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Context: Clinical reasoning is an inferential process of collecting and evaluating data in patient cases, necessary in all care. Athletic training residency programs are emerging rapidly as the industry standard for developing clinical specialists who possess advanced clinical reasoning needed for complex cases. Objective: The purpose of this study was to explore current practices of advanced clinical reasoning development and assessment in athletic training residency programs. Design: Inductive qualitative research. Setting: Web-based teleconferencing platform (Zoom Video Communications). Patients or Other Participants: Seven of 10 Commission on Accreditation of Athletic Training Education--accredited residency program directors (RPDs) (age = 46 ± 9 years, years as RPD = 5 ± 6). Data Collection and Analysis: We used qualitative, semistructured interviews. Audio files were transcribed verbatim, checked for accuracy, deidentified, and member checked before analysis. We used a 2-person data analysis team and an inductive coding approach. The researchers reviewed the transcripts independently, met to develop a codebook, applied the codes, and conducted internal auditing. Trustworthiness was established through member checking, multiple-analyst coding, and auditing. Results: Three themes emerged from the RPDs about developing advanced clinical reasoning: (1) defining clinical reasoning; (2) instructional tactics; and (3) assessment tactics. RPDs defined clinical reasoning as the process of the resident justifying their decision-making and the accuracy of their decisions. RPDs described both clinical and didactic instructional tactics, including mentoring, lectures and discussions, case presentations, and journal club. RPDs described assessing advanced clinical reasoning through patient and preceptor feedback in structured and unstructured formats, self-reflection, and knowledge testing to measure clinical reasoning. RPDs highly relied on preceptors and clinical mentoring, but also described a singular reliance on residents to appraise the clinical reasoning capacity of their own preceptors. Conclusions: RPDs define clinical reasoning as rationalization and accuracy of decisions. Although the programs are engaged in effective clinical and didactic approaches to teach advanced clinical reasoning, they rely heavily on the subjectivity of preceptors and residents to assess these outcomes.

Context: Within the athletic training profession, Doctor of Athletic Training (DAT) programs are expected to develop advanced practice leaders; however, little is known about whether this is achieved. Objective: Assess DAT graduates' perceived importance and confidence in performing personal leadership competencies as well as the level of influence a DAT program had on the development of these competencies. Design: Cross-sectional design. Setting: A 73-item Web-based survey. Patients or Other Participants: Seventy-seven DAT graduates, from a possible 205 graduates responded to the survey. Forty-five respondents completed the survey (21.9%) and were included in this study (age = 31.5 ± 6.1 years; years since graduating from DAT = 1.13 ± 0.90; years of experience = 8.69 ± 5.6; years employed at current job = 3.00 ± 4.04). Intervention(s): Each participant completed a questionnaire with 7 demographic items and 66 items to assess perceived importance, confidence, and influence of the DAT on 22 personal leadership competencies. The questionnaire was adapted from the Leadership Development in Athletic Training instrument. Main Outcome Measure(s): Descriptive statistics were used to characterize participant demographics and assess the perceived importance, confidence, and influence of the DAT program on leadership competencies. Partial data were included in the analysis. Results: All competencies were rated as important or higher with critical thinking (mean = 4.84 ± 0.37) rated very important (mode = 5, n = 37/45, 82.2%). Graduates were moderately confident or higher on all competencies with being credible (mean = 4.5 ± 0.55) rated extremely confident (mode = 5, n = 23/45, 51.1%). Graduates indicated that the DAT was extremely influential on their being future minded (mean = 4.63 ± 0.58; mode = 5, n = 29/45, 64.4%). Conclusions: Doctor of Athletic Training graduates' perceptions suggest that programs may be meeting the goal of developing advanced practice leaders. Respondents indicated higher perceptions of confidence in competencies they deemed as important. Respondents also indicated that DAT programs were influential in shaping their perceptions about certain leadership competencies. Other factors may influence graduates' perceptions outside of the DAT, such as previous education and experience.

This article describes the integration of self-authorship theory to aid post-professional healthcare students in the continued development of professional identity. Specific teaching and instructional strategies are provided along with curricular development using a self-authorship framework.

Objective: To investigate the influences of feedback on manual therapy skill acquisition as presented in the literature. Data Source(s): An electronic search was conducted across 4 databases: PubMed, EBSCOhost, SPORTDiscus, and CINAHL. The key words that were used in the search included "manual therapy," "physiotherapy," "mobilizations," "manipulation," "education," "instruction," "feedback," "intrinsic feedback," and "extrinsic feedback." The Boolean phrases AND and OR were used to combine the search terms. Study Selections: Studies that collected outcomes related to manual therapy skill acquisition from inception of the databases to September 2019 were included. Studies were excluded if they examined solely patient-rated or clinical outcomes of manual therapy or did not use feedback as the primary instructional intervention. Data Synthesis: After quality appraisal with the Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental Studies, the articles included in the review were categorized according to generalized manual therapy skills. Joint distraction/traction was the skill examined in 2 studies. The effect of feedback on joint mobilizations was investigated in 5 studies. Studies examining joint manipulations represented the largest portion of the articles in this review, with 11 total studies being included. The primary forms of feedback that were examined in the literature included visual, verbal, and combined forms of auditory and visual feedback. Conclusion(s): Visual feedback that provides learners with graphical representations of their performance, such as force-time relationships, appear to have the greatest effects in improving force-related parameters. Visual feedback can be useful during the initial acquisition phases of manual therapy skills, as indicated by the concentration of significant findings immediately after use in training sessions. A limited number of studies examining outcomes at long-term follow-up reported that training effects decrease rapidly over time. Thus, future studies should investigate if optimal dosages or scheduling strategies exist to increase the retention of effects.

Context: Athletic training is at the forefront of the prevention of injury and illness. As the push for population-level approaches continues, including the expansion of standards related to professional preparation, there is a need to examine the knowledge and practice application of public health topics of athletic trainers (ATs), as they may serve as role models or preceptors. Objective: To assess ATs' knowledge and practice application of public health topics. Design and Setting: Online survey with knowledge assessment. Participants: Four hundred eighty-seven ATs (age = 35.8 ± 11.1 years, years credentialed = 12.8 ± 10.6) voluntarily participated. Intervention(s): The instrument included a demographic section, a pre and post perceived-knowledge assessment, a practice-behavior frequency matrix, and the Public Health Assessment Tool (PHAT) developed by the authors and Delphi panelists. Main Outcome Measure(s): Measures of central tendency were calculated for the practice-behavior frequency matrix. Perceived knowledge was compared pre- and post-PHAT. We calculated a total PHAT score to measure actual knowledge, and compared perceived and actual knowledge to determine if a knowledge gap existed. Results: A significant difference (P > 0.001) was identified for perceived knowledge before and after the PHAT. On the PHAT, participants scored 12.14 ± 2.21 out of 19. The 3 most commonly missed questions directly related to the 3 least practiced topics: social determinants of health, assessing environmental health factors, and assessing health-related quality of life. When exploring the relationship between perceived and actual knowledge, we identified a weak, significant relationship between post-PHAT perceived-knowledge mean and actual-knowledge assessment scores (r = 0.105, P = 0.022). Conclusions: A knowledge gap exists concerning public health topics in ATs. A lack of knowledge related to public health topics identifies the need for ATs to be mindful of the intersection of daily clinical practice and population health with a future emphasis on deploying community-based health promotion.

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. [ABSTRACT FROM AUTHOR]

Context: Approximately 70,000 Americans miss work annually due to tendinopathies causing pain, disability, and lower quality of life. Various conservative treatments have been demonstrated to improve outcomes in these conditions. Dry needling (DN) and therapeutic exercise are 2 such interventions that have been proposed to be a positive intervention for addressing tendinopathy. Objective: To summarize the best available evidence on the use of DN and exercise combined to treat tendinopathy. Evidence Acquisition: PubMed, EBSCOHost, and Web of Science were systematically searched from inception to March 2021. Articles were assessed to determine eligibility and evaluated for methodological quality using the PEDro scale. The PRISMA guidelines were used for this review. Inclusion criteria consisted of use of DN in combination with therapeutic exercise, human participants, and active tendinopathy pathology. Evidence Synthesis: Seven studies met the inclusion and exclusion criteria, which averaged 6/11 on the PEDro scale. The level of agreement of evaluators was 94%. Current evidence supports the use of DN combined with therapeutic exercises, especially those including eccentric exercises, can improve pain and function for various tendinopathies. However, limited evidence exists regarding specific therapeutic interventions to be combined with DN. Conclusion: There is moderate, level B evidence to suggest the use of DN techniques targeted at the tendon and combined with eccentric therapeutic exercise to improve pain and functional outcomes for tendinopathies. [ABSTRACT FROM AUTHOR]

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. To investigate supervisor practices regarding support, hindrance, and enforcement of medical documentation standards at an individual organization level. Mixed-methods study. Online surveys and follow-up interviews. 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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

Context: Mulligan's Mobilization with Movement (MWM) is a common intervention used to address dorsifiexion range of motion (DFROM) impairments. However, the treatment dosage of MWMs varies within the literature. Objective: The aim of this study was to examine the effect of serial MWM application on DFROM . Design: Repeatedmeasures cohort. Setting: A Midwestern University and the surrounding community . Participants: A total of 18 adults (13 females; age = 29 [12.87] y ; DFROM = 30.26° [4.60°]) with decrease dorsifiexion (<40°) participated. Inclusion criteria consisted of a history of ≥1 ankle sprain, ≥18 years old, no lower-extremity injury in the last 6 months, and no history of foot/ankle surgery. Intervention: Participants completed a single data collection session consisting of 10 individual sets of MWMs. Main Outcome Measures: DFROM was taken at baseline and immediately after each intervention set (post 1,post 2,... post 10) DFROM was measured with a digital inclinometer on the anterior aspect of the tibia during the weight-bearing lunge test with the knee straight and knee bent. Analysis of variances examined DFROM changes over time. Post hoc analysis evaluated sequential pairwise comparisons and changes from baseline at each time point. Results: Analysis of variance results indicated a significant time main effect for weight-bearing lunge test with knee bent (P <.001) and a nonsignificant effect for weight-bearing lunge test with knee straight (P < .924). Post hoc analysis indicated improvements in the weight-bearing lunge test with knee bent at each timepoint compared with baseline (P < .005). Post 2 improved compared with post 1 (P = .027). No other pairwise sequential comparisons were significant (P> .417). Conclusions: MWMs significantly improved acute knee bent DFROM and indicated that after 2 sets of MWMs, no further DFROM improvements were identified. Future research should investigate the lasting effects of DFROM improvements with variable MWM dosages. [ABSTRACT FROM AUTHOR]

Context: Chronic ankle instability (CAI) is one of the most common chronic conditions in the world, resulting in millions of dollars contributed to the health care system. Joint mobilizations have been shown to effectively improve patient and disease-specific impairments secondary to CAI. The ability for patients to complete an effective manual therapy intervention without the need for continuous visits to a health care provider can alleviate burdens on the health care system and improve patient satisfaction. Objective: To examine the effect of clinician-applied Maitland talocrural joint mobilization and self-mobilization (Self-Mob) on dorsiflexion range of motion (DFROM), dynamic balance, strength, and perceived function in those with CAI. Design: Single-blind randomized trial. Setting: Research laboratory. Participants: A total of 18 participants (7 males and 11 females; age = 20.78 [2.02] y, height = 67.66 [3.83] cm, limb length = 87.74 [5.05] cm) with self-reported CAI participated. Interventions: The participants received 6 interventions over a 2-week period. The participants received either Maitland grade III anterior-to-posterior talocrural joint mobilizations or weight-bearing lunge Self-Mob. Each intervention consisted of four 2-minute sets, with a 1-minute rest between sets. Main Outcome Measures: The DFROM (weight-bearing lunge), dynamic balance (Y-Balance Test), isometric strength, Foot and Ankle Ability Measure Quick, Disablement of the Physically Active modified, Fear Avoidance Beliefs Questionnaire, and Tampa Scale of Kinesiophobia-11 were measured preintervention and postintervention. Results: Dynamic balance, isometric strength, and perceived function significantly improved in both groups at postintervention. The DFROM significantly improved in the Self-Mob group. Higher individual responder rates were demonstrated within the Self-Mob group compared with clinician-applied mobilizations. Conclusions: Clinician-applied mobilizations and Self-Mobs are effective interventions for improving dynamic balance, isometric strength, and perceived function. Application of Self-Mobs can effectively improve DFROM compared with joint mobilization. Self-Mobs may be an effective intervention to incorporate into a home care plan. [ABSTRACT FROM AUTHOR]

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. To identify differences in access to athletic training services in public secondary schools based on school SES. Cross-sectional study. Database secondary analysis. Data for 3482 public high schools. 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. 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). 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. [ABSTRACT FROM AUTHOR]

Purpose: Locus of control (LOC) is the level of control an individual feels they have over the outcomes in their life; work locus of control (WLOC) is the control someone feels over their work. Both LOC and WLOC can be internally or externally affected and influence athletic trainers' ability to change their clinical circumstances. The purpose of this study was to explore athletic trainers' LOC and WLOC. Method: Cross-sectional web-based survey. The survey was created from two existing, validated surveys which measure locus of control and work locus of control in athletic trainers along with the collection of 8 demographic variables. Results: Of the 213 participants, athletic trainers expressed an external LOC (n=108, 50.7%) in their personal lives while reporting an internal WLOC (n=197, 92.5). Conclusion: Participants demonstrated external LOC and internal WLOC. Future investigations should examine LOC and WLOC with work conditions like burnout and job satisfaction to understand barriers faced in the workplace by athletic trainers. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate athletic trainers' confidence and ability to deliver independent medical care in the secondary school setting. Methods: A cross-sectional survey design was used with open- and closed-ended questions using a tool that was modified from a previously validated tool used within the collegiate setting; the tool was adapted through content expert validation. Results: Athletic trainers perceived themselves as confident in providing independent medical care through the school district healthcare delivery model (n=109/121, 90%) more often than those functioning within the hospital/clinic outreach model (n=85/'30, 65%). Conclusions: Despite not having nationalized legislation and having variable support structures in place, secondary school athletic trainers are confident in providing independent medical care even when their direct supervisor may not be a healthcare provider. This is contradictory to similar findings within the collegiate setting governed by National Collegiate Athletics Association legislation enforcing independent medical care. [ABSTRACT FROM AUTHOR]

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. To explore athletic trainers' (ATs') PO over their employing organizations and the athletic training profession. Cross-sectional study. Web-based survey. Clinically practicing ATs who were active members of the National Athletic Trainers' Association. 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. 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. 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. [ABSTRACT FROM AUTHOR]

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. 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. Qualitative study. Semistructured interviews. Fifteen secondary school ATs with experience communicating with NNES patients or their support systems. 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. 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. 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. [ABSTRACT FROM AUTHOR]

Context: Carpal bossing is a bony growth or mass that typically occurs at the 2nd or 3rd carpometacarpal joint. Carpal bossing is often overlooked placing the patient at an increased risk for pain or injury, such as osteoarthritis or inflammatory joint disease if left untreated. Individuals such as combat sport athletes who experience repetitive trauma to this area are at a high risk to develop carpal bossing. The literature suggests conservative or surgical interventions to manage symptoms. The goal of this systematic review is to synthesize the current literature for clinical knowledge and intervention outcomes for carpal bossing. Methods: A systematic search of the literature was performed across three electronic databases (Science Direct, PubMed, and EDSCOhost) to identify articles that investigated the effects of surgical intervention or conservative management for carpal bossing. A combination of the keywords and Boolean Operators (Carpal Bossing, Carpal Boss, Surgical Intervention, Wedge Resection, Excision, Conservative Treatment, and Intervention) related to the research question were used. The search was restricted to full text, human studies (including cadaveric studies) research, and manuscripts available in English. Articles were included if they examined the effect of either conservative or surgical interventions for the treatment of carpal bossing. Articles were excluded from the review if the study did not examine carpal bossing treatment options or it did not include pain, range of motion, strength, or functional measures of the hand and wrist. Two independent reviewers used the Joanna Briggs Institute Checklist for Case Reports and Checklist for Case Studies to appraise the quality of the articles. A score of 50% was used to remove low-quality studies. The Strength of Recommendation Taxonomy (SORT) method was used to grade the evidence for the articles included. Results: After the initial search, 10 articles et the inclusion criteria, while 3 were eliminated due to low quality appraisal scores. The average scores for case reports and case studies were 5.5/7 or 7.5/9 respectively. There was s total of 58 participants across the 7 studies. Generally speaking, conservative treatment reduced average daily pain and patients were able to return to full participating within two weeks. Conversely, patients undergoing surgical intervention experience episodic pain, including over the surgical incision, typically averaging 2/10 on the Visual Analog Scale. Findings from the surgical intervention showed inconsistent measurements for wrist/hand strength and range of motion. There is level C evidence on the treatment for carpal bossing. Conclusion: The limited evidence suggests conservative management may reduce pain and improve clinical outcomes. However, clinicians should consider level C evidence with skepticism as the quality on this topic is low. Further investigations should be performed with more rigor. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this investigation was to examine ADs perceptions on satisfaction of current care provided, factors influencing the hiring of ATs, and the roles and responsibilities of ATs. Methods: We used a mixed methods design with an online survey (Qualtrics®, Provo, UT), which we distributed to Indiana secondary school ADs (n = 410) with publicly available emails. The survey remained open for 5 weeks with reminder emails sent weekly. We used a panel (n=2) with experience in survey research and/or the secondary school setting. The survey included both quantitative (7 items) and qualitative (8 items) data. Participants were asked to share their perceptions on the roles/responsibilities of ATs as well as experiences with the challenges, barriers, and benefits of hiring ATs in open-ended questions. We used Kruskal-Wallis one-way ANOVAs to compare employment status, type of employer, and school size on satisfaction. We coded the open-ended responses using inductive coding with multi-analyst triangulation and auditing to establish trustworthiness. Results: We identified significant differences relative to employment status of the AT on satisfaction with overall care, whereby those with full-time athletic training services were more satisfied with care than those with per-diem, part-time services (p=0.010). When participants were asked about factors influencing the decision to provide services ADs reported liability, cost, and workload as major considerations. Conclusions: Consistent with previous research, financial challenges continue to play a role in the hiring of ATs in the secondary school setting, participants also identified the benefits of ATs in promoting safety, reducing liability, as well as the increased workload and cost. Access to qualified athletic healthcare continues to be a public health concern in America and all stakeholders should reconsider how to offer both a comprehensive athletics program and the healthcare needed to ensure safety in that participation. [ABSTRACT FROM AUTHOR]

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: Chronic ankle instability (CAI) is one of the most common chronic conditions in the world, resulting in millions of dollars contributed to the health care system. Joint mobilizations have been shown to effectively improve patient and disease-specific impairments secondary to CAI. The ability for patients to complete an effective manual therapy intervention without the need for continuous visits to a health care provider can alleviate burdens on the health care system and improve patient satisfaction., Objective: To examine the effect of clinician-applied Maitland talocrural joint mobilization and self-mobilization (Self-Mob) on dorsiflexion range of motion (DFROM), dynamic balance, strength, and perceived function in those with CAI., Design: Single-blind randomized trial., Setting: Research laboratory., Participants: A total of 18 participants (7 males and 11 females; age = 20.78 [2.02] y, height = 67.66 [3.83] cm, limb length = 87.74 [5.05] cm) with self-reported CAI participated., Interventions: The participants received 6 interventions over a 2-week period. The participants received either Maitland grade III anterior-to-posterior talocrural joint mobilizations or weight-bearing lunge Self-Mob. Each intervention consisted of four 2-minute sets, with a 1-minute rest between sets., Main Outcome Measures: The DFROM (weight-bearing lunge), dynamic balance (Y-Balance Test), isometric strength, Foot and Ankle Ability Measure Quick, Disablement of the Physically Active modified, Fear Avoidance Beliefs Questionnaire, and Tampa Scale of Kinesiophobia-11 were measured preintervention and postintervention., Results: Dynamic balance, isometric strength, and perceived function significantly improved in both groups at postintervention. The DFROM significantly improved in the Self-Mob group. Higher individual responder rates were demonstrated within the Self-Mob group compared with clinician-applied mobilizations., Conclusions: Clinician-applied mobilizations and Self-Mobs are effective interventions for improving dynamic balance, isometric strength, and perceived function. Application of Self-Mobs can effectively improve DFROM compared with joint mobilization. Self-Mobs may be an effective intervention to incorporate into a home care plan.

Context: Mulligan's Mobilization with Movement (MWM) is a common intervention used to address dorsiflexion range of motion (DFROM) impairments. However, the treatment dosage of MWMs varies within the literature., Objective: The aim of this study was to examine the effect of serial MWM application on DFROM., Design: Repeated-measures cohort., Setting: A Midwestern University and the surrounding community., Participants: A total of 18 adults (13 females; age = 29 [12.87] y; DFROM = 30.26° [4.60°]) with decrease dorsiflexion (<40°) participated. Inclusion criteria consisted of a history of ≥1 ankle sprain, ≥18 years old, no lower-extremity injury in the last 6 months, and no history of foot/ankle surgery., Intervention: Participants completed a single data collection session consisting of 10 individual sets of MWMs., Main Outcome Measures: DFROM was taken at baseline and immediately after each intervention set (post 1, post 2, … post 10). DFROM was measured with a digital inclinometer on the anterior aspect of the tibia during the weight-bearing lunge test with the knee straight and knee bent. Analysis of variances examined DFROM changes over time. Post hoc analysis evaluated sequential pairwise comparisons and changes from baseline at each time point., Results: Analysis of variance results indicated a significant time main effect for weight-bearing lunge test with knee bent (P < .001) and a nonsignificant effect for weight-bearing lunge test with knee straight (P < .924). Post hoc analysis indicated improvements in the weight-bearing lunge test with knee bent at each timepoint compared with baseline (P < .005). Post 2 improved compared with post 1 (P = .027). No other pairwise sequential comparisons were significant (P > .417)., Conclusions: MWMs significantly improved acute knee bent DFROM and indicated that after 2 sets of MWMs, no further DFROM improvements were identified. Future research should investigate the lasting effects of DFROM improvements with variable MWM dosages.