, which include measuring wet bulb globe temperature (WBGT). This study aimed to determine the prevalence of WBGT use among the 130 National Collegiate Athletic Association Football Bowl Subdivision athletic training staffs. Of 82 respondents, 59 use WBGT to assess heat stress. The majority of Football Bowl Subdivision training programs (72% of respondents) use the WBGT, but adherence to this National Athletic Trainers’ Association recommendation varies throughout the season (practice versus games) and is likely influenced by the geographical location of the university.

Patient Care Documentation in the Secondary School Setting: Unique Challenges and Needs.

Athletic trainers (ATs) recognize patient care documentation as an important part of clinical practice. However, ATs using 1 electronic medical record (EMR) platform reported low accountability and lack of time as barriers to documentation. Whether ATs using paper, other EMRs, or a combined paper-electronic system exhibit similar behaviors or experience similar challenges is unclear. To explore ATs' documentation behaviors and perceived challenges while using various systems to document patient care in the secondary school setting. Qualitative study. Individual telephone interviews. Twenty ATs (12 women, 8 men; age = 38 ± 14 years; clinical experience = 15 ± 13 years; from National Athletic Trainers' Association Districts 2, 3, 6, 7, 8, 9, and 10) were recruited via purposeful and snowball-sampling techniques. Two investigators conducted semistructured interviews, which were audio recorded and transcribed verbatim. Following the consensual qualitative research tradition, 3 researchers independently coded transcripts in 4 rounds using a codebook to confirm codes, themes, and data saturation. Multiple researchers, member checking, and peer reviewing were the methods used to triangulate data and enhance trustworthiness. The secondary school setting was central to 3 themes. The ATs identified challenges to documentation, including lack of time due to high patient volume and multiple providers or locations where care was provided. Oftentimes, these challenges affected their documentation behaviors, including the process of and criteria for whether to document or not, content documented, and location and timing of documentation. To enhance patient care documentation, ATs described the need for more professional development, including resources or specific guidelines and viewing how documentation has been used to improve clinical practice. Challenges particular to the secondary school setting affected ATs' documentation behaviors, regardless of the system used to document care. Targeted professional development is needed to promote best practices in patient care documentation.

Exertional Heat Illness Preparedness Strategies: Environmental Monitoring Policies in United States High Schools.

Background and objectives: Environmental monitoring allows for an analysis of the ambient conditions affecting a physically active person’s ability to thermoregulate and can be used to assess exertional heat illness risk. Using public health models such as the precaution adoption process model (PAPM) can help identify individual’s readiness to act to adopt environmental monitoring policies for the safety of high school athletes. The purpose of this study was to investigate the adoption of policies and procedures used for monitoring and modifying activity in the heat in United States (US) high schools. Materials and Methods: Using a cross-sectional design, we distributed an online questionnaire to athletic trainers (ATs) working in high schools in the US. The questionnaire was developed based on best practice standards related to environmental monitoring and modification of activity in the heat as outlined in the 2015 National Athletic Trainers’ Association Position Statement: Exertional Heat Illness. The PAPM was used to frame questions as it allows for the identification of ATs’ readiness to act. PAPM includes eight stages: unaware of the need for the policy, unaware if the school has this policy, unengaged, undecided, decided not to act, decided to act, acting, and maintaining. Invitations were sent via email and social media and resulted in 529 complete responses. Data were aggregated and presented as proportions. Results: Overall, 161 (161/529, 30.4%) ATs report they do not have a written policy and procedure for the prevention and management of exertional heat stroke. The policy component with the highest adoption was modifying the use of protective equipment (acting = 8.2%, maintaining = 77.5%). In addition, 28% of ATs report adoption of all seven components for a comprehensive environmental monitoring policy. Conclusions: These findings indicate a lack of adoption of environmental monitoring policies in US high schools. Secondarily, the PAPM, facilitators and barriers data highlight areas to focus future efforts to enhance adoption.

College Athletic Trainers' Perceptions of Rest and Physical Activity When Managing Athletes With a Sport-Related Concussion.

Cognitive and physical rest are commonly utilized when managing a sport-related concussion (SRC); however, emerging research now suggests that excessive rest may negatively impact recovery. Despite current research recommendations, athletic trainers (ATs) may be behind in implementing this emerging research into clinical practice. To assess college ATs' perceptions and implementation of an emerging SRC management approach (cognitive and physical rest and activity). Cross-sectional study. Survey. A total of 122 (11.8%) ATs (53.3% female; 10.8 [9.8]y experience; 8.7 [6.9] SRCs managed annually) responded to the survey, which was randomly distributed to 1000 members of the National Athletic Trainers' Association, as well as 31 additional ATs from varying universities. A 5-point Likert scale assessed the ATs' perceptions and clinical practices as they relate to specific athlete behaviors (ie,texting, sleeping). The ATs were asked about their willingness to incorporate physical activity into clinical practice. Playing video games (95.9%) and practicing (93.4%) were the activities most perceived to extend SRC recovery. However, sleeping more than usual (7.4%) and increased time in a dark environment (11.5%) were viewed as less likely to extend recovery. ATs restricted practicing (98.4%) and working out (91.8%) for athletes with SRC, while sleeping more than usual (6.6%) and increased time in a dark environment (13.1%) were less restricted. About 71% of the ATs would implement light physical activity for athletes with a symptom score of 1 to 5, 31% with scores of 6 to 10, and 15% with scores of 11 to 20. About 43%, 74%, and 97% believe that light, moderate, and vigorous physical activity, while symptomatic, will extend recovery, respectively. The ATs were receptive to including light physical activity into their SRC management, although only in certain situations. However, most ATs' beliefs and clinical practices did not completely align with emerging research recommendations for the management of SRCs.

Work-Family Conflict of Collegiate and Secondary School Athletic Trainers Who Are Parents.

The work-life interface has been a much discussed and researched area within athletic training. The National Athletic Trainers' Association position statement on work-life balance highlighted the profession's interest in this topic. However, gaps in the literature remain and include the roles of time-based conflict and social support. To compare work-family conflict (WFC) and social support among athletic trainers (ATs) employed in the 2 most common practice settings. Cross-sectional observational survey. Collegiate and secondary school settings. A total of 474 (females = 231, males = 243) ATs who were employed in the collegiate (205, 43.2%) or secondary school (269, 56.8%) setting. Data were collected through a Web-based survey designed to measure conflict and social support. Likert responses were summed. Demographic information was analyzed for frequency and distribution. Independent t tests and Mann-Whitney U tests were calculated to determine group differences. Linear regression was used to determine if social support predicted WFC. Social provisions and WFC were negatively correlated, and the social provisions score predicted WFC. No WFC differences (P = .778) were found between collegiate and high school ATs even though collegiate ATs worked more hours (63 ± 11) during their busiest seasons compared with those in the high school setting (54 ± 13, P < .001). Similarly, no difference (P = .969) was present between men and women, although men worked more hours. Our participants scored highest on time-based WFC items. Work-family conflict was experienced globally in 2 of the most common athletic training settings and between sexes. This indicates WFC is universally experienced and therefore needs to be addressed, specifically with a focus on time-based conflict. In addition to time-management strategies, ATs need support from coworkers, peers, and family members.