Athletic Training and Sports Health Care

Original Research Supplemental Data

A Preliminary Investigation Into Athletic Trainers’ Views and Experiences of a Multidisciplinary Team Approach to Sports Injury Rehabilitation

Monna Arvinen-Barrow, PhD, CPsychol; Damien Clement, PhD, ATC

Abstract

This study aimed to document athletic trainers’ views and experiences of a multidisciplinary team approach to sports injury rehabilitation. A cross-sectional online survey was completed by 393 athletic trainers (180 male, 213 female), representing a response rate of 19.65%. The results revealed that most athletic trainers thought it was either very important (n = 166; 42.2%) or somewhat important (n = 108; 27.5%) to ensure injured athletes have access to a multidisciplinary team of professionals. Of the sample, athletic trainers (n = 255; 64.9%) typically worked as part of a multidisciplinary team 66.7% of the time. Athletic trainers indicated their role was to be the primary point person for such teams. To ensure athletes’ full physical and psychosocial recovery, and successful return to sport, different individuals and professionals should work together for the benefit of the athlete, highlighting the importance of adopting holistic multidisciplinary care during sports injury rehabilitation. [Athletic Training & Sports Health Care. 2015;7(3):97–107.]

From the Department of Kinesiology, University of Wisconsin–Milwaukee, Milwaukee, Wisconsin (MA-B); and the College of Physical Activity and Sport Sciences, West Virginia University, Morgantown, West Virginia (DC).

The authors have no financial or proprietary interest in the materials presented herein.

Correspondence: Monna Arvinen-Barrow, PhD, CPsychol, Department of Kinesiology, P.O. Box 413, University of Wisconsin–Milwaukee, Milwaukee, WI 53201-0413. E-mail: arvinenb@uwm.edu

Received: September 25, 2014
Accepted: February 24, 2015

Abstract

This study aimed to document athletic trainers’ views and experiences of a multidisciplinary team approach to sports injury rehabilitation. A cross-sectional online survey was completed by 393 athletic trainers (180 male, 213 female), representing a response rate of 19.65%. The results revealed that most athletic trainers thought it was either very important (n = 166; 42.2%) or somewhat important (n = 108; 27.5%) to ensure injured athletes have access to a multidisciplinary team of professionals. Of the sample, athletic trainers (n = 255; 64.9%) typically worked as part of a multidisciplinary team 66.7% of the time. Athletic trainers indicated their role was to be the primary point person for such teams. To ensure athletes’ full physical and psychosocial recovery, and successful return to sport, different individuals and professionals should work together for the benefit of the athlete, highlighting the importance of adopting holistic multidisciplinary care during sports injury rehabilitation. [Athletic Training & Sports Health Care. 2015;7(3):97–107.]

From the Department of Kinesiology, University of Wisconsin–Milwaukee, Milwaukee, Wisconsin (MA-B); and the College of Physical Activity and Sport Sciences, West Virginia University, Morgantown, West Virginia (DC).

The authors have no financial or proprietary interest in the materials presented herein.

Correspondence: Monna Arvinen-Barrow, PhD, CPsychol, Department of Kinesiology, P.O. Box 413, University of Wisconsin–Milwaukee, Milwaukee, WI 53201-0413. E-mail: arvinenb@uwm.edu

Received: September 25, 2014
Accepted: February 24, 2015

A multidisciplinary team approach to injury rehabilitation involves the use of a variety of individuals with different specialties, all of whom work either together or separately with the aim of getting the injured athlete back to the field of play.1,2 Adopting a multidisciplinary team approach has the potential to expose injured athletes to “holistic care,” make the referral process more efficient, and, more importantly, open additional lines of communication between different members of the sports medicine team.

Within the athletic training literature, Prentice3 was among the first to discuss the concept of a sports medicine team approach to injury rehabilitation. He emphasized the importance of a “group effort” and the involvement of many different individuals with varying expertise. The significance of this concept is further validated by its incorporation into the education competencies currently required in athletic training education programs. More specifically, athletic training students should be able to “recognize the unique skills and abilities of other health care professionals and understand their scope of practice” (p. 8).4 However, despite the references and incorporation of this notion within athletic training educational curricula, the sports injury rehabilitation literature appears to have limited references to this concept.

Clement and Arvinen-Barrow1 proposed a conceptual model for a multidisciplinary approach within the sports injury rehabilitation context. More specifically, they suggested that such approach should include “a number of people working closely together for the benefit of the athletes” (p. 150) and should consist of two “layers” of professionals and individuals forming a primary and secondary rehabilitation team. The primary rehabilitation team should consist of professionals (eg, physiotherapists, athletic trainers, physicians, and surgeons) who spend a great deal of time working closely with injured athletes during the course of their injury rehabilitation. These individuals, by nature of their training, are ideally suited to deal with the physical issues these injured athletes present with but are able to recognize other needs.5 On the other hand, the secondary rehabilitation team should consist of allied health professionals (eg, strength and conditioning coaches, biomechanists, sport psychology consultants, and sport nutritionists) and other individuals (eg, coaches, family members, friends, and teammates) who also play a significant role in the rehabilitation process. Although these individuals may not be directly involved in the rehabilitation process of the injured athlete, their indirect involvement can help, or hinder, the athlete’s reactions to the injury, recovery, and overall experience.1 The model also proposes a distinction in the types of interactions between members of the primary and secondary teams and the injured athlete.1 More specifically, members of the primary team are thought to have direct interactions with the injured athlete, whereas those in the secondary team may have both direct and indirect interactions with the athlete and the other members of the team, depending on the individual athlete’s needs. Both types of interactions are deemed to be important, and the authors advocate active and open lines of communication among all members of the rehabilitation teams to ensure they are aware of other individuals involved in the rehabilitation process and assist in identification of potential gaps in the athlete’s care. By doing so, all of those involved can work in the best interest of the injured athlete’s physical and psychological well-being.

Research on practicalities of adopting a multidisciplinary approach to sports injury rehabilitation is lacking. Although references to this concept appear in the athletic training literature, and more recently in the sports injury rehabilitation literature, there appears to be an overall void with regard to assessing the extent to which this approach is used. As a result and given the potential benefits that could be derived from adopting this approach, the primary purpose of this exploratory study was to document athletic trainers’ views on adopting a multidisciplinary team approach. The study also aimed to document athletic trainers’ experiences of working as part of a multidisciplinary team. A tertiary aim of the study was to explore any potential empirical evidence in support of, or against, the existing conceptual model of a multidisciplinary team approach to injury rehabilitation as proposed by Clement and Arvinen-Barrow.1

Methods

Research Design and Setting

A cross-sectional research design was used to examine athletic trainers’ views and experiences via an online survey that consisted of both quantitative and qualitative items.

Participants

A randomly selected sample of athletic trainers (N = 2,000) who held an active membership in the National Athletic Trainers’ Association (NATA) during 2013 was approached for this study. The participants were employed in a range of settings (eg, college/university, secondary school, clinic, hospital, professional sports, independent contractors, industrial, occupational, corporate, amateur, recreational, and youth sports).

Instrumentation

An online survey was developed by the authors based on the conceptual model of multidisciplinary teams in sports injury rehabilitation.1 The survey consisted of two parts documenting athletic trainers’ views (Section 1) and experiences (Section 2) on: (1) the composition of a multidisciplinary team; (2) the relationships and interactions between different members of the multidisciplinary team; and (3) the process of working as part of a multidisciplinary team (see Appendix A, available in the online version of this article). In addition, the survey also included a demographic section in which participants were asked to complete questions related to gender, age, country of residence, level of education, and years of experience as a sports medicine professional. Consistent with the study’s aims, and to ensure content validity, all of the items in the questions were derived from the published conceptual model.1 Prior to instrumentation, the survey was also examined for face and content validity6 by conveniently selected professionals representing both athletic trainers (ATC and LAT), and sport psychology consultants (CC-AASP and CPsychol) who have expertise (minimum of 10 years or formal exposure/experience and/or training) in this area. All professionals had experience of working as an applied practitioner in the field and held university faculty positions.

The survey was not tested for criterion or construct validity6 because the aim of the survey was to explore views and experiences of working in a multidisciplinary team. The data from this study will be used to develop survey instruments that can capture attitudes and expectations on a multidisciplinary approach to sports injury rehabilitation. The process of survey development and evaluation of validity and reliability followed similar structure and process as previous research investigating participants’ views and experiences within the psychology of sports injury context.7–14 Following the above, a few minor modifications to the language were made to ensure ease of use, clarity, and readability. Because the survey items were based on an existing conceptual model,1 no major changes to the content were made as a result of the face and content validity review process.

Procedures

Prior to data collection, written approval from the Institutional Review Board for the Protection of Human Subjects was obtained from the first author’s university. Following approval, a list of e-mail addresses (N = 2,000) of current NATA members was obtained. A cover letter that described the purpose of the study and included a link to the survey hosted on Qualtricsx Online Survey Software (Qualtrics, LLC, Provo, UT) was e-mailed to all prospective participants. If participants were interested in the study, they were advised to follow the link, which brought them to the survey website and provided further information about the study, informed about their rights to confidentiality and anonymity, and provided instructions on how to withdraw from the study. This was followed by a question regarding informed consent, and those participants who agreed to take part were then directed to the survey questions.

All participants completed the first section of the survey (athletic trainers’ views on different aspects of the multidisciplinary team). Those athletic trainers who answered 0% of the time to the first question in Section 2 (ie, question 8: When working with injured athletes, how often do you typically work as part of a multidisciplinary team?) were directed to the end of the survey and thanked for their involvement. All other participants (answered 1% or more of the time) were directed to continue with the remainder of Section 2. At the end of the survey, participants were thanked for their valuable contribution to the study and a reminder about the lead researcher’s contact details was also provided. Approximately 1 month after the initial e-mail, prospective participants who had yet to respond to the survey were sent a reminder e-mail encouraging them to take part in the study.

Data Analysis

Descriptive statistics (frequencies, means, and standard deviations) were calculated using SPSS software (IBM SPSS Statistics 20; SPSS, Inc., Chicago, IL) for all close-ended multiple response questions and Likert-scale type questions. A thematic analysis was conducted on the open-ended responses using the steps described by Braun and Clark.15 First, the responses were transcribed and both authors familiarized themselves with the responses. Initial codes were then generated. Once all data were coded, they were subsequently organized into broader level themes. Themes were then refined and clarified, ensuring they were reflective of the data collected. They were then reviewed, and eventually named, by the authors until a mutual agreement of the emergent themes was found.

Results

Demographics

Of the 2,000 e-mails sent, 423 certified athletic trainers expressed interest in participating in the survey by clicking the e-mail link. Of those potentially interested participants, 30 did not consent to participate, leaving a total of 393 participants (19.65% response rate) who completed the survey (male mean age: 39.48 ± 10.87 years; female mean age: 33.65 ± 9.76 years). On average, the participants had 13.31 ± 9.99 years of experience as athletic trainers. Table 1 provides further demographic details of the study sample.

Demographics of Study Sample

Table 1:

Demographics of Study Sample

Athletic Trainers’ Views on Multidisciplinary Approach to Sports Injury Rehabilitation

Descriptive statistical analyses (question 1) revealed that, on average, participants thought that ensuring injured athletes have access to a multidisciplinary team during rehabilitation was important (5.56 ± 1.149). Moreover, 72.4% of the respondents (n = 174) considered a multidisciplinary team approach to be either very important (44.9%; n = 166) or important (27.5%; n = 108). The results (question 2) also revealed that all of the professionals and individuals identified in the conceptual framework by Clement and Arvinen-Barrow1 were endorsed by the participants as individuals who should be part of a multidisciplinary team during sports injury rehabilitation. As shown in Table 2, the most frequently identified professionals and individuals listed were: athletic trainer (n = 352), injured athlete (n = 344), physician (n = 335), athletic coach (n = 300), strength and conditioning coach (n = 279), parent/family (n = 265), and surgeon (n = 233).

Professionals and Individuals Who Should Be Included in Multidisciplinary Teams for Sport Injury Rehabilitation

Table 2:

Professionals and Individuals Who Should Be Included in Multidisciplinary Teams for Sport Injury Rehabilitation

More specifically, the five most frequently identified professionals and individuals to be included in the primary rehabilitation team (question 3) were: athletic trainer (n = 332), injured athlete (n = 308), physician (n = 274), athletic coach (n = 204), and surgeon (n = 168). With regard to the secondary rehabilitation team (question 4), the five most frequently identified professionals and individuals were: strength and conditioning coach (n = 156), athletic coach (n = 147), (sport) nutritionist (n = 145), sport/exercise psychology consultant (n = 136), and teammates (n = 135). Tables 34 list all professionals and individuals identified as part of a primary and secondary rehabilitation team.

Professionals and Individuals Who Should Be Included in the Primary Team for Sport Injury Rehabilitation

Table 3:

Professionals and Individuals Who Should Be Included in the Primary Team for Sport Injury Rehabilitation

Professionals and Individuals Who Should Be Included in the Secondary Team for Sport Injury Rehabilitation

Table 4:

Professionals and Individuals Who Should Be Included in the Secondary Team for Sport Injury Rehabilitation

Participants indicated that the interactions different professionals and individuals could have with the injured athletes may be direct, indirect, or a combination of both (question 5). Of those who responded, more than half of the respondents believed that the injured athlete’s interactions with the athletic trainer (n = 273; 95.5%), physician (n = 187; 65.4%), strength and conditioning coach (n = 165; 58.7%), surgeon (n = 147; 52.1%), and athletic coach (n = 139; 50.4%) should be primarily direct in nature. More than half of the respondents (n = 138; 50.9%) also felt that the interactions between the biomechanist and the injured athlete should be indirect in nature. A majority (n = 217; 77.8%) of the participants also felt that it was the athletic trainer’s role to act as the primary point person for the multidisciplinary team (question 6). Of the sample, 43 (15.4%) felt that a physician could also act in this role.

Question 7 asked the participants’ views on which professionals and individuals should be typically involved in making decisions about the (1) composition of the multidisciplinary team, (2) roles and responsibilities of those included in the team, and (3) level of involvement of those included in the team. Results revealed that the five most commonly listed individuals to be included in all of the three areas of the decision making included athletic trainers, physicians, surgeons, injured athletes themselves, and parents/family. With regard to making decisions about roles and responsibilities of those included in the team, the participants felt that sport and exercise psychology consultants were the fifth most important (instead of parents/family) to be included in the team.

Athletic Trainers’ Experiences of Multidisciplinary Approach to Sports Injury Rehabilitation: Quantitative Data

Of the participants, two-thirds (n = 255; 64.9%) reported adopting a multidisciplinary team approach in their work with injured athletes. Such an approach was typically adopted approximately 66.7% (standard deviation = 30.26; range: 3% to 100%) of the time in their work (question 8). As such, the data presented in the following section only include the answers from those participants who had experiences of working as part of a multidisciplinary team. Results from question 10 revealed that among those participants who had experience working as part of a multidisciplinary team, a majority (n = 161; 64.1%) indicated that typically these teams are set up informally as opposed to following a formal, set protocol (n = 75; 29.9%). Of the respondents, 15 (6%) indicated in their open-ended responses to question 10 that in their experience, setting up a multidisciplinary team was a combination of both informal and formal procedures and this varied depending on individual needs of the athlete and the situation (eg, level of competition may influence the process).

Based on the data, participants typically interacted (question 13; see Table 5) mostly with the physician (n = 235), injured athlete (n = 231), athletic coach (n = 210), other athletic trainers (n = 186), surgeon (n = 179), injured athlete’s parents/family (n = 163), and strength and conditioning coach (n = 126).

Professionals and Individuals Who Athletic Trainers Typically Interact With During Sport Injury Rehabilitation

Table 5:

Professionals and Individuals Who Athletic Trainers Typically Interact With During Sport Injury Rehabilitation

The frequency analyses also revealed that among the participants who had experience working as part of a multidisciplinary team, more than half stated that their working interactions (question 14) with surgeons (n = 116; 52.7%), physicians (n = 140; 61.6%), athletic coaches (n = 134; 61.5%), and other athletic trainers (n = 175; 80.3%) were primarily direct in nature. Interactions with physiotherapists, strength and conditioning coaches, (sport) nutritionist, parent(s)/family, friends, and teammates appeared to be a mixture of direct, indirect, combination of direct and indirect, or not applicable (ie, was not relevant to their own experiences) interactions. A majority of the participants, in their role as athletic trainers, felt they typically acted as the primary point person for the multidisciplinary team (n = 184; 78%, question 15), whereas the physician (n = 32; 13.6%) was the second most commonly listed professional for this role.

Participants’ experiences of different professionals and individuals being part of the decision making (question 16) about the (1) composition of the multidisciplinary team, (2) roles and responsibilities of those included in the team, and (3) level of involvement of those included in the team appeared to reflect their views on the above matter in that the five most commonly listed individuals to be included in all of the three areas of the decision making included athletic trainers, physicians, surgeons, injured athletes themselves, and parents/family. Despite viewing the role of sport and exercise psychology consultant as the fifth most important person to be included in making decisions about roles and responsibilities of team members, this was not reflected in their experiences of making such decisions.

Athletic Trainers’ Experiences of Multidisciplinary Approach to Sports Injury Rehabilitation: Qualitative Data

To elaborate on their experiences of working as part of a multidisciplinary team, question 9 asked the athletic trainers to further describe their typical experiences of working as a member of such a team during rehabilitation. Of those who had experiences of such practices (n = 255; 64.9%), 72% chose to answer this question and, as a result, a total of 184 open-ended responses were analyzed. Results from the qualitative content analyses revealed that athletic trainers’ experiences of working as a part of a multidisciplinary team broadly fell into two main themes: (1) athletic trainer in a central role in multidisciplinary team and (2) working as part of a multidisciplinary team is a generally positive and rewarding experience but also has its challenges.

Athletic Trainer in a Central Role in Multidisciplinary Team. Based on athletic trainers’ own accounts, their role in sports injury rehabilitation was to provide day-to-day care to the athlete. This typically meant that they adopted the role of a point person for the injured athlete and other individuals/professionals. They would also consult with other medical professionals, and the main individual with whom they would work was the physician. Participants also reported that they had a role in deciding who should be involved in the team and to what extent, as well as dealt with referrals to other healthcare professionals.

Working as Part of a Multidisciplinary Team Is Generally a Positive and Rewarding Experience but Also Has Its Challenges. Athletic trainers also felt that working as part of a multidisciplinary team can be rewarding and can provide opportunities to learn from other disciplines. In their experiences, multidisciplinary team interactions included both direct and indirect interactions with those involved. More specifically, interactions with professionals were typically direct, and other individuals (eg, significant others, sport team members) were indirect unless deemed necessary otherwise. Respondents highlighted the importance of knowing one’s role within the team approach and how everyone should be “on the same page” for the experience to be successful. Good communication between different members of the team was also seen as vital, whereas lack of communication can be negative.

Communication Methods. To better understand how communication between different members of the team typically occurred, the results revealed that the methods used to communicate between different members of the multidisciplinary rehabilitation team varied, depending on the individual athlete’s needs, rehabilitation process, and level of competition. The most commonly used methods of communication were e-mail (n = 187), telephone calls (n = 157), informal face-to-face meetings (n = 149), and text messaging (n = 121). Other methods used to a lesser extent included formal face-to-face meetings, use of written notes, use of fax, medical notes, Skype, conference calling, and online tracking systems.

Areas of Improvement. The qualitative data from question 17 indicated that slightly more than half of the athletic trainers (n = 130; 55.3%) who had experience working as part of a multidisciplinary team did not feel that there was anything that could be done differently to ensure better care for the athlete during rehabilitation. On the other hand, some athletic trainers (n = 105; 44.7%) felt that current practices could be improved. Results from the qualitative content analyses on the open-ended responses (n = 105) revealed that the main themes that emerged included the following: access, communication, and central role of athletic trainers in the multidisciplinary team. More specifically, the theme access included better access to other professionals (n = 33), of which several people identified sport psychologist (n = 9) and sport nutritionist (n = 8) as particularly important, and unified referral protocols (n = 6) and unified electronic records (n = 3) of the patient. The emergent theme communication was also characterized by several components: approximately one-quarter (n = 27) of the respondents indicated that communication between different members of the team should be increased. Moreover, a few respondents (n = 6) also felt that other areas of improvement included a better understanding of what each professional is able to do for the athlete and further education about the benefits of multidisciplinary approach for both the sports medicine professionals and the athletes. Of the respondents, a total of five felt that athletic trainers’ role as a primary point person should be further highlighted to improve care.

Discussion

To date, little research has been done regarding the adoption of a multidisciplinary team in sports medicine injury rehabilitation. As a result, the current study aimed to determine athletic trainers’ views and experiences of using this approach. Furthermore, the study explored any evidence supporting the existing conceptual model of a multidisciplinary team approach to injury rehabilitation as proposed by Clement and Arvinen-Barrow.1

For the most part, athletic trainers’ views on and experiences of (1) the composition of a multidisciplinary team; (2) the relationships and interactions between different members of the multidisciplinary team; and (3) the process of working as part of a multidisciplinary team seemed to be similar. Results revealed that athletic trainers believed it was important for athletes to have access to a multidisciplinary team and most, who worked with athletes of all levels, reported being a part of a multidisciplinary team most of the time. This is definitely a positive trend toward more holistic care of the athlete, especially for those at lower levels of competition.

The results also helped to identify which professionals and individuals belong to the primary and secondary teams as described in the conceptual framework proposed by Clement and Arvinen-Barrow1 and the way in which different individuals and professionals listed were viewed as beneficial to both the primary and secondary multidisciplinary teams, and how interactions (direct, indirect or a combination of both) between different professionals and the injured athlete would vary depending on the individual needs of the athlete. Unsurprisingly, the most frequently identified professional included in the rehabilitation team was the athletic trainer. Consistent with the proposals made in the conceptual model,1 the most frequently listed members of the primary team included the athletic trainer, the injured athlete, the physician, and the surgeon. In addition, athletic coaches were also frequently identified as professionals who should be part of the primary team.

The inclusion of athletic coaches as part of a primary team is in contrast to the conceptual model1 in that it places athletic coaches as part of the secondary team, mainly due to existing research highlighting some contradicting findings with regard to conflicting role of coaches in injury rehabilitation,16,17 particularly as a source of social support.18,19 Indeed, despite existing research identifying athletic coaches as potentially beneficial in the recovery of athletes with injuries,18,19 not always having a coach involved in the rehabilitation has been found to be beneficial.18,20 For example, Podlog and Eklund21 found that when coaches were making decisions about whether an injured athlete was ready to return to sport, they tended to make these decisions based on the athlete’s physical readiness as opposed to psychological readiness. In a similar manner, coaches themselves have found conflicts in their own involvement in being part of injury rehabilitation, because they may think this is unfair to the rest of the team.22

On the other hand, if an athlete has an excellent relationship with the coach, his or her involvement can be highly beneficial and welcomed18 because it has also been found that coaches are seen as excellent sources of task appreciation and task challenge support during rehabilitation.20 However, given the findings above and the potential issues that coaches’ direct involvement could bring forth, the authors believe that the coaches’ role in rehabilitation is potentially best served as a member of a secondary rehabilitation team with the aim of (1) increasing the athlete’s feelings of belonging to the team; (2) demonstrating task appreciation and challenging when appropriate; and (3) helping facilitate the athlete’s mood and readiness to return to activity. All of the above could be achieved, if an athlete is ready and willing, by simply involving the athlete in training activities that would not impede the healing process or increase the risk of further injury, and/or by simply showing interest in the athlete’s progress by personally making his or her way to rehabilitation a few times a week to see the athlete, rather than simply discussing progress with the athletic trainer.20

With regard to athletic trainers’ views on the members of the secondary rehabilitation team, the results revealed that all individuals and professionals listed in the conceptual model1 were seen as relevant to varying degrees. It could be that this is dependent on the setting in which the athletic trainer works, because not all professionals and individuals are always available for all injured athletes. As such, an important part of the multidisciplinary team approach is to ensure the primary point person identifies who needs to be involved in the team,1 where potential gaps in needed support are, and how these could be addressed. Such identification should be done in consultation with the athletes to ensure their personal needs are well accounted for physically, psychosocially, and tangibly.

Another interesting area highlighting the identification of individual needs emerged from the open-ended responses. More specifically, a few athletic trainers identified other medical professionals (eg, school nurse) and members representing spirituality and/or faith (eg, pastor and minister), both of which had not been explicitly considered in the conceptual model. For some injured athletes, the inclusion of relevant religious/spiritual members as part of the secondary rehabilitation team might also be of importance. Thus far, previous research has indicated that spirituality plays a role in athletes’ peak performance,23 and it has also been found that for some athletes prayer can be an important source of strength and means of coping with anxiety,24 particularly during times of increased stress25 such as during sports injury rehabilitation.26 Research has also indicated that spirituality also forms a significant part of athlete counseling,27 particularly when an athlete has sustained a career-ending injury and/or is in a process of athletic retirement. It is likely that these individuals will be faced with a range of existential questions related to meaning, values, and spirituality28 and, as a result, with the aim of providing athletes with “holistic care” during rehabilitation, inclusion of spiritual members to secondary rehabilitation team might be beneficial for those athletes who embrace and consider spirituality and/or religion as a significant part of their identity, (sporting) success, and life as a whole.

In general, the athletic trainers viewed their experiences of working as part of a multidisciplinary team rewarding, but with some difficulties. Their views and experiences indicated that being the primary point person in the rehabilitation was part of an athletic trainer’s role and within that role their views and experiences of the interactions with different professionals varied greatly. In particular, it appeared that athletic trainers felt they should have direct interactions with other athletic trainers, the physician, the strength and conditioning coach, the surgeon, and the athletic coaches. For the other professionals and individuals listed, the opinions varied from direct to indirect or a combination of both. Only interactions with a biomechanist were viewed as they should be primarily indirect in nature. Interestingly, among the athletic trainers who had experience working as part of a multidisciplinary team, their personal experiences did not explicitly reflect the above views, because their experiences with strength and conditioning coaches were typically indirect in nature.

Such lack of interaction with other professionals could be due to different reasons. First, the current athletic training competency requirements4 indicate that athletic trainers should possess competencies in areas outside of traditional physical treatment modalities. For example, through the Prevention and Health Promotion Competencies, athletic trainers should be trained to “develop and implement strategies and programs to prevent the incidence and/or severity of injuries and illnesses and optimize their clients’/patients’ overall health and quality of life”, which would also include the knowledge on importance of nutrition and overall physical activity (p. 12).4 Similarly, the competencies for Psychosocial Strategies and Referral state that athletic trainers should have the ability to make referrals as needed.4 As such, the existing athletic training educational competencies are partially inclusive of competencies typically associated with those of other professionals and therefore should be within the scope of their practice.

The results from the survey also indicated that typically multidisciplinary teams are set up informally as opposed to following a formal, set protocol. The most commonly used methods of communication were e-mail, telephone calls, informal face-to-face meetings, and text messaging, rather than set team meetings on a regular basis, thus suggesting that currently the teams are indeed functioning in a multidisciplinary way. It might therefore be advisable to develop formal, set protocols for multidisciplinary teams to use in the rehabilitation process, including but not limited to: referral forms and protocols, case notes, and patient records. By doing so, better communication between the different members of the team can be facilitated and, as a result, a more “holistic” care plan can be devised for the injured athletes in question.

The study was not without its limitations. The sample of athletic trainers obtained from the NATA was representative of athletic trainers working in a range of settings, and we did not ask the athletic trainers to report their work setting. This may have affected some of the findings (eg, availability of other professionals or financial and organizational constraints) and therefore future research should also try to examine the role of work setting on athletic trainers’ views and experiences of a multidisciplinary team. Although the sample size obtained was relatively large, the number of participants who indicated having experience working as part of a multidisciplinary team was low. Such a low response rate was somewhat disappointing, particularly because athletic training education competency promotes this concept. Future research could possibly involve the use of a qualitative approach to investigate potential barriers for adopting such an approach.

It would also be beneficial to gain insight into the views of other professionals and individuals on the importance of the multidisciplinary team approach to sports injury rehabilitation. Replicating the survey with different professionals, particularly those who were seen to be of primary importance by athletic trainers (ie, athletes themselves, physicians, surgeons, strength and conditioning coaches, sport and exercise psychology consultants, (sport) nutritionist, athletic coaches, and parents) in a range of ways would be beneficial to understanding how multidisciplinary teams are viewed and how they function in reality. Moreover, conducting an action research intervention study in which the multidisciplinary team would be implemented in practice (potentially framed around the conceptual model1), and documenting its practicalities, strengths, and weaknesses and evaluating a range of biopsychosocial29 rehabilitation outcomes could provide further understanding on how multidisciplinary teams can best work in clinical settings to benefit the athlete with injuries.

Overall, the results from this survey helped to identify which professionals and individuals belong to the primary and secondary teams as described in the framework proposed by Clement and Arvinen-Barrow,1 and that different individuals and professionals are required during sports injury rehabilitation, in varying capacity. Athletic trainers viewed sports injury rehabilitation as a multifaceted phenomenon, and most athletic trainers felt that having access to a multidisciplinary team during rehabilitation was important. Indeed, two-thirds of the respondents indicated working as part of a multidisciplinary team more than half of the time and, in general, this was viewed as positive and rewarding, but also a challenging process. It was also evident that the working practices (ie, how the teams are set up, communication, and referral strategies) of multidisciplinary teams could be improved further. The importance of communication, knowledge of one’s own and other professionals’ role, and referral was also highlighted by the athletic trainers.

Implications for Clinical Practice

The findings provided insights into athletic trainers’ views and experiences of using a multidisciplinary team approach to sports injury rehabilitation. Based on the results, and being mindful of the current athletic training competency requirements, including interprofessional education as part of athletic training education programs’ curriculum is also recommended to ensure greater levels of working alliances between athletic trainers and other relevant professionals and, as such, further facilitate the natural development of well-functioning multidisciplinary teams. When working as part of a multidisciplinary team, communication, knowledge of one’s own and other professionals’ role, and the process of making referrals is important.

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Appendix A

APPENDIX A

A Survey of Athletic Trainers’ Views and Experiences of Multidisciplinary Teams in Sport Injury Rehabilitation

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Appendix A

10.3928/19425864-20150422-05

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