July 2021

Like Athletes on the Field, Pandemic Required Pivots with Limited Input

By Jay Hertel, PhD, ATC, and Kathy Dieringer, EdD, LAT, ATC

The past few decades have seen a prioritization of evidence-based practice in athletic training, sports medicine, and all of healthcare. The premise of evidence-based practice is that clinical decisions should be based on a combination of the best available research evidence: prior clinical experience patient values and preferences.

The COVID-19 pandemic presented a huge challenge to the athletic training and sports medicine communities in terms of designing and implementing safety protocols to restart sports and return athletes to participation following the initial lockdown.

There was no best research evidence on how to do this and very few sports medicine clinicians had prior clinical experience on which to draw when making decisions involving a global pandemic. The values and preferences of athletes ranged from those eager to get back to sport as quickly as possible to others who were extremely cautious about returning too soon due to ongoing and unknown risks of the virus. The gravity of the pandemic was compounded by disparities in the severity of illness and heightened risk of death among individuals from disadvantaged populations.

Decisions had to be made based on expert opinion from infectious disease specialists. Those opinions changed often based on insights gleaned from rapidly emerging study data, the results of which were often not peer reviewed. These circumstances presented the antithesis of evidence-based practice. Decisions about the restarting of sport, safety, screening and testing protocols, contact tracing and quarantine procedures for athletes and staff who contracted COVID-19, and processes for returning infected athletes to sport after they had contracted the virus all had to be made in this challenging environment. The ability of athletic trainers to objectively evaluate expert opinions was essential in making informed decisions. The ability to confidently pivot and enact policy changes as new evidence emerged was critical.

I wonder how the experience of navigating the pandemic will change the framework of evidence-based practice going forward. Performing clinical trials and the subsequent peer review and publication process has tended to be slow and deliberate.

Going forward, regardless of the clinical problem or application, will clinicians’ and patients’ desires or expectations for the newest evidence, even if it is not what we would traditionally consider a high level of evidence, challenge the tenets of clinical research and evidence-based practice?

Is disruption coming to the medical research community that will change our customary ways of doing things?

Will the production and consumption of medical research change in the coming years at a scale that mimics what Uber and Lyft have done to taxi cabs or what Airbnb has done to the hotel industry?

Perhaps, because if the pandemic taught me anything, it’s that nothing is impervious to change, and we are all adaptable to change.
Jay Hertel, PhD, ATC

Embracing Change, Practicing Vigilance

COVID-19 immediately and profoundly affected practices and protocols throughout all of healthcare and athletic trainers (ATs) were no exception. Public health is paramount to the very essence of who we are and what we do as ATs. Like many healthcare providers, ATs were stressed by the demands of COVID-19 prevention, detection, and management and the challenge of accessing up-to-date information that was changing daily.

The ability to pivot when new information became available was critical to the health and safety of our patients. Because the skillset of ATs is centered in prevention, the increased use of technology in patient intervention that became common in 2020 must remain an integral part our practice in the future. Moving forward, we also must be increasingly cognizant of our mental health status as well as that of our colleagues and  patients in this post-COVID-19 world, while remaining ever vigilant in infectious disease prevention. ATs and other healthcare professionals excelled during 2020 and did so by embracing change, practicing vigilance, and quickly implementing optimal, and at times new solutions, techniques, and opportunities – lessons that must not be forgotten once the pandemic is over.
Kathy Dieringer, EdD, LAT, ATC 

Jay Hertel, PhD, AT, is chair of the Department of Kinesiology and the Joe H. Gieck Professor of Sports Medicine at the University of Virginia. He is also Editor-in-Chief of the Journal of Athletic Training.

Kathy Dieringer, EdD, LAT, ATC, is president of D&D Sports Med, an outpatient physical, occupational therapy and athletic training group in the Denton, Texas area. She is the current President of the National Athletic Trainers’ Association.

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