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Consensus Definition of Sport Specialization in Youth Athletes Using a Delphi Approach
A single, widely accepted definition of sport specialization does not exist. A consensus definition is necessary to guide youth sport stakeholders on issues associated with sport specialization.
The aim of this study was to develop a consensus definition of youth sport specialization and to identify elements that support the construct of specialization.
Delphi Study Setting: Directed Surveys Patients or Other Participants: A consensus panel of 17 experts was created to provide a broad multidisciplinary perspective on sport specialization in youth athletes.
The final definition was developed per an iterative process that involved four rounds of review. A comprehensive review of literature and expert input supported our initial proposed umbrella definition that included six additional elements. The study team reviewed the results after each round and changes were made to the definition based on panel feedback.
Panel members were provided with the definition and six elements and then asked to rate each specific to importance, relevance, and clarity using a 4-point Likert scale.
In four Delphi consensus rounds, 17 experts reviewed the umbrella definition and six elements before consensus was reached. The umbrella definition and three of the initial six elements achieved >80% agreement for importance, relevance, and clarity after the fourth round of review. The remaining 3 components did not reach >80% agreement even after iterative edits and were removed. The process resulted in a final consensus definition: Sport specialization is intentional and focused participation in a single sport for a majority of the year that restricts opportunities for engagement in other sports and activities.
A consensus-based conceptual definition for sport specialization has been developed using a Delphi method. This definition has important implications for clinicians and sports medicine professionals who support youth athletes.
Journal Article
Buried alive
A group of college friends were on a road trip to a remote desert cabin. As a night of extreme truth-or-dare and wild partying gives way to sheer fright, the teens are torrorized by a vengeful corpse who was cruelly entombed on the property.
DVD
Secondary School Athletic Trainers’ Perceptions of the Influence of Social Determinants of Health and Socioeconomic Status on Clinical Management Decisions
Evidence suggests that lower socioeconomic status (SES) and negative social determinants of health (SDOH) contribute to health care disparities. Due to their accessibility in the high school setting, secondary school athletic trainers (SSATs) may encounter patients who are historically underserved in health care, such as patients with low SES. However, a significant gap in knowledge exists regarding how SDOH and SES may influence SSATs' clinical management decisions.
To describe SSATs' perceptions of how patient SDOH and SES influence clinical management decisions and to identify barriers to athletic health care.
Cross-sectional study.
Online survey.
National Athletic Trainers' Association SSATs (6.7% response rate).
Secondary school athletic trainers were asked about their perceptions of patient SDOH and SES (content validity index = 0.83 for relevancy). The levels of relevance and agreement were answered on a 4-point Likert scale. Data were summarized using means and SDs, frequencies and proportions (%), and median scores.
A total of 380 SSATs participated (mean years of experience = 14.9 ± 11.7 years). When providing care, most (71.3%) SSATs believed their patients' health or health care access to be the most relevant of the 5 SDOH, whereas the other 4 SDOH were less than 60% relevant. Most SSATs agreed or strongly agreed that patient SES affected both referral (67.4%) and the reliance on conservative treatment before referral (71.2%). Secondary school athletic trainers identified patient or guardian compliance (70.2%) and type of health insurance (61.5%) as barriers to providing care to patients with low SES.
Secondary school athletic trainers perceived health or health care access as the most relevant social determinant when providing care to patients with low SES. When SSATs further considered the SES of patients, they identified all SDOH as barriers that they were ill equipped to navigate as they delivered care and engaged in patient referral.
Journal Article
Mental health, physical activity, and quality of life of us adolescent athletes during covid-19-related school closures and sport cancellations
Context In the spring of 2020, US schools closed to in-person teaching and sports were cancelled to control the transmission of coronavirus disease 2019 (COVID-19). It is critical to understand the mental and physical health of adolescent athletes during this time. Objective To describe the health of athletes during COVID-19-related school closures and sport cancellations. Design Cross-sectional study. Setting A national sample recruited via social media. Patients or Other Participants A total of 13 002 US adolescent athletes (age = 16.3 ± 1.2 years, females = 52.9%, males = 47.0%) completed an anonymous online survey. Main Outcome Measure(s) Demographic information collected was sex, grade, sport(s) played, and zip code. Assessments used were the General Anxiety Disorder 7-Item for anxiety, Patient Health Questionnaire 9-Item for depression, the Pediatric Functional Activity Brief Scale for physical activity, and the Pediatric Quality of Life Inventory 4.0 for quality of life. Mental health, physical activity, and health-related quality-of-life variables were compared among sex, grade, sport(s) played, and poverty level using means and 95% confidence intervals (CIs) from the survey-weighted analysis of variance. Results Females reported a higher prevalence of moderate to severe anxiety symptoms (females = 43.7% versus males = 28.2%). The Pediatric Functional Activity Brief Scale score was highest (best) for grade 9 (mean = 14.5, 95% CI = 14.0, 15.0) and lowest for grade 11 (mean = 10.9, 95% CI = 10.5, 11.3). The prevalence of depression symptoms was highest in team sport (74.1%) and lowest in individual sport (64.9%) participants. The total Pediatric Quality of Life Inventory score was lowest (worst) for athletes from counties with the highest poverty levels (high: mean = 74.5, 95% CI = 73.7, 75.3; middle: mean = 78.9, 95% CI = 78.0, 79.8; and low: mean = 78.3, 95% CI = 77.4, 79.1). Conclusions The health of US adolescents during the COVID-19-related school closures and sport cancellations varied to differing degrees depending on sex, grade level, type of sport participation, and level of poverty. Health policy experts should consider these findings in the future when creating and implementing policies to improve the health of adolescents in the United States.
Journal Article
A Comparison of Psychological Readiness and Patient-Reported Function Between Sexes After Anterior Cruciate Ligament Reconstruction
Postoperative functional and return-to-sport outcomes after anterior cruciate ligament reconstruction (ACLR) differ by sex. However, whether sex disparities are observed in patient-reported outcome measures (PROMS) before return to sport after ACLR is unclear.
To compare common PROMS between young men and women who had not yet returned to sport after ACLR.
Cross-sectional study.
University laboratory.
Forty-five young men (age = 18.7 ± 2.7 years, time since surgery = 6.8 ± 1.4 months) and 45 matched for age (±1 year) and time since surgery (±1 month; age = 18.8 ± 2.8 years, time since surgery = 6.9 ± 1.4 months) with ACLR participated. Participants completed the Tegner Activity Scale, ACL Return to Sport After Injury scale, Tampa Scale of Kinesiophobia, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Score, and Knee Injury and Osteoarthritis Outcome Score (KOOS). The PROMS were compared between men and women using Mann-Whitney U tests. Odds ratios were calculated to evaluate the odds of a male reporting a PROM value above the previously established normative value as compared with a female.
Sex differences were present for the IKDC score (P = .01) and KOOS Pain score (P = .04) but not for the Tegner activity level (P = .22), ACL Return to Sport after Injury scale score (P = .78), Tampa Scale of Kinesiophobia score (P = .64), or other KOOS subscales (P values = .40 to .52). The odds of reporting values above normative levels differed only for the IKDC score (odds ratio = 2.72, 95% confidence level = 1.16, 6.38).
After ACLR, young men and women reported similar levels of knee-related function, fear of movement, and readiness for return to sport and were equally likely to meet clinically meaningful normative values before return to sport. Overreliance on patient reports or objective functional outcomes in evaluating patient progress and readiness for return to sport after ACLR may limit clinicians in their ability to comprehensively evaluate and develop individualized interventional approaches that optimize patient outcomes.
Journal Article
Secondary School Athletic Trainers’ Navigation of Patient Socioeconomic Status Challenges in Care: A Qualitative Study
Secondary school ATs (SSATs) are uniquely positioned healthcare providers at an optimal public health intersection where they can provide equitable healthcare to low socioeconomic status (SES) adolescents. SSATs face similar challenges to physicians in treating low SES patients, but their strategies may be different compared to other medical professions. However, the consequences of low SES population healthcare delivery by SSATs have not been explored. SSATs were asked to share what challenges, if any, they encounter with providing care for their low SES patients and what strategies they find most effective to overcome these challenges. Data were collected via semi-structured interviews and reflective field notes and analyzed using a four-step, interpretative phenomenological analysis (IPA) guided theme development. Data saturation was met, and the sample size aligned with other IPA studies. Trustworthiness was established with research triangulation and Yardley’s four principles. Three interrelated themes emerged: (a) mechanisms for identifying SES, (b) the impact of SES on care, and (c) navigating SES challenges. SSATs described many strategies that were gained through their clinical experiences to overcome healthcare barriers. SSATs have the potential to decrease health disparities through their role as a liaison and advocates for their low SES patients.
Journal Article
Authors' Response
When strong empirical evidence is lacking, a Delphi consensus method is commonly used to create agreement on a definition.2 Doing so allows for consistent approaches to evaluate the relationships between sport specialization and outcomes, predictors of sport specialization, and the efficacy of interventions to mitigate any identified negative consequences. The Delphi method is an accepted empirical technique used to gain consensus through expert opinion on a real-world problem.7 Sport specialization, a unique type of sport participation, likely requires a complex systems approach to understand how the multitude of relationships between direct and indirect risk factors result in some athletes demonstrating specialized behaviors.8 Youth athletic programs, coaches, parents, and athletes across the globe will be best served by contemporary approaches because sport specialization is a complex phenomenon that cannot be explained using reductionism. Psychometrically sound, patient-reported assessments are often used to assess unobservable, latent traits, including measures of health status.12 Researchers10,12 who have established standards specific to developing novel patient-reported assessments recommend starting with an established conceptual definition to avert future confusion or problems. 13 Similarly, we rely on universally accepted definitions when we ask athletes to report the degree to which they experience “sensitivity to light” or “feeling like in a fog” during the evaluation of concussion.14 Content validity standards stipulate that careful attention must be paid to the interpretation of the instructions, each item, and all response options when operationalizing patient-reported assessment tools.15 4.
Journal Article