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Life-threatening tachyarrhythmias in athletes.

The arrhythmias in competitive athletes may be classified as "benign," "paraphysiological" due to prolonged athletic training, or "pathological" due to hemodynamic effects on the athletic performance-risk-arrhythmogenic substratum. Pathological arrhythmias include life-threatening forms that are severe enough to produce symptoms (presyncope, syncope, cardiac arrest) during athletic activity. These forms are in particular rapid VT, VF, torsades de pointes, preexcited atrial fibrillation, sinus atrial and AV block. Our study population includes 766 competitive athletes, mean age 21.1 years (74 top international level), investigated with a cardioarrhythmological work-up for symptoms and for arrhythmias from 1974 to June 30, 1991. Three leading categories, represented by 16 aborted sudden death, 8 sudden death, and 7 induced VF (by EES or TAP) athletes, are described. All athletes with life-threatening arrhythmias, previously as asymptomatic or with minor symptoms had an arrhythmogenic substratum due to underlying silent cardiopathy or primary arrhythmic disorders. Athletic activity can be regarded as a trigger of electrical destabilization.

Adolescent↗

Attributes of curriculum athletic training programs related to the passing rate of first-time certification examinees.

The purpose of this study was twofold: (1) to identify attributes of athletic training programs that have been accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) as they relate to outcomes of their students on the National Athletic Training Association Board of Certification (NATABOC) examination and (2) to determine the most effective curriculum in preparing candidates for the examination. For all subjects, the following survey information was assessed: the seven domains (competencies), number of clinical rotation sites, grade point average requirement, faculty responsibilities, faculty terminal degrees, faculty K-12 experience, association with allied health schools, capstone course availability, and course examination similarities. Fifty-four subjects, representing 60% of all of the program directors of CAAHEP accredited athletic training programs, responded in this study. Data were analyzed using a general linear model procedure and regression analyses. Even domains of athletic training, variety of rotation sites, clinical responsibility of faculty, faculty terminal degrees, and faculty K-12 school experience significantly affected the passing rate of first time certification examinees. Grade point average requirement, allied health school association, course examination format, and capstone course were not related significantly to the passing rate of first-time certification examinees. The most effective curricular model included the seven domains of athletic training, faculty clinical responsibilities, and faculty K-12 work experience as related to the passing rate. Emphasizing the domains of athletic training (competencies), having a variety of rotation sites, separating clinical and academic responsibilities for faculty, and having faculty with terminal degrees and less public school experience increase the passing rate of first-time NATABOC examinees. The most effective curricular model in affecting passing rate, according to this study, includes emphasizing the seven domains of athletic training (competencies), separating clinical and academic responsibilities of faculty, and not focusing on hiring faculty with K-12 work experience. Although this article focuses primarily on athletic training education, we believe that this study can be used as a model to evaluate educational programs in other allied health, competency-based educational programs.

Allied Health Personnel↗

Physiologic Screening Test for Eating Disorders/Disordered Eating Among Female Collegiate Athletes.

OBJECTIVE: To develop and evaluate a physiologic screening test specifically designed for collegiate female athletes engaged in athletic competition or highly athletic performances in order to detect eating disorders/disordered eating. No such physiologically based test currently exists. METHODS: Subjects included 148 (84.5%) of 175 volunteer, National Collegiate Athletic Association Division I (n = 92), club (n = 15), and dance team (n = 41) athletes 18 to 25 years old who attended a large, Midwestern university. Participants completed 4 tests: 2 normed for the general population (Eating Disorders Inventory-2 and Bulimia Test-Revised); a new physiologic test, developed and pilot tested by the investigators, called the Physiologic Screening Test; and the Eating Disorder Exam 12.0D, a structured, validated, diagnostic interview used for criterion validity. RESULTS: The 18-item Physiologic Screening Test produced the highest sensitivity (87%) and specificity (78%) and was superior to the Eating Disorders Inventory-2 (sensitivity = 62%, specificity = 74%) and Bulimia Test-Revised (sensitivity = 27%, specificity = 99%). A substantial number (n = 51, 35%) of athletes were classified as eating disordered/disordered eating. CONCLUSIONS: The Physiologic Screening Test should be considered for screening athletes for eating disorders/disordered eating. The Physiologic Screening Test seems to be a viable alternative to existing tests because it is specifically designed for female athletes, it is brief (4 measurements and 14 items), and validity is enhanced and response bias is lessened because the purpose is less obvious, especially when included as part of a mandatory preparticipation examination.

Journal Article↗

Effects of Clinical Field-Experience Setting on Athletic Training Students' Perceived Percentage of Time Spent on Active Learning.

OBJECTIVE: Our purpose was to examine undergraduate athletic training students' perceptions of how time is utilized during clinical field experiences while enrolled in Commission on Accreditation of Allied Health Education Program (CAAHEP)-accredited athletic training programs and to determine the effects of clinical field-experience length and setting, academic standing, sex, clinical assignment, and National Collegiate Athletic Association level on active learning. DESIGN AND SETTING: Using the Athletic Training-Clinical Education Time Framework (AT-CETF) and Utilizing Time and Active Learning Survey, subjects completed a 1-day, self-reported observation of how their clinical field-experience time was utilized. SUBJECTS: Program directors at 131 CAAHEP-accredited athletic training programs were sent survey packages. Seventy-two (41%) male subjects and 105 (59%) female subjects from 25 institutions completed the survey packages. Eight of the 10 National Athletic Trainers' Association districts were represented in the study. MEASUREMENTS: The AT-CETF is a behavioral time-profiling framework that measures athletic training students' perceptions of utilization of clinical field-experience time based on the performance domains associated with the 1999 National Athletic Trainers' Association Board of Certification Role Delineation Study and literature related to time and learning. RESULTS: Subjects spent 51% of their clinical field-experience time engaged in active learning, 9% in managerial activities, 17% in unengaged activities, and 23% in waiting activities. Multiple 2 x 2 x 3 analyses of variance (length of clinical field experience x academic standing x clinical field-experience setting) revealed a significant difference between the levels of clinical field-experience setting and the dependent variables of perceived percentage of active learning time and waiting time. A 2 x 3 analysis of variance (sex x clinical assignment) revealed a significant difference between the levels of clinical assignment and the dependent variable of perceived percentage of active learning time. CONCLUSIONS: The type of clinical field-experience setting and clinical assignment affects the amount of time spent in active learning. Therefore, profiling students' use of time may allow educators to identify clinical field-experience settings that maximize active learning time, expose students to their own unique learning situations, and offer students access to clinical field-experience settings aligned with their professional goals.

Journal Article↗

[Eating disorders among athletes].

Over the past 20 years, a number of studies have been published that generally suggest a higher frequency of eating disorders among athletes than among non-athletes. Participation in competitive sport has also been considered an important factor related to the development of eating disorders. Taken together, most studies have suggested that eating disorders are particularly prevalent in sports that emphasise leanness or low body weight. However, some studies suggest a similar or lower prevalence of eating disorders compared with controls or athletes at a lower competitive level. Athletes constitute a unique population and the impact of factors such as training, eating pattern, extreme diets, restriction of food intake and psychopathological profile among them must be evaluated differently from that among non-athletes. A concerted effort by coaches, athletic trainers, parents, athletes and healthcare personnel is optimal in order to recognise, prevent and treat eating disorders in athletes.

Anorexia Nervosa↗

A Prospective Study of Overuse Knee Injuries Among Female Athletes With Muscle Imbalances and Structural Abnormalities.

OBJECTIVE: To prospectively examine the influence of hamstring-to-quadriceps (H:Q) ratio and structural abnormalities on the prevalence of overuse knee injuries among female collegiate athletes. DESIGN AND SETTING: We used chi-square 2 x 2 contingency tables and the Fischer exact test to examine associations among H:Q ratios, structural abnormalities, and overuse knee injuries. SUBJECTS: Fifty-three apparently healthy women (age = 19.4 +/- 1.3 years, height = 167.6 +/- 10.1 cm, mass = 65.0 +/- 10.0 kg) from National Collegiate Athletic Association Division I women's field hockey (n = 23), soccer (n = 20), and basketball teams (n = 10) volunteered. MEASUREMENTS: The H:Q ratio was determined from a preseason isokinetic test on a Biodex system at 60 degrees /s and 300 degrees /s. We measured athletes for genu recurvatum and Q-angles with a 14-in (35.56-cm) goniometer. Iliotibial band flexibility was assessed via the Ober test. RESULTS: Ten overuse knee injuries (iliotibial band friction syndromes = 5, patellar tendinitis = 3, patellofemoral syndrome = 1, pes anserine tendinitis = 1) occurred in 9 athletes. The H:Q ratio below the normal range at 300 degrees /s (P = 0.047) was associated with overuse knee injuries, as was the presence of genu recurvatum (P = 0.004). In addition, athletes possessing lower H:Q ratios at 300 degrees /s and genu recurvatum incurred more overuse knee injuries than athletes without these abnormalities (P = 0.001). CONCLUSIONS: The presence of genu recurvatum and an H: Q ratio below normal range was associated with an increased prevalence of overuse knee injuries among female collegiate athletes. Further investigation is needed to clarify which preseason screening procedures may identify collegiate athletes who are susceptible to overuse knee injuries.

Journal Article↗

Isokinetic Scapular Muscle Performance in Overhead Athletes With and Without Impingement Symptoms.

Context: Overhead activities such as throwing, tennis, or volleyball place athletes at considerable risk for overuse injuries. A relationship between scapulothoracic muscle imbalance and shoulder pain has been suggested.Objective: To compare the isokinetic muscle performance of the scapular muscles between overhead athletes with impingement symptoms and uninjured overhead athletes and to identify strength deficits in the patient population.Design: A repeated-measures analysis of variance with 1 within-subjects factor (side) and 1 between-subjects factor (group) was used to compare strength values and agonist:antagonist ratios across sides and across groups.Setting: University laboratory.Patients or Other Participants: Thirty overhead athletes with chronic shoulder impingement symptoms and 30 overhead athletes without a history of shoulder pain.Intervention(s): A linear protraction-retraction movement in the scapular plane at 2 velocities (12.2 cm/s and 36.6 cm/s).Main Outcome Measure(s): Isokinetic strength values and protraction:retraction ratios for both velocities.Results: Overhead athletes with impingement symptoms showed decreased force output:body weight at both velocities in the protractor muscles on the injured side compared with the uninjured side (-13.7% at slow velocity, -15.5% at high velocity) and compared with the control group at high velocity (-20.7%). On both sides, the patient group had significantly lower protraction:retraction ratios than the control group, measured at slow velocity (nondominant = -11%, dominant = -13.7%).Conclusions: Overhead athletes with impingement symptoms demonstrated strength deficits and muscular imbalance in the scapular muscles compared with uninjured athletes.

Journal Article↗

Celiac disease in an elite female collegiate volleyball athlete: a case report.

OBJECTIVE: To present the case of an elite female volleyball player who complained of diarrhea and fatigue after preseason training. BACKGROUND: The athlete lost 8.1 kg during the first 20 days of training, and we initially suspected an eating disorder. The sports medicine team interviewed the athlete and found she did not have psychological symptoms indicative of an eating disorder. The results of routine blood tests revealed critically high platelet counts; in conjunction with the physical findings, the athlete was referred to a gastroenterologist. DIFFERENTIAL DIAGNOSIS: Our initial suggestion was an eating disorder. Therefore, the differential diagnosis included anorexia athletica, anorexia nervosa, and bulimia nervosa. On referral, the differential diagnosis was anemia, gastrointestinal dysfunction, lymphoma, or bowel adenocarcinoma. Diarrhea, weight loss, and blood test results were suggestive of active celiac disease, and a duodenal biopsy specimen confirmed this diagnosis. TREATMENT: The athlete was treated with a gluten-free diet, which excludes wheat, barley, and rye. Dietary substitutions were incorporated to maintain adequate caloric intake. UNIQUENESS: The presence of active celiac disease may not be uncommon. However, elite athletes who face celiac disease present a new challenge for the athletic trainer. The athletic trainer can help guide the athlete in coping with the lifestyle changes associated with a gluten-free diet. CONCLUSIONS: One in every 200 to 400 individuals has celiac disease; many of these individuals are asymptomatic and, therefore, their conditions are undiagnosed. Undiagnosed, untreated celiac disease and patients who fail to follow the gluten-free diet increase the risk of further problems.

Journal Article↗

A third generation approach to detect erythropoietin abuse in athletes.

BACKGROUND AND OBJECTIVES: Information derived from blood analyses can assist in the detection and/or deterrence of blood doping in sport. We investigated whether comparing an athlete's hematologic values against his or her own historical baseline rather than population-derived thresholds enhanced the ability to detect blood doping. DESIGN AND METHODS: We developed an approach whereby an athlete's true baseline value could be estimated with just one prior blood test. We also estimated a universal value for within-subject variability for key hematologic parameters using the highest value obtained among four separate cohorts of male athletes including 80 elite rowers, 124 endurance-trained or team-sport subjects, 288 professional football players and 630 athletes competing at national or international level. The (individual) baseline and (universal) variability were then incorporated so as to define expected thresholds for subsequent blood tests. The sensitivity of our approach was obtained by analyzing data from 49 recreational athletes administered either recombinant human erythropoietin (n=37) or placebo (n=12). RESULTS: We found that removing within-subject variability by comparing new results against an historical baseline heightened the capacity to detect blood doping. It was possible to delineate the longitudinal changes in either hemoglobin (Hb) or the OFF-hr model score (an algorithm using both Hb and percent reticulocytes) caused by recombinant human erythropoietin treatment from the natural biological fluctuations found in subjects treated with placebo. INTERPRETATION AND CONCLUSIONS: Our objective data supported the intuitive belief that longitudinal monitoring of athletes' blood profiles will help detect blood doping. This information could be used to instigate target-testing of suspicious athletes, or even warrant the exclusion from competition of athletes with aberrant variations in key hematologic values.

Cohort Studies↗

Motivational congruency and discrepancy of hawaiian athletic trainers.

Motivation is an integral part of an effective organizational management scheme. In March 1992, we sent a survey designed to assess motivational preference to all certified athletic trainers in the State of Hawaii. The population included: 6 high school athletic trainers, 10 university athletic trainers, and 9 clinic athletic trainers. The surveys were completed and returned by 80% of the population. With the exception of being an integral part of a work team (p<.05), athletic trainers in the State of Hawaii showed little discrepancy in terms of motivation. Further, there are differences among the three groups of athletic trainers in rating the importance of motivators concerning being appreciated, receiving raises, and being an integral part of a team (p< .05) Differences in motivational factors among these three groups could be influenced by the organizational structure in which the athletic trainers operate. Further investigation should include a mainland population that includes athletic trainers in professional sports and the industrial setting.

Journal Article↗

Financial resources for conducting athletic training programs in the collegiate and high school settings.

The distribution of resources to athletic training programs varies greatly, depending on the size and scope of the athletic program. No research has been found that assesses the differences in dollars allocated within various athletic training settings or assesses whether the different program levels allocate similar proportions of their resources to like categories of expenditures. In this study, I assessed the financial resources available to athletic training programs at major football NCAA Division IA schools, small football NCAA Division IA schools, NCAA Division IAA schools, NCAA Division II schools, NCAA Division III schools, and high schools. All schools had men's and women's sports and football programs. Categories assessed included: size and scope of the athletic program, supplies and equipment, operating expenses, medical expenses, salaries and benefits, malpractice insurance, and use of competitive bids in purchasing. Data supported the conclusion of wide disparities within many categories and in total expenses. Large-scale football NCAA Division IA programs spent $925.86 per athlete, while NCAA Division III programs spent $181.22, and high school programs spent $95.62. However, athletic trainers at all levels are conducting athletic training programs governed by the same professional competencies and standards of care.

Journal Article↗

Delphi Study: HIV/AIDS and the Athletic Population.

Recent announcements in the news of HIV/AIDS contraction by famous sports figures have focused world attention on the fact that athletes are not immune to this deadly virus. In view of this, we reviewed the literature to examine what studies have been directed specifically at the athletic population and HIV/AIDS. Unfortunately, because of the relatively new nature of this problem, little data exists for examination. A panel of experts was assembled to participate in a Delphi methodology project. This educational study was designed to examine three issues surrounding the athletic community and HIV/AIDS. The three questions examined in this study were: 1) should medical testing be undertaken within the athletic community to determine exposure to the virus; 2) if testing is undertaken, what privacy/confidentiality measures should be incorporated to protect the individual and the results of the test; and 3) what educational interventions should be developed and implemented to help the athlete understand the disease and prevent the spread. The responses from the Delphi participants indicate that the HIV/AIDS dilemma is a societal issue and should not single out a segment of the population-in this case the athletic community. The panel also indicated that privacy and confidentiality are crucial in protecting the individual athlete and test results. The development and implementation of educational interventions is the most important component in the entire issue of HIV/AIDS and the athletic community.

Journal Article↗

Dehydration, hyperthermia, and athletes: science and practice.

OBJECTIVE: To present the recent research that underscores the value of preventing both dehydration and hyperthermia. Such efforts will improve the athlete's capacity to perform physical activity and reduce the risk of heat-related problems. DATA SOURCES: Data were drawn from an extensive review of the scientific literature over the past 50 years with an emphasis on recent research (> 1990) that focuses on the physiological and performance benefits of fluid replacement. DATA SYNTHESIS: Even low levels of dehydration (eg, less than a 2% loss of body weight) impair cardiovascular and thermoregulatory response and reduce the capacity for exercise. Heat exposure also reduces the athlete's ability to train and compete, an effect that can be independent of hydration status. Even if athletes are well hydrated, hot weather alone will reduce their capacity to exercise. Optimal performance is possible only when dehydration and hyperthermia are minimized by ingesting ample volumes of fluid during exercise and by taking common-sense precautions in keeping cool. Recent research has demonstrated that consuming fluid in volumes approximating sweat loss maintains important physiological functions and significantly improves exercise performance, even during exercise lasting only 1 hour. Carbohydrate ingestion also improves exercise performance, an effect that is independent of, and additive to, preventing dehydration. CONCLUSION/APPLICATION: Athletes should follow an aggressive fluid replacement and temperature regulation regimen. Successful implementation of this regimen requires that athletic trainers, coaches, athletes, and support personnel are made aware of the benefits of adequate fluid replacement, that appropriate fluid replacement strategies are developed and implemented, that athletes have the opportunity to train themselves to ingest larger volumes of fluid more frequently, and that other practical steps are taken to keep athletes cool during both training and competition.

Journal Article↗

Salary survey of certified athletic trainers in delaware, new jersey, new york, and pennsylvania.

OBJECTIVE: The objective of this study was to obtain salary information from certified athletic trainers in District Two of the National Athletic Trainers' Association (NATA) for use as a reference guide to assist entry-level and experienced ATCs interested in obtaining athletic training positions in Delaware, New Jersey, New York, and Pennsylvania. DESIGN AND SETTING: Mailed survey, sample of convenience. This study was conducted in the Sports Medicine Department of a children's hospital. SUBJECTS: A survey was sent to all 2,274 certified members of District Two. Of the surveys mailed, 970 (42.7%) were returned. Of the surveys returned, 725 (74.7%) were from full-time athletic trainers, 105 (10.8%) were from part-time athletic trainers, and 140 (14.4%) were unusable. MEASUREMENTS: A survey consisting of 15 questions related to salaries and demographics of the athletic trainers' employment settings. RESULTS: Forty-eight percent of the respondents were employed in the clinic or hospital setting, and almost 48% of those responding possessed a master's degree. The state with the highest response rate was Pennsylvania with 45% of the total. The highest rate of response according to experience was 27% from athletic trainers having 4 to 6 years of experience. According to practice setting, the lowest mean salary was $32,928 +/- $10,098 at the college or university level, and the highest was $59,778 +/- $48,803 at the professional sport level. According to education level, the lowest mean salary was $30,132 +/- $9,584 (bachelor's degree), and the highest was $48,070 +/- $12,973 (PT or ATC). The mean salary by state was lowest in Delaware ($32,330 +/- $12,865) and highest in New Jersey ($36,695 +/- $12,593). The highest mean salary by years of experience was $57,308 +/- $30,723 (25 years or more). CONCLUSIONS: Further comparative studies in this area need to be conducted to recognize current trends with the intent of establishing national or regional standards of salary compensation for certified athletic trainers.

Journal Article↗

An assessment of learning styles among undergraduate athletic training students.

OBJECTIVE: Increased attention has been directed toward assessing and improving academic quality in athletic training education. The educational process has been assessed from a global level, but little is known about how athletic training students learn. The purpose of this investigation was to assess the learning styles of undergraduate athletic training students. DESIGN AND SETTING: Undergraduate students enrolled in a Committee on Accreditation of Allied Health Education Programs (CAAHEP)-accredited athletic training education program completed a learning styles inventory during a regularly scheduled athletic training class at the start of the spring semester. SUBJECTS: Twenty-seven student athletic trainers (age range, 19-30 yrs, mean age = 20.5 yrs) served as subjects. Sixteen subjects (7 male, 9 female) were in the first year of this 3-year program. Eleven subjects (7 male, 4 female) were second-year students. MEASUREMENTS: Learning style was assessed using the Productivity Environmental Preference Survey. RESULTS: Parametric and nonparametric one-way analyses of variance for each learning subscale by sex and by year in program revealed significant differences (P < .05) in light preferences for male and female students. There were also significant differences (P < .05) between first-and second-year students in preferences for afternoon learning activities. CONCLUSIONS: These findings suggest that undergraduate athletic training students function best as leamers in a well-lit leaming environment. The significance of aftemoon as the preferred time for learning reinforces the importance of the clinical setting in the introduction and mastery of skills. Athletic training educators and clinical instructors can use these results as they examine their teaching strategies and educational environments.

Journal Article↗

Certified athletic trainers in secondary schools: report of the council on scientific affairs, american medical association.

BACKGROUND: In June 1997, the American Academy of Pediatrics introduced a resolution asking the American Medical Association (AMA) to support efforts to place certified athletic trainers in all secondary schools. The AMA Council on Scientific Affairs studied that resolution and presented this report to the AMA House of Delegates in June 1998. OBJECTIVE: To identify the professional responsibilities, educational requirements, and current use of certified athletic trainers in the prevention and care of high school sports injuries. DATA SOURCES: MEDLINE and HealthSTAR databases were searched for English-language articles published from 1980 to 1998. Additional references were derived from references in pertinent articles, communication with experts, and the Internet sites of athletic training and sports medicine associations. DATA SYNTHESIS: One in 5 of approximately 6 million adolescents who participate in high school sports each year sustains a sport-related injury. Most of these injuries are minor and occur during practices rather than competitions. Approximately 1 of every 100000 high school athletes will sustain a catastrophic injury. About 35% of US high schools use the services of a certified athletic trainer, who, under a physician's supervision, is responsible for the prevention and care of athletic injuries and coordination of the school athletic health program. CONCLUSIONS/RECOMMENDATIONS: Emphasis should be given to ensuring the health, safety, and well-being of participants in high school sports. Whereas most high school sports injuries are minor, adequately trained personnel should be present on site to ensure that such injuries are recognized early, treated immediately, and allowed to heal properly, thereby reducing the risk of more serious injury or reinjury. For such care, team physicians and coaches should have the assistance of a certified athletic trainer.

Journal Article↗

Job search and employment-related issues in athletic training education programs.

OBJECTIVE: To investigate the amount of classroom instruction appropriated for employment-related issues and how career service centers were used by students in National Athletic Trainers' Association (NATA)-approved/Commission on Accreditation of Allied Health Education Programs (CAAHEP)-accredited undergraduate athletic training curriculums. DESIGN AND SETTING: We developed a job placement survey and mailed it to subjects. The study was conducted through the School of Physical Education at West Virginia University. SUBJECTS: The subjects were all undergraduate athletic training curriculum directors employed in an NATA-approved or CAAHEP-accredited program. MEASUREMENTS: We developed a survey instrument based on our experiences with instructional and educational issues in athletic training. The survey instrument consisted of items that investigated the amount of classroom time and education devoted to different aspects of preparing athletic training students for the job market. RESULTS: A total of 74 surveys were returned, for an 88% return rate. Eighty-six percent of the curriculum directors spent an average of 116 minutes (mean = 116 +/- 142.09; range, 5 to 780) instructing students about employment issues. Curriculum directors spent 63 minutes (mean = 63 +/- 47.86; range, 10 to 270) instructing students on how to develop a résumé. Most curriculum directors (74%) spent time with students discussing how to prepare for an interview (mean = 51 +/- 47.07 minutes; range, 1 to 270). Nearly all curriculum directors (97%) responded that students learned about recognizing allied health postgraduate career options other than athletic training. College or university career service centers were available to 96% of students, but only 53% sought instructional assistance from them. Curriculum directors spent an average of 38 +/- 49.31 minutes (range, 15 to 120) discussing programs available at career service centers. CONCLUSIONS: Athletic training curriculum directors were providing basic employment preparation skills to students. However, a wide variance existed for time allotted to employment- related issues. Additional research is needed to compare employment instructional methods with program success rates for job placement within athletic training.

Journal Article↗

Integrating and analyzing psychosocial and stage theories to challenge the development of the injured collegiate athlete.

OBJECTIVE: To integrate a psychosocial developmental theory and a psychological stage theory for challenging an injured collegiate student-athlete's personal development and to highlight future areas of research. DATA SOURCES: I searched Education Abstracts, ERIC, Social Science Citation Index, and SPORT Discus for the years 1990-2001 using the key words student-athlete,injury,psychological reaction,Chickering, and psychosocial. DATA SYNTHESIS: Stage theories are theoretic models that outline basic reactions to a stressor, regardless of age, sex, or ethnicity. In textbooks addressing the injured athlete, the Kubler-Ross stages of bereavement constitute one of the most commonly presented stage theories addressing the psychological reaction to injury. Psychosocial theories, on the other hand, such as the Chickering and Reisser theory, are theoretic models developed in the educational literature that outline the personal development process (ie, vectors) through which adolescents and adults progress. For this review, the Kubler-Ross and Chickering and Reisser revised theories will be used to outline possible psychological reactions to injury throughout the development progression from vector 1, competence, through vector 7, integrity. CONCLUSIONS: The 1999 Athletic Training Clinical Proficiencies as outlined by the National Athletic Trainers' Association Education Council require clinical proficiencies in the area of psychosocial intervention and referral, yet psychosocial theory is rarely addressed in athletic training educational curricula or texts. Presenting a universal psychosocial developmental theory, such as the Chickering and Reisser 7 vectors, and integrating a common stage theory, such as the Kubler-Ross stages of bereavement, are beneficial in providing athletic training students and athletic trainers additional skills to recognize and mediate negative psychological reactions to injury and in illuminating new areas of research.

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