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Context: 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., Objective: This study investigated differences in AT access based on race/ethnicity and SES on a national scale., Design: Cross-sectional study., Setting: 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., Patients or Other Participants: 10,983 public schools., Main Outcome Measure: 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., Results: 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)., Conclusion: 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.

Context: Research that has examined the association between specialization and injury in basketball has been limited to cross-sectional or retrospective studies., Objective: To determine whether specialization is a risk factor for injury among high school basketball athletes., Design: Prospective cohort study., Setting: Basketball players from 12 high schools participating in the National Athletic Treatment, Injury, and Outcomes Network Surveillance Program (NATION-SP) were recruited prior to the 2022-2023 interscholastic basketball season., Patients or Other Participants: 130 athletes (mean age (SD) = 15.6 (1.3); girls' basketball: n=68 (52.3%))., Main Outcome Measures: Participants completed a questionnaire prior to the start of their school basketball season that had questions regarding participation in various specialized sport behaviors. During the basketball season, the school's athletic trainer reported all athletic exposures (AEs) and injuries (regardless of time loss) for participating athletes into NATION-SP. Injury incidence (IR) and incidence rate ratios (IRR) with 95% confidence intervals [95%CI] were calculated for the specialized sport behaviors previously described., Results: There was no difference in injury risk between highly specialized and low specialized athletes (IRR [95%CI]: 1.9 [0.9, 3.7]). Players who participated in basketball year-round were twice as likely to sustain an injury compared to those who did not play year-round (IRR [95%CI]: 2.1 [1.1, 3.6]). Similarly, players who reported participating in basketball skills camps were at increased risk of injury compared to athletes who did not participate in basketball skill camps (IRR [95%CI]: 2.5 [1.2, 5.7])., Conclusion: Injury risk related to sport specialization in basketball may be specific to certain behaviors such as year-round play and participation in skills camps. Validated measures of comprehensive sport activity are needed to better measure specialization in youth sports to better determine injury risk related to sport specialization and develop injury prevention programs for basketball athletes., Competing Interests: Declarations of Interest: None.

Context: 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., Objective: To examine the SDOH characteristics of Indiana secondary schools and AT availability., Design: Cross-sectional study., Setting: Database secondary analysis., Patients or Other Participants: A total of 426 secondary schools., Main Outcome Measure(s): 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., Results: 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)., Conclusions: 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., (© by the National Athletic Trainers’ Association, Inc.)

Context: Although guidance is available, no nationally recognized standard exists for medical documentation in athletic training, leaving individual organizations responsible for setting expectations and enforcing policies. Previous research has examined clinician documentation behaviors; however, the supervisor's role in creating policy and procedures, communicating expectations, and ensuring accountability has not been investigated., Objective: To investigate supervisor practices regarding support, hindrance, and enforcement of medical documentation standards at an individual organization level., Design: Mixed-methods study., Setting: Online surveys and follow-up interviews., Patients or Other Participants: We criterion sampled supervising athletic trainers (n = 1107) in National Collegiate Athletic Association member schools. The survey collected responses from 64 participants (age = 43 ± 11 years; years of experience as a supervisor = 12 ± 10; access rate = 9.6%; completion rate = 66.7%), and 12 (age = 35 ± 6 years; years of experience as a supervisor = 8 ± 5) participated in a follow-up interview., Data Collection and Analysis: We used measures of central tendency to summarize survey data and the consensual qualitative research approach with a 3-person data analysis team and multiphase process to create a consensus codebook. We established trustworthiness using multiple-analyst triangulation, member checking, and internal and external auditing., Results: Fewer than half of supervisors reported having formal written organization-level documentation policies (n = 45/93, 48%) and procedures (n = 32/93, 34%) and an expected timeline for completing documentation (n = 24/84, 29%). Participants described a framework relative to orienting new and existing employees, communicating policies and procedures, strategies for holding employees accountable, and identifying purpose. Limitations included lack of time, prioritization of other roles and responsibilities, and assumptions of prior training and record quality., Conclusion: Despite a lack of clear policies, procedures, expectations, prioritization, and accountability strategies, supervisors still felt confident in their employees' abilities to create complete and accurate records. This highlights a gap between supervisor and employee perceptions, as practicing athletic trainers have reported uncertainty regarding documentation practices in previous studies. Although supervisors perceive high confidence in their employees, clear organization standards, employer prioritization, and mechanisms for accountability surrounding documentation will result in improved patient care delivery, system outcomes, and legal compliance., (© by the National Athletic Trainers’ Association, Inc.)

Context: Significant health care disparities exist in the United States based on socioeconomic status (SES), but the role SES has in secondary school athletes' access to athletic training services has not been examined on a national scale., Objective: To identify differences in access to athletic training services in public secondary schools based on school SES., Design: Cross-sectional study., Setting: Database secondary analysis., Patients or Other Participants: Data for 3482 public high schools., Main Outcome Measure(s): Data were gathered from the Athletic Training Locations and Services (ATLAS) database, US Census Bureau, and National Center for Education Statistics. We included schools from 5 states with the highest, middle, and lowest poverty percentages (15 states total) and collected county median household income, percentage of students eligible for free or reduced-price lunch, race and ethnicity demographics, and access to athletic training services (full-time athletic trainer [AT], part-time AT only, no AT) for each school. Data were summarized in means, SDs, medians, interquartile ranges (IQRs), frequencies and proportions, 1-way analyses of variance, and Kruskal-Wallis tests., Results: Differences were present in school SES between schools with full-time, part-time-only, and no athletic training services. Schools with greater access to athletic training services had fewer students eligible for free or reduced-price lunch (full time: 41.1% ± 22.3%, part time only: 45.8% ± 24.3%, no AT: 52.9% ± 24.9; P < .001). Similarly, county median household income was higher in schools with increased access to athletic training services (full time median [IQR]: $56 026 [$49 085-$64 557], part time only: $52 719 [$45 355-$62 105], and no AT: $49 584 [$41 094-$57 688]; P < .001)., Conclusions: Disparities in SES were seen in access to athletic training services among a national sample of public secondary schools. Access to ATs positively influences student-athletes' health care across several measures. Pilot programs or government funds have been used previously to fund athletic training services and should be considered to ensure equitable access, regardless of school SES., (© by the National Athletic Trainers' Association, Inc.)

Context: Psychological ownership (PO) is a state in which an individual feels possession over an object, organization, or entity (eg, PO over the organization where one works, PO over the profession one serves). Understanding PO could provide insight into the "vitality of the profession" as defined in the Prioritized Research Agenda for the Athletic Training Profession., Objective: To explore athletic trainers' (ATs') PO over their employing organizations and the athletic training profession., Design: Cross-sectional study., Setting: Web-based survey., Patients or Other Participants: Clinically practicing ATs who were active members of the National Athletic Trainers' Association., Main Outcome Measure(s): Demographic variables, Psychological Ownership Questionnaire (POQ) scores, and Psychological Ownership Questionnaire for athletic training (POQ-AT) scores were the primary outcomes measured. Descriptive statistics were calculated for the demographic variables, POQ and POQ-AT overall scores, form scores, and dimension scores. Nonparametric tests were used to investigate differences between the POQ and POQ-AT by demographic characteristics., Results: The ATs indicated greater PO over the athletic training profession (Z = -3.45, P = .001) than over their employing organizations. They displayed greater belongingness (Z = -9.51, P < .001) and self-identity (Z = -8.71, P < .001) and less territoriality (Z = -5.52, P < .001) and accountability (Z = -5.33, P < .001) over their profession than their organization. Those ATs who supervised others had higher overall POQ (Mann-Whitney U test = 34 372, P < .001) and overall POQ-AT (U = 36 624, P = .014) scores than ATs who did not supervise others. A difference was evident in overall POQ (Kruskal-Wallis statistical analysis H4 = 20.47, P < .001) and overall POQ-AT (H4 = 21.34, P < .001) scores by years of experience., Conclusions: Respondents indicated greater PO over their profession than their employing organizations. They demonstrated greater self-identity and belongingness and less territoriality and accountability over the athletic training profession than over their employing organization, suggesting that they were connecting aspirations and accomplishments with the profession but connecting duty and responsibility with their organizations. Years of experience and supervisor status may play roles in the level of organizational PO., (© by the National Athletic Trainers' Association, Inc.)

Context: Nonnative English speakers (NNESs) in the United States have more than doubled since 1990, increasing the likelihood of their seeking health care and experiencing language barriers. Language barriers in health care result in ineffective communication, a decreased level of care, and a reduction in overall provider satisfaction., Objective: To investigate the experiences of secondary school athletic trainers (ATs) who provided care to patients who were NNESs or communicated with their NNES support systems., Design: Qualitative study., Setting: Semistructured interviews., Patients or Other Participants: Fifteen secondary school ATs with experience communicating with NNES patients or their support systems., Data Collection and Analysis: Participants were interviewed, and the interviews were transcribed. A 3-person data-analysis team used the multiphase, consensual qualitative research approach to develop a consensus codebook with domains and categories. Trustworthiness was established through member checking, multiple-researcher triangulating, and auditing., Results: Four domains emerged from the data: (1) communication, (2) welcoming environment, (3) cultural agility, and (4) resourcefulness. Participants enhanced communication by relying on nonverbal communication, translated resources, and interpreters. The ATs discussed a difference in care delivery based on fluency. Respondents explained efforts to create a welcoming environment by speaking in the NNES's native language, increasing comfort, and serving as an advocate within the health care system. Acknowledging customs, demonstrating respect, and understanding potential fear, shame, or both associated with language barriers were discussed as ways to increase cultural agility. The ATs identified a lack of formal training, which increased their on-the-job training and health information technology use. Participants perceived spending increased amounts of initiation, effort, and time on adaptability while caring for and communicating with NNESs., Conclusions: The ATs perceived that they had little formal training and, therefore, became more resourceful and increased communication strategies to provide equitable care. Participants indicated that adapting their care to meet cultural needs and creating a welcoming environment for NNESs were important when cultivating a patient-centered experience., (© by the National Athletic Trainers' Association, Inc.)

Reference:  Schiftan GS, Ross LA, Hahne AJ. The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: a systematic review and meta-analysis. J Sci Med Sport. 2015;18(3):238-244., Clinical Question:   Does the use of proprioceptive training as a sole intervention decrease the incidence of initial or recurrent ankle sprains in the athletic population?, Data Sources:   The authors completed a comprehensive literature search of MEDLINE, CINAHL, SPORTDiscus, and Physiotherapy Evidence Database (PEDro) from inception to October 2013. The reference lists of all identified articles were manually screened to obtain additional studies. The following key words were used. Phase 1 population terms were sport*, athlet*, and a combination of the two. Phase 2 intervention terms were propriocept*, balance, neuromusc* adj5 train*, and combinations thereof. Phase 3 condition terms were ankle adj5 sprain*, sprain* adj5 ankle, and combinations thereof., Study Selection:   Studies were included according to the following criteria: (1) the design was a moderate- to high-level randomized controlled trial (>4/10 on the PEDro scale), (2) the participants were physically active (regardless of previous ankle injury), (3) the intervention group received proprioceptive training only, compared with a control group that received no proprioceptive training, and (4) the rate of ankle sprains was reported as a main outcome. Search results were limited to the English language. No restrictions were placed on publication dates., Data Extraction:   Two authors independently reviewed the studies for eligibility. The quality of the pertinent articles was assessed using the PEDro scale, and data were extracted to calculate the relative risk. Data extracted were number of participants, intervention, frequency, duration, follow-up period, and injury rate., Main Results:   Of the initial 345 studies screened, 7 were included in this review for a total of 3726 participants. Three analyses were conducted for proprioceptive training used (1) to prevent ankle sprains regardless of history (n = 3654), (2) to prevent recurrent ankle sprains (n = 1542), or (3) as the primary preventive measure for those without a history of ankle sprain (n = 946). Regardless of a history of ankle sprain, participants had a reduction in ankle-sprain rates (relative risk [RR] = 0.65, 95% confidence interval [CI] = 0.55, 0.77; numbers needed to treat [NNT] = 17, 95% CI = 11, 33). For individuals with a history of ankle sprains, proprioceptive training demonstrated a reduction in repeat ankle sprains (RR = 0.64, 95% CI = 0.51, 0.81; NNT = 13, 95% CI = 7, 100). Proprioceptive training as a primary preventive measure demonstrated significant results (RR = 0.57, 95% CI = 0.34, 0.97; NNT = 33, 95% CI = 16, 1000)., Conclusions:   Proprioceptive training programs were effective in reducing the incidence rates of ankle sprains in the athletic population, including those with and those without a history of ankle sprains.