Exploring the Preparation, Perceptions, and Clinical Profile of Athletic Trainers Who Use Instrument-Assisted Soft Tissue Mobilization
2018; Volume: 10; Issue: 4 Linguagem: Inglês
10.3928/19425864-20180201-02
ISSN1942-5872
AutoresRussell T. Baker, Amanda R. Start, Lindsay W. Larkins, Damon Burton, James May,
Tópico(s)Orthopedic Surgery and Rehabilitation
ResumoOriginal Research freeExploring the Preparation, Perceptions, and Clinical Profile of Athletic Trainers Who Use Instrument-Assisted Soft Tissue Mobilization Russell T. Baker, PhD, DAT, AT, , , PhD, DAT, AT Amanda Start, PhD, , , PhD Lindsay Larkins, DAT, AT, CSCS, , , DAT, AT, CSCS Damon Burton, PhD, , and , PhD James May, DAT, AT, CMP, , DAT, AT, CMP Russell T. Baker, PhD, DAT, AT , Amanda Start, PhD , Lindsay Larkins, DAT, AT, CSCS , Damon Burton, PhD , and James May, DAT, AT, CMP Athletic Training & Sports Health Care, 2018;10(4):169–180Published Online:February 01, 2018https://doi.org/10.3928/19425864-20180201-02Cited by:4PDFAbstract ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInRedditEmail SectionsMoreAbstractPurpose:To explore the preparation methods, perceptions, and clinical profile of athletic trainers who use instrument-assisted soft tissue mobilization and to compare group differences regarding the use of one's hands versus instruments to apply soft tissue mobilization.Methods:Athletic trainers completed an electronic survey. Descriptive statistics were calculated for participant demographics, clinical profile items, and items assessing instrument-assisted soft tissue mobilization application. Exploratory factor analysis was conducted to determine underlying factors.Results:Athletic trainers completed formal (59.7%) and informal (95%) instrument-assisted soft tissue mobilization training. Those who completed professional courses rated instruments as more effective than those who did not.Conclusions:Instruments were perceived to be as or more effective than one's hands when applying soft tissue mobilization to treat chronic musculoskeletal pathologies. Further research is needed to determine whether type of preparation affects the application strategies or clinical efficacy of instrument-assisted soft tissue mobilization.[Athletic Training & Sports Health Care. 2018;10(4):169–180.]IntroductionA soft tissue mobilization technique that has gained popularity during the past few decades is instrument-assisted soft tissue mobilization. Although the technique is based on the soft tissue mobilization rationale of James Cyriax,1–4 it deviates from traditional cross-friction massaging in a few distinct ways. First, the treatment is applied through an instrument designed to treat the targeted area versus the clinician applying the force through his or her hands.1,2 Second, the treatment is typically applied along the length of the fibers2 as opposed to across the fibers, but may be applied in a variety of directions depending on the instrument-assisted soft tissue mobilization technique being applied.3,5–7 Finally, the treatment sessions are often much shorter on the target tissue and typically involve applying the instruments to structures other than the isolated location of the pain.3,7–9The theory supporting the use of instrument-assisted soft tissue mobilization is that specifically designed instruments augment a clinician's ability to perform soft tissue mobilization.1,2,5,10 The intended benefit of using an instrument during soft tissue mobilization is to improve the clinician's ability to detect changes in soft tissue texture.3,8,11 The texture change is thought to be more palpable because the instrument is designed to amplify the irregularity of the tissue to the clinician and patient through increased vibration within the instrument.2,6,12 Additionally, it has been theorized that the mechanical advantage gained by applying the soft tissue mobilization technique with instruments allows for deeper penetration and possibly increases specificity of the treatment3,4 while also reducing the imposed stress on the clinician's hands during soft tissue mobilization treatment.8,12,13Clinically, it has been proposed that the application of soft tissue mobilization with instruments enhances the manipulation of soft tissue14 and mobilization of soft tissue fibrosis.2 The theoretical mechanism of these benefits is the introduction of a specific and controlled amount of microtrauma to the targeted area to initiate a local inflammatory response. The inflammatory response would then stimulate connective tissue remodeling and induce the repair and regeneration of collagen secondary to fibroblast recruitment.2,3,14,15 As a result, the patient would experience improved function and decreased symptoms through the breakdown of scar tissue, adhesions, and fascial restrictions.8,9,12,16Despite the popularity of instrument-assisted soft tissue mobilization and its proposed benefits, researchers have not examined the preparation methods, application patterns, and perceptions of athletic trainers who use the technique. There are numerous purported benefits for clinicians, from improved patient outcomes to reduced physical stress on the clinician's hands,7,11,12,16 but little is known regarding the benefits perceived by clinicians who use the technique. Therefore, the purpose of the current study was two-fold: (1) to explore preparation methods, investigate perceptions, and develop a clinical profile of athletic trainers who use instrument-assisted soft tissue mobilization, and (2) to compare perceptions of those who did or did not complete professional instrument-assisted soft tissue mobilization training regarding the effectiveness of using their hands versus instruments to apply soft tissue mobilization in clinical practice.MethodsParticipantsThe project was reviewed by the institutional review board and was certified "Exempt." Each participant reviewed and provided informed consent prior to completing the survey. Respondents were recruited for either in-person responses at the National Athletic Trainers' Association (NATA) Annual Meeting or through an online e-mail distribution list provided by the NATA. A total of 31 athletic trainers were recruited for the in-person survey and each of the participants completed the online survey using an iPad (Apple, Inc., Cupertino, CA). An e-mail soliciting participation was sent to a random sample of 2,091 NATA members from all membership categories (eg, student, certified, or certified-student) using Qualtrics (Provo, UT) online survey software. A total of 315 individuals started the survey (15% response rate), and 280 respondents (74% completion rate) completed the survey.Because the purpose of the study was to assess perceptions of athletic trainers who use instrument-assisted soft tissue mobilization in practice, the responses of 56 participants were excluded from data analysis because the participants indicated that they had not completed instrument-assisted soft tissue mobilization training and did not use the technique in their clinical practice. An additional 16 participants were then removed for not indicating whether they were currently certified athletic trainers. Missing data was treated conservatively and any respondent who failed to provide an answer to a question, excluding demographic items, was also removed (n = 29). A total of 179 responses from both recruitment methods were included for data analysis. Participants included athletic trainers (95 females [53.1%], 84 males [46.9%]; age: 33.42 ± 9.32 years; experience: 10.25 ± 8.78 years) from varied educational (Table 1) and employment (Table 2) backgrounds.Table 1 Participant-Reported Highest Degree EarnedDegreeFrequency (%)Bachelor's In athletic training21 (11.7) Not in athletic training3 (1.7)Professional (ie, entry-level) master's In athletic training34 (19) Not in athletic training15 (8.4)Post-professional master's In athletic training41 (22.9) Not in athletic training47 (26.3)Professional (ie, entry-level) doctoral (eg, DC, DPT)3 (1.7)Post-professional doctoral (eg, PhD, EdD, DAT, DSc)15 (8.4)Table 2 Participant-Reported Employment SettingEmployment SettingFrequency (%)Academic/research/faculty14 (7.8)College and university athletic training clinic90 (50.3)Hospital1 (0.6)Massage therapy clinic1 (0.6)Military2 (1.1)Occupational health2 (1.1)Performing arts1 (0.6)Physician practice3 (1.7)Physical therapy/outpatient clinic7 (4.9)Professional sports team2 (1.1)Secondary school athletic training clinic46 (25.7)Split academic/clinic2 (1.1)Split secondary school/outpatient clinic1 (0.6)Sales and marketing1 (0.6)Fitness and performance training1 (0.6)International1 (0.6)Student2 (1.1)InstrumentsData regarding athletic trainers' demographics and perceptions of instrument-assisted soft tissue mobilization were collected via an electronic survey containing 67 items. The survey was an original instrument based on a review of the literature regarding instrument-assisted soft tissue mobilization.3,7,8,10,11,16 The survey was evaluated for content validity by five athletic trainers who had more than 5 years of clinical experience, had previously taken an instrument-assisted soft tissue mobilization course, and had survey research experience. Additionally, two researchers with an expertise in survey design reviewed the instrument. Based on reviewer evaluations, the survey was altered to improve content and sentence structure was altered to improve clarity. In addition to the agreement on the general question structure and format (eg, demographic items and clinical profile items) for the survey, the group proposed two major constructs: perceptions of instrument-assisted effectiveness and perceptions of traditional soft tissue mobilization effectiveness. Each member of the expert panel approved the final survey.The first section of the survey included items designed to assess any previous instrument-assisted soft tissue mobilization training for each participant. The next section of the survey included items used to assess general perceptions of using traditional and instrument-assisted soft tissue mobilization during soft tissue mobilization as it related to the proposed constructs (ie, perceptions of instrument-assisted and traditional soft tissue mobilization effectiveness). An application section was used to assess participant preferences for soft tissue mobilization application when treating specific pathologies. The survey concluded with a demographic section (eg, sex, age, profession, highest level of education completed, years of experience, professional training, and primary work setting).Data AnalysisData were downloaded from Qualtrics for data analyses using SPSS software (version 24.0; SPSS, Inc., Chicago, IL). Descriptive statistics (mean ± standard deviation) and frequency counts were calculated for participant demographics and clinical profile items (eg, instrument-assisted soft tissue mobilization training and type of instrument used). The survey also contained items designed to measure two proposed constructs related to athletic trainers' perceptions of the effectiveness of their hands and instruments for soft tissue mobilization (instrument-assisted and traditional soft tissue mobilization effectiveness).To assess construct validity, exploratory factor analysis was conducted on the 18 items designed to assess the constructs. A maximum likelihood factor analysis with oblimin rotation was conducted to assess the underlying dimensional structure of the 18 items designed to measure participant perception of the effectiveness of using one's hands versus instruments. Factorability of the data was determined by substantial bivariate correlations between items more than .30, Kaiser–Meyer–Olkin measure of .813 (recommended > .70), and Bartlett test of sphericity P value of less than .001 (recommended < .05).17 Factor dimensions were extracted based on the eigenvalue greater than 1.0 criterion.17 If constructs were validated during the exploratory factor analysis process, univariate analysis of variance tests were conducted to determine between-group differences. Alpha was set a priori at a P value of .05 or less.ResultsAll of the included respondents indicated that they were certified athletic trainers. A small portion of the respondents also indicated having earned another health care profession credential or competed additional training/certifications (Table 3). Respondents reported spending an average of 52.43% ± 25.23% (range: 0% to 100%) of their day in clinical practice.Table 3 Participant Credentials and CertificationsCredential/CertificationFrequencyCertified athletic trainer179Emergency medical technician1Orthopedic technologist3Chiropractor1Physical therapist4Physical therapy assistant1Massage therapist4Teaching certification1Corrective exercise specialist3Certified kinesio taping practitioner1Certified strength and conditioning specialist10Positional release therapy certified2Performance exercise specialist4Functional movement screen certified1Regarding instrument-assisted soft tissue mobilization training, 107 (59.8%) respondents reported completing an official course from a professional provider/company (Table 4), whereas 72 (40.2%) reported not having completed training in this fashion. Of the 107 respondents who completed an official, professional course, 93 (87%) completed an in-person course, 6 (5.6%) completed a live web-based course, and 8 (7.5%) completed a previously recorded course (eg, DVD). Among the 107 respondents, it was not uncommon to take multiple official courses; 38 (36%) respondents reported completing two or more professional courses. The most commonly completed instrument-assisted soft tissue mobilization courses were those provided by the Graston Technique (Indianapolis, IN) and Técnica Gavilán, Inc. (Tracey, CA) (Table 4).Table 4 Participant-Reported Professional/Official IASTM Mobilization Training Course CompletedIASTM Mobilization CourseFrequencyASTYM2Functional and Kinetic Treatment with Rehab (FAKTR)3Graston Technique61HawkGrips Technique8Técnica Gavilán30Select Medical/NovaCare3Sound Assisted Soft Tissue Mobilization8Rehab Education6IASTM technique1Fascial Abrasion Technique1Advanced Continuing Education Institute1IASTM = instrument-assisted soft tissue mobilizationOf the 179 respondents, 43 (24%) reported having instrument-assisted soft tissue mobilization training as part of their professional or post-professional degree coursework, 92 (51.4%) reported receiving informal training (eg, in-service training) and 4 (2.2%) selected "other" (2 respondents reported being "self-taught," 1 indicated being "mentored" by a preceptor, and 1 reported learning from reading about the technique in a book). Of the 92 respondents who completed informal training, 70 (77%) reported completing two or more informal training sessions. Finally, 7 (4%) respondents indicated that they had not received any training in instrument-assisted soft tissue mobilization, but were still applying it in their practice.Respondents also reported a diverse profile in manual therapy use in clinical practice, but they shared similar clinical practice philosophies for soft tissue mobilization application (Table 5). In addition to instrument-assisted soft tissue mobilization, other massage-based therapies were reportedly used regularly, with the next most commonly reported massage-based therapies being cross-friction massage (n = 161), myofascial release (n = 153), and active release therapy (n = 122). Other common manual therapies reportedly used regularly by respondents were proprioceptive neuromuscular facilitation exercises (n = 165), joint mobilizations (n = 162), muscle energy techniques (n = 145), positional release therapy (n = 99), and strain–counter strain (n = 94) (Table 6).Table 5 Participant-Reported Clinical Practice PhilosophyResponseFrequency (%)Which of the following best describes your clinical practice philosophy as it relates to soft tissue mobilization? I am primarily a soft tissue mobilization professional who uses my hands28 (15.6) I am primarily a soft tissue mobilization professional who uses the instruments4 (2.2) I am a professional who uses both my hands and instruments depending on the patient and contextual factors146 (81.6) I am a professional who does not use soft tissue mobilization in my clinical practice1 (0.6)Table 6 Manual Therapy Paradigms/Techniques Used in Clinical PracticeManual Therapy Paradigm/TechniqueFrequency (%)Active release therapy122 (68.2)Acupuncture3 (0.02)Craniosacral therapy9 (0.05)Cross-friction massage161 (90.0)Cupping/myofascial decompression66 (37.0)Dry-needling16 (0.09)Dynamic neuromuscular stabilization41 (23.0)Instrument-assisted soft tissue mobilization179 (100.0)Joint mobilizations (grades 1 to 4)162 (91.0)Joint manipulation/high-velocity, low-amplitude thrust30 (17.0)Mechanical diagnosis and therapy22 (12.3)Mulligan concept76 (42.5)Muscle energy techniques145 (81.0)Myofascial release153 (85.5)Myokinesthetics26 (15.0)Neuromobilizations61 (34.1)PNF strengthening/recruitment exercises165 (92.2)Positional release therapy99 (55.3)Postural restoration44 (25.0)Primal reflex release technique34 (19.0)Strain-counterstrain94 (53.0)Total motion release45 (25.1)PNF = proprioceptive neuromuscular facilitationRespondents reported using a variety of instruments when applying instrument-assisted soft tissue mobilization in clinical practice (Table 7). Commercially produced instruments were commonly used, although respondents also reported using non-commercially made instruments (eg, generic aluminum instruments or baby spoon). The most commonly used commercially produced stainless steel instruments were Graston (n = 60), Edge Tool (n = 30; EDGE Rehab and Sport Science, Buffalo, NY), Técnica Gavilán (n = 28), HawkGrips (n = 24; HawkGrips, Conshohocken, PA), and Adhesion Breakers (n = 22; Adhesion Breakers, Inc., Corona, CA) instruments. When considering the type of material of the instrument, stainless steel (commercial or generic) was the most commonly reported instrument material. Respondents also reported using generic instruments made from aluminum (n = 23), plastic (n = 34), and polycarbonate (n = 11) sources.Table 7 Participant-Reported Instrument Type Used to Perform Instrument-Assisted Soft Tissue MobilizationInstrument UsedFrequencyAdhesion Breakers instruments22Animal product (eg, horn or bone)9ASTYM instruments11Edge tool30Ellipse tool3FAKTR instruments3FAT-Tool2Generic Aluminum23 Glass3 Plastic34 Polycarbonate11 Rubber coated metal1 Stainless steel48 Spoon1 Wood1Graston Technique instruments60Gua Sha instruments24HawkGrips instruments24IAM tools4MyoBar1Myofascial release3RockTape RockBlades1Scimitar tool1Sound Assisted Soft Tissue Mobilization instruments7STAR tool2Stone (eg, jade)9Técnica Gavilán instruments28ZUKA tool1The Adhesion Breakers instruments are manufactured by Adhesions Breakers, Inc., Corona, CA; ASTYM instruments by Performance Dynamics, Inc., Muncie, IN; Edge tool by EDGE Rehab and Sport Science, Buffalo, NY; Ellipse tool by Myofascial Releaser, Chandler, AZ; FAKTR instruments by FAKTR, Inc., Houston, TX; FAT-Tool by The FIT Institute, Chicago, IL, Graston Technique instruments by Graston Technique, Indianapolis, IN; HawkGrips instruments by HawkGrips, Conshohocken, PA; IAM tools by IAM Tools, Warwickshire, UK; MyoBar by Myo-Bar LLC, Viola, WI; RockTape Rock Blades by RockTape USA, Campbell, CA; Sound Assisted Soft Tissue Mobilization instruments by Carpal Therapy, Inc., Indianapolis, IN; STAR tool by Mobility Stars, Chattanooga, TN; Técnica Gavilán instruments by Técnica Gavilán, Inc., Tracey, CA; and ZUKA tool by ZUKA Tools, Houston, TX.Respondents were also asked to compare their perceptions of using their hands versus instruments in patient care and when treating specific pathologies. In general, instrument use was reported to improve one's ability to detect restriction or tissue abnormalities, improve treatment efficiency, and produce improved outcomes when applying soft tissue mobilization compared to using their hands. However, the use of instruments was also reported to result in increased discomfort and bruising for the patient during treatment (Table 8). The use of instruments as a component of soft tissue mobilization treatments was also commonly reported across a variety of pathologies (Table 9). Respondents reported using instruments equally or more often than their hands when applying soft tissue mobilization to patients who presented with chronic pain or injuries perceived to be caused by overuse (eg, tendinopathy). When treating acute conditions or those associated with edema, respondents reported relying on their hands more often than instruments.Table 8 Respondent Comparison of Soft Tissue Mobilization Application Using Hands Versus InstrumentsaCompared to My Hands, the Use of Soft Tissue Mobilization Instruments:Strongly DisagreeDisagreeSlightly DisagreeNeither Agree or DisagreeSlightly AgreeAgreeStrongly AgreeImproves my ability to identify soft tissue restriction2 (1.1)11 (6.1)21 (11.7)34 (19)43 (24)52 (29.1)15 (8.4)Reduces the amount of treatment time necessary to address localized soft tissue restriction2 (1.1)1 (.6)10 (5.6)15 (8.4)36 (20.1)91 (50.8)24 (13.4)Increases the amount of fatigue I experience during soft tissue mobilization treatments24 (13.4)62 (34.6)29 (16.2)20 (11.2)11 (6.1)27 (15.1)6 (3.4)Reduces the amount of stress placed on my hands during soft tissue mobilization treatments3 (1.7)2 (1.1)8 (5.5)7 (3.9)29 (16.2)88 (49.2)42 (23.5)Increases the number of areas I treat during soft tissue mobilization treatments1 (0.6)10 (5.6)5 (2.8)36 (20.1)41 (22.9)63 (35.2)23 (12.8)Reduces the amount of time I spend treating a specific lesion/area0 (0)3 (1.7)7 (3.9)22 (12.3)39 (21.8)86 (48.0)22 (12.3)Increases the size of the area I treat during soft tissue mobilization treatments1 (1.6)11 (6.1)18 (10.1)43 (24)39 (21.8)48 (26.8)19 (10.6)Reduces the precision of my soft tissue mobilization treatments7 (3.9)49 (27.4)47 (26.3)44 (24.6)19 (10.6)11 (6.1)1 (0.6)Increases the amount of force I apply during soft tissue mobilization treatments7 (3.9)28 (15.6)22 (12.3)33 (18.4)46 (25.7)33 (18.4)9 (5.4)Decreases my ability to sense changes (eg, texture, contour, or abnormalities) in musculoskeletal soft tissue10 (5.6)47 (26.3)49 (27.4)27 (15.1)24 (13.4)18 (10.1)4 (2.2)Results in increased discomfort for my patient during soft tissue mobilization treatments10 (5.6)17 (9.5)26 (14.5)50 (27.9)60 (33.5)15 (8.4)1 (0.6)Causes me to incorrectly identify normal anatomical structures (eg, veins) as a soft tissue adhesion or restriction11 (6.1)56 (31.3)36 (20.1)42 (23.5)25 (14)7 (3.9)1 (0.6)Increases the number of abnormalities I detect during soft tissue mobilization treatments3 (1.7)9 (5.0)17 (9.5)35 (19.6)72 (40.2)34 (19)8 (4.5)Results in increased tissue bruising for my patient during soft tissue mobilization treatments10 (5.6)15 (8.4)13 (7.3)31 (17.3)71 (39.7)31 (17.3)8 (4.5)More effectively promotes tissue remodeling3 (1.7)1 (0.6)2 (1.1)43 (24)59 (33)59 (33)12 (6.7)More effectively promotes tissue healing1 (0.6)3 (1.7)3 (1.7)48 (26.8)60 (33.5)52 (29.1)11 (6.1)Results in better patient outcomes2 (1.1)1 (0.6)4 (2.2)43 (24)44 (24.6)64 (35.8)21 (11.7)aValues are presented as frequency (percent).Table 9 Respondent-Reported Soft Tissue Mobilization Application for Specific PathologiesaPreferred Method for Applying Soft Tissue Mobilization Techniques When TreatingI Only Use My HandsI Predominantly Use My HandsI Use My Hands and the Instruments EquallyI Predominantly Use the InstrumentsI Only Use the InstrumentsScar tissue at a post-surgical incision site13 (7.3)51 (28.5)68 (38)42 (23.5)5 (2.8)Fascial restriction6 (3.4)18 (10.1)72 (40.2)75 (41.9)7 (3.9)Capsular restriction20 (11.2)61 (34.1)56 (31.3)26 (20.1)2 (1.1)Tendinopathy6 (3.4)28 (15.6)57 (31.8)81 (45.3)5 (2.8)Sub-acute ligament sprain29 (16.2)68 (38)62 (34.6)16 (8.9)1 (0.6)Chronic ligament sprain13 (7.3)45 (25.1)59 (33)57 (31.8)3 (1.7)Sub-acute muscle strain11 (6.1)56 (31.3)80 (44.7)30 (16.8)1 (0.6)Chronic muscle strain5 (2.8)18 (10.1)74 (41.3)75 (41.9)6 (3.4)Peripheral neurological entrapment38 (21.2)53 (29.6)66 (36.9)15 (8.4)2 (1.1)Acute musculoskeletal pain40 (22.3)65 (36.3)59 (33)10 (5.6)3 (1.7)Sub-acute musculoskeletal pain21 (6.7)40 (22.3)85 (47.5)38 (21.2)3 (1.7)Chronic musculoskeletal pain5 (2.8)17 (9.5)64 (35.8)81 (45.3)10 (5.6)Sub-acute compartment syndrome40 (22.3)54 (30.2)62 (34.6)18 (10.1)0 (0.0)Chronic compartment syndrome32 (17.9)45 (25.1)62 (34.6)33 (18.4)2 (1.1)Sub-acute edema36 (20.1)86 (48)47 (26.3)9 (5.0)0 (0.0)Chronic edema25 (14)67 (37.4)61 (34.1)19 (10.7)6 (3.4)Non-acute bursitis25 (14)63 (35.2)67 (37.4)21 (11.7)2 (1.1)aValues are presented as frequency (percent).Initial factor analyses resulted in the removal of 10 items that exhibited substantial cross-loadings. The final 8-item solution consisted of a 4-item factor (ie, "Attitudes Toward the Use of Your Hands for Soft Tissue Mobilization"; traditional) that represented indicators of effectiveness when using hands during soft tissue mobilization (eg, "My hands are effective tools for assessing soft tissue restriction") and a 4-item factor (ie, "Attitudes Toward the Use of Your Instruments for Soft Tissue Mobilization"; instrument-assisted) representing indicators of effectiveness when using instruments (eg, "Soft tissue mobilization instruments are effective tools for localizing my soft tissue treatment to the restricted area"). The total variance accounted for in the items by the two factors was 65.1%, with the instrument-assisted factor accounting for 35.3% of the variance and the traditional factor accounting for 29.8% of the variance (Table 10).Table 10 Exploratory Factor Analysis Pattern Matrix LoadingsItemMaximum Likelihood Extraction LoadingsAttitudes Toward the Use of Your Instruments for STMAttitudes Toward the Use of Your Hands for STMSTM instruments are effective tools for detecting changes (ie, texture, contour, or abnormalities) in musculoskeletal soft tissue.889Palpating/scanning with soft tissue mobilization instruments is an effective method for identifying soft tissue adhesions/scar tissue.868STM instruments are effective tools for assessing soft tissue restriction.855STM instruments are effective tools for localizing my soft tissue treatment to the restricted area.568My hands are effective tools for assessing soft tissue restriction.891Palpating/scanning with my hands is an effective method for identifying soft tissue adhesions/scar tissue.848My hands are effective tools for detecting changes (ie, texture, contour, or abnormalities) in musculoskeletal soft tissue.835My hands are effective tools for localizing my soft tissue treatment to the restricted area.615Eigenvalue2.822.39Percent of variance35.2929.82Cronbach's alpha.868.866STM = soft tissue mobilizationWhen evaluating the traditional construct, the mean scores indicated general agreement that hands were effective tools for applying soft tissue mobilization. Those who had not completed an official instrument-assisted soft tissue mobilization course from a professional provider/company rated their hands (mean = 6.00) as more effective tools than those who had completed a course (mean = 5.71); the mean difference in scores (meandiff = −0.298) was statistically significant (F[1,177] = 4.78; P = .03; η2 = .026). When evaluating the instrument-assisted construct, the mean scores indicated general agreement that instruments were effective tools for applying soft tissue mobilization. Those who had not completed an instrument-assisted soft tissue mobilization course rated the instruments (mean = 5.45) as less effective tools than those who had completed a course (mean = 5.82); the mean difference in scores (meandiff = 0.368) was statistically significant (F[1,177] = 5.17, P = .024, η2 = .028) (Table 11).Table 11 Group Mean Scores on STM FactorsFactorGroup Mean ScoresParticipants Who Completed an Official IASTM CourseParticipants Who Did Not Complete an Official IASTM CourseAttitudes toward the use of your hands for STM6.005.71Attitudes toward the use of your instruments for STM5.455.82Mean difference0.2980.368P.03.024Effect size.026.028STM = soft tissue mobilization; IASTM = instrument-assisted soft tissue mobilizationDiscussionTraining and Clinical Profile of Athletic Trainers Using Instrument-Assisted Soft Tissue Mobilization TrainingOne of the objectives of the current study was to explore the instrument-assisted soft tissue mobilization preparation methods of athletic trainers who use the technique. Most (n = 107, 59.8%) athletic trainers who responded to our survey reported completing at least one professional (ie, "official") training course offered by an instrument-assisted soft tissue mobilization company/organization. A large portion (n = 72, 40.2%) also completed informal training, which is congruent with previous findings suggesting that athletic trainers often seek out informal continuing education focused on enhancing clinical skills.18 However, more than one-third (n = 38) of these respondents reported completing two or more professional courses. A possible explanation for completing multiple courses may be that some athletic trainers perceive the need to complete multiple training sessions to improve their application of the technique or that variations exist between instrument companies and formal training to learn the intricacies from each company may be beneficial.Most (n = 93, 86.9%) respondents who completed an official course did so in a live, face-to-face course as opposed to video-based training. This may indicate that athletic trainers prefer to complete this training in-person or it may suggest that respondents training predates readily available video-based training. Another potential explanation is that athletic trainers may not perceive video-based training to be an effective method for learning clinical skills. As video-based training (eg, online or DVD) grows in popularity,19,20 is established as an effective method for clinical skill training,21,22 and becomes more readily available, athletic trainers may choose to seek out this type of instrument
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