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Professors Collaborate on Epidemiology for Athletic Trainers Textbook

Dr. Swiger (middle) and Dr. Adams (right) instructing an athletic training...
Dr. Swiger (middle) and Dr. Adams (right) instructing an athletic training student

When you’ve created a class and you can’t find a textbook for your students, what can you do? Write your own, of course. Which is exactly what a couple of professors in Keene State’s Physical Education Department did.

About three years ago, doctors Wanda Swiger, associate professor of Physical Education, and Melanie Adams, assistant professor of PE, created an Epidemiology of Injury and Illness class, making the College’s Athletic Training Education (ATE) major the first in the nation to offer a stand-alone athletic injury epidemiology course. Not surprising, the pair soon found that there was no undergraduate textbook for their new class. After trying pull readings from different journals and other texts, they realized that they would have to write their own. And so they, (along with Keene State faculty members Jeffrey Timmer, associate professor of Physical Education, and Scot A. Ward, assistant clinical professor, and other athletic training professionals around the country) collaborated on the just-released Epidemiology for Athletic Trainers: Integrating Evidence-Based Practice.

Epidemiology for Athletic Trainers: Integrating Evidence-Based Practice

Basically, the book guides athletic training students to an understanding of how epidemiology (the study and analysis of the patterns, risk factors, causes, and outcomes of diseases in defined populations) shapes healthcare practices for physically active patients. Armed with that understanding, athletic trainers can make informed decisions about the effectiveness of different methods of training practices and therapy for injuries.

Doctors Adams and Swiger realized that the book needed to reach a much broader audience than just Keene State students. "I had to ensure that this text book would be used nationally for all ATEs across the country," Dr. Swiger said. "Therefore, as we discussed the topics of the text, I ensured that the educational competencies for the Commission on Accreditation of Athletic Training Education were a prime focus of our content. Athletic trainers have been at the forefront for collecting data for athletic injury rates, and as the profession becomes even more recognized as a health care provider, the book hopes to ensure that young professionals have the skills they need to continue to be active participants in the process."

Dr. Adams points out that many undergraduate students understand research as experiments. “When they want to find the best treatment for an injury, they want to do an experiment,” she explained. “They want to compare ice to heat, for example, or whether using a foam roller is better than stretching to relieve muscle soreness. They want to do side-by-side comparisons. This is a perfectly legitimate way to determine which of the two has an effect, but where are you going to get 20 people with the same injury at the same time for your study? It’s very difficult to do well-controlled experiments in our field.”

The Importance of Epidemiology

This is where the value of epidemiology comes in. Epidemiology studies are unique in that they’re not experiments—they’re correlational. They gather data on large groups of people—high school football players in the US, for example—and then they look for patterns and information that indicate practices that possibly lead to injury, or seem to prevent injury.

"While the text begins with the history of epidemiology in health and physical activity, the focus of the book is to move toward how athletic injury is similar to and different from the traditional study of illness," Dr. Swiger said. "The book is therefore divided into sections that introduce students to basic epidemiology concepts and trends in athletic injury and illness and finishes with applying these concepts to recognizing and preventing possible risk factors."

“Our book begins with physical activity guidelines, because that’s something that young athletic trainers can understand—they all know that physical activity is good for your health, and that you should do 150 minutes of moderate physical activity per week,” Dr. Adams said. “But they didn’t know the depth of the epidemiological research that it took to reach that guideline. Dr. Timmer’s chapter on physical activity and epidemiology basically pulls all the important studies together to show how much physical activity Americans need to get in order to see health benefits. The chapter demonstrates how evidence-based practice happens—it’s how epidemiology works in medicine. You piece together the health benefits—or the risk factors for certain diseases—indicated from very long studies of lots of people. When you see a benefit or a risk factor popping up over and over again, then you know that you’ve found something you can deal with.”

Begin pull-quote…Athletic trainers have been at the forefront for collecting data for athletic injury rates, and as the profession becomes even more recognized as a health care provider, the book hopes to ensure that young professionals have the skills they need to continue to be active participants in the process. …end pull-quote
– Dr. Wanda Swiger

Epidemiological research shows that certain characteristics about an athlete can make them more susceptible to injuries. Position, age, body size, and prior history are considered risk factors for concussion. Football quarterbacks, for example, are more likely to suffer a concussion than wide-receivers, but the linebacker has the greatest risk. And in any sport, once you’ve had a concussion, you’re more susceptible to another one. So what’s the best way for an athletic trainer to deal these at-risk athletes? “I want my students to understand that risk factors are not causes,” Dr. Adams explained. “Risk factors are characteristics that put people at greater risks for injury or disease, and some are changeable and some are not. You need a holistic view of the person and those characteristics that may predispose them towards one thing or another, but just because someone has a risk factor doesn’t mean that they’re definitely going to get the attendant disease or injury.”

The idea is not to scare someone with a risk factor away from physical activity, because physical activity is so important to maintain good health. It’s important that the trainer provide correct information to help the athlete train and play safely, and to work around the risk factors. “We’ve got to balance the benefits of being active and maybe getting injured with the known problems of being sedentary,” Dr. Adams said. “For example, if we have a soccer goalie who’s had 3–4 concussions, we can try to move that player to a different position where concussion isn’t as likely.”

“Students often want clear answers: ‘If A happens, tell me what B is, and that’s what I’ll do,’” Dr. Adams concluded. "But that’s not how the medical professions operates. It requires a lot of clinical understanding and intuition, and knowing what’s in the literature that supports your decisions. Students need to know that there are multiple factors in any disease or injury, whether it’s developing cardiovascular disease or tearing your Achilles tendon.”