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.

Context: Non-native English speakers (NNES) in the United States have more than doubled since 1990, increasing the likelihood of NNESs seeking healthcare and experiencing language barriers. Language barriers in healthcare result in ineffective communication, decreased care, and reduction in overall provider satisfaction. Objective: To investigate experiences of secondary school athletic trainers (ATs) who provided care to patients that were NNES or communicated with their NNES support systems. Design: Qualitative. Setting: Semi-structured 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 a 3-person data analysis team used the multi-phased consensual qualitative research approach to develop a consensus codebook with domains and categories identified from the transcripts. Trustworthiness was established through member checking, multiple researcher triangulation, 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. Participants discussed a difference in care delivery based on fluency. Participants explained efforts to create a welcoming environment by speaking in the NNESs native language, increasing comfort, and serving as an advocate within the healthcare system. Acknowledging customs, demonstrating respect, and understanding potential fear/shame associated with language barriers were discussed as ways to increase cultural agility. Participants identified a lack of formal training, which increased their on-the-job training and health information technology usage. Participants perceived spending increased amounts of time, initiation, effort, and adaptability while caring for and communicating with NNESs. Conclusions: Participants perceived they had little formal training, therefore, they became more resourceful and increased communication strategies to provide equitable care. Participants indicated adapting their care to meet cultural needs and creating a welcoming environment for NNESs was important when cultivating a patient-centered experience.

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.

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.

In 2015, the Strategic Alliance adopted the International Classification of Functioning, Disability, and Health (ICF) as the disablement model framework for delivery of and communication about patient care in athletic training. The purpose of this study was to examine athletic trainers’ familiarity, knowledge, application, and implementation of the ICF framework. We used a cross-sectional online survey with 185 athletic trainers (age = 35 ± 9 y), which included 32 items focused on familiarity, knowledge, application, and implementation of the ICF framework. Most participants (n = 96, 51.9%) reported never learning about the ICF framework. During the knowledge assessment, participants scored 4.3 ± 2.7 out of 8, which is equivalent to 53.7%. For the sorting assessment, participants scored 10.9 ± 3.9 out of 18, which is equivalent to 60.5%. On the implementation matrix, the most frequently reported ICF tasks elicited by the athletic trainers included neuromusculoskeletal and movement, structure related to movement, and mobility. The most common ‘never elicited’ ICF tasks included voice and speech, sexual orientation, and structures related to genitourinary and reproductive system. Deficits related to the ICF framework exist. Athletic trainers reported low implementation across all ICF categories. The decision to not elicit information on these areas of health may reduce the ability to provide patient-centered healthcare.

Context: Psychological ownership (PO) is a state where an individual feels possession over an object (e.g. PO over the organization where one works, PO over the profession one serves). Understanding PO could provide insight to “vitality of the profession” as defined in the Prioritized Research Agenda for the Athletic Training Profession. Objective: The purpose of this study was to explore athletic trainers' (AT) PO over their employing organization and the athletic training profession. Design: Cross-Sectional Study Setting: Web-based survey Patients or Other Participants: Clinically practicing ATs that were active members of NATA. Main Outcome Measure(s): Demographic variables, Psychological Ownership Questionnaire (POQ), and Psychological Ownership of Athletic Training (POQ-AT) were the primary outcomes measured. Descriptive statistics were calculated for demographic variables, POQ and POQ-AT overall scores, form scores, and dimension scores. Non-parametric tests were used to investigate differences between the POQ and POQ-AT among demographic characteristics. Results: ATs indicated greater PO over the athletic training profession (Z=−3.45, p=0.001) than over their employing organization. They indicated greater belongingness (Z=−9.51, p<0.001) and self-identity (Z=−8.71, p<0.001) and less territoriality (Z=−5.52, p<0.001) and accountability (Z=−5.33, p<0.001) over their profession than within their organization. ATs that supervised others indicated greater overall POQ (U=34372, p<0.001) and overall POQ-AT score (U=36624, p=0.014) than ATs that did not supervise others. There was a difference in overall POQ (H(4)=20.47, p<0.001) and overall POQ-AT scores (H(4)=21.34, p<0.001) between groupings of years of experience. Conclusions: ATs indicate greater PO over their profession than their employing organizations. They indicate greater self-identity and belongingness and less territoriality and accountability over the athletic training profession than over their employing organization suggesting ATs are connecting aspirations and accomplishments with the profession but connecting duty and responsibility to their organizations. Years of experience and supervisor status may play a role in the level of organizational PO.