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Athletic Training Outcomes Research Lab


Mission Statement

The mission of the Athletic Training Research Program is to promote evidence based medical practice in athletic training through research and scholarship. This is accomplished through the collaborative efforts between the athletic training faculty, students, and other researchers at UNI and around the country. Athletic training research at UNI is guided by a paradigm based on the expertise of the faculty and the mission of the program.

 

Research Program
Research Activities

Research Paradigm

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Evidence Based Medicine

Evidence based medicine (EBM) is the integration of research evidence and clinical expertise in the application of medical and therapeutic procedures. A clinician who practices EBM uses procedures and therapies that good scientific research has demonstrated reliable and valid. The practice of EBM has become a central issue in the struggle to demonstrate that certified athletic trainers are effective clinicians.

Evidence based medicine is based on a research question, an intervention or procedure, a comparison intervention, and an outcome. The research question usually involves a specific disorder or patient. The intervention could be a specific exposure, diagnostic test, or a therapy. The outcome involves a clinical outcome of interest to the clinician, and more importantly, to the patient. To study a particular intervention or outcome, epidemiological and kinesmetric techniques are used. Once a particular question has been adequately answered, decision makers in the areas of education and implementation determine if the results warrant policy change. EBM Resource Center

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Injury Epidemiology

The study of epidemiology can be described as the distribution and consequences of disease and injury in defined populations. Chronic diseases like cancer and heart disease, which are mitigated by physical activity, are the most commonly recognized examples of epidemiological questions. Epidemiology has many sub disciplines however, and injury and chronic disease in those physically active through sport and recreation are of particular interest to certified athletic trainers.

 

The science of epidemiology is thought to have begun when John Snow first identified the source of transmission during the cholera epidemics in London during the early part of the 19th century. Although technology has improved, the same basic methods first used by John Snow continue to be used in modern times when epidemics like the Ebola outbreak occur.

 

Epidemiology can be further described as descriptive or analytic. Descriptive epidemiology is often the product of surveillance or observation and describes the scope of the problem or outcome. Analytic epidemiology involves hypothesis testing, analysis of risk factors, and experimental testing of interventions. Before analytic methods can be used, the reliability and validity of the tools and procedures must be examined through measurement and kinesmetrics.

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Kinesmetrics

Recently, the term Kinesmetrics was coined by Zhu (2003) to describe the area of study within Kinesiology dealing with measurement and evaluation. The label to describe this area of Kinesiology has mimicked the natural progression of the field. The first step in understanding Kinesmetrics is to define the theoretical bases. The components to Kinesmetrics includes measurement theory (Classical test theory: Sperman, 1904; Generalizability theory: Brennan, 1968; Item Response Theory: Lord, 1968), statistical and mathematical models and techniques (parametric and non-parametric, univariate and multivariate), research design (quasi-experimental, cross sectional, longitudinal), data characteristics (clustered, repeated measures), legal and ethical consequences (AERA, APA, NCME, 1999: decision made based on measure), and computers and technology (Software, Hardware).


Kinesmetrics will make a huge impact addressing the measurement challenges in Athletic Training. This will be achieved by borrowing many techniques from a great many disciplines. Perhaps the largest contributing area in measurement theory is from the psychometric field. It is the early work done by Spearman (1904) and Thurston (1930) that helped to develop classical testing theory. This theory is widely integrated into many disciplines including evidence-based medicine. Classical test theory is the partitioning an observed score into the true score and the error score. This is a fundamental principle in measurement. Generalizability theory (Brennan, 1968), which is the partitioning of the error variances into smaller more specific components rather than just one error component like in classical test theory (Safrit et al., 1976) is another well established theory that can be used in athletic training research. As the field of psychometrics continues to progress the ability to integrate theory into athletic training to solve or address measurement issues will be exciting.


The measurement field in kinesiology has also tackled many challenges in order to address critical issues. From a historical perspective early work by Jackson and colleagues (1967) and Baumgartner (1967) started to address the issue of reliability for repeated measures. Hale and Hale (1972) address the issue of how to measure change. Safrit (1977) introduced criterion-referenced interpretation to kinesiology. Through a relatively short history the measurement and evaluation have adopted techniques to address issues in the field and have developed their own approaches to handle the unique type of data. In Kinesiology, researchers may have continuous variables or nominal/ categorical variables in a hierarchical structure or clusters and the measurement field had evolved to tackle the unique demands of the field. This includes the application of Item response theory (IRT) to various types of data (Spray, 1987). New models and applications are starting to develop (Looney, 2002; Zhu, 1996).

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Health Outcomes

Although “outcomes” has various meanings, within the medical community, health outcomes refer to the changes that occur in a person’s health status, as a direct result of health care intervention. Outcomes represent the end result of health care and contribute to the evidence on which health care providers base their practice.

 

Dr. Avedis Donabedian identified the importance of assessing quality of health care and provided a framework for its assessment. He defined quality of care as achieving a desirable health status through medical intervention. His framework included measuring structure (resources required), process (services provided), and outcomes; with outcomes representing the end result of the structure and process of patient care.

 

Outcomes can be measured objectively by the health care providers or subjectively by the individual’s own self-report. Examples of traditionally objective measures include X-rays, laboratory results, strength tests, and performance tests. Self-reported measures are usually in survey form and the questions address different components of health (i.e. physical, psychosocial, functional). Although these instruments can vary, they all attempt to quantify a person’s health.

 

Currently, one key issue within athletic training is a paucity of instruments available to adequately quantify the health status of the physically active. In our current research initiative at the University of Northern Iowa, the Division of Athletic Training is attempting to address this issue by examining the measurement properties of commonly used outcome instruments. More specifically, we are examining the usefulness of these instruments in measuring the heath status of the physically active. The results of health outcomes studies provide administrators with the information needed to implement policy and make decisions.

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Policy & Implementation

Policy can be defined as statements or positions that seek to guide the decision making process. Policy is implemented in many fashions and at many levels. Evidence based medicine can lead to policy changes regarding the education of medical students, athletic training students, and others. Additionally, EBM can lead to policy changes regarding the availability and application of interventions.

 

Unfortunately, many of the current practices and procedures used in all facets of medicine are not based on good evidence. As an example, you could examine any special test or nearly any piece of therapeutic exercise equipment used in orthopaedic rehabilitation and find that little to no evidence exists that adequately demonstrates validity, reliability, specificity, or sensitivity. Taking that further, there is little to no evidence that suggests that any particular procedure or therapy is better than the next.

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