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
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Research Activities
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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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