Editor’s note: The Strategic Alliance’s Athletic Training Research Agenda Task Force is highlighting clinical members who have been recognized by one of their colleagues in athletic training as a Clinical Scholar Champion for their efforts in collecting point of care research. This blog series will celebrate clinical scholars in order to illustrate how research is being used in the clinical practice.
Tom Abdenour’s, DHSc, ATC, CES, career included time as a head athletic trainer at the professional and collegiate levels. While working within the National Basketball Association, Abdenour encountered an injured athlete whose health care providers gave differing rehabilitation opinions for the injury. The research Abdenour conducted about the injury led to the final nonsurgical decision. This illustrated to Abdenour just how important research is to being able to provide the best patient care
Though his interest in research piqued early in his career, he continued his involvement in research and gained positive feedback, which encouraged him to purse his doctorate degree. Abdenour has co-authored a book and co-developed a patented product in the name of research. He is a clinical scholar because of his curiosity, dedication and passion for patient care.
Tell us how you got started with integrating research with your clinical practice.
Early in my career, I tried to employ pearls of wisdom from our outstanding researchers and supportive physicians that I learned at the NATA Clinical Symposia & AT Expo or district meetings. Studying their research or the abstracts in the Journal of Athletic Training was also immensely valuable. It also stimulated me to study ideas further.
For example, one of my NBA players had a SLAP (superior labral tear from anterior to posterior) II lesion for which the initial opinion came back for surgery, but a second opinion differed. That led me to a PubMed search of basketball players with SLAP lesions. We did find one group studying this specific topic and forwarded them our athlete’s magnetic resonance imaging (MRI). They concurred that the player met their nonsurgical criteria. Our team physician reviewed the case with other physicians, and the player opted for the rehabilitation route and had no further sequelae. Fast forward several years later to an athlete at San Diego State University with an identical injury, and we opted for rehabilitation rather than surgery and had no adverse effect.
The tarsal bone bruise is a common injury among NBA players. The white-hot MRI findings exactly correspond with the location of pain the player indicates. When I researched “bone marrow edema” on PubMed, I found a paper from Europe advocating IV ibandronate to relieve the pain. I consulted our team physician, who specialized in osteoporosis, and we opted to try this approach. Three players with this injury displayed good results after using IV ibandronate based on a lower level of pain when they returned to play. Looking back, this would have been a fascinating case series.
What motivated you to become involved in research?
My interest in research dates back to my undergraduate days. My mentor, Bob White, then athletic trainer of Wayne State University, encouraged me to read our journal, The Physician and Sportsmedicine, American Journal of Sports Medicine and Medicine and Science in Sports and Exercise.
My undergrad degree was in biology, and my original graduate program was going to be in exercise physiology; thus, I became very familiar with Index Medicus. My first two papers were based on graduate school work: one regarding knee anatomy for high school coaches and the other a comparison of taped and nontaped ankles for strength and range of motion, which was published in JAT in 1979.
I continued this interest and curiosity of things I observed in practice at Hillsdale College, Weber State College, the Golden State Warriors of the NBA and San Diego State University. I was fortunate to have published or presented in various settings, which further stoked my interest in research projects. This feedback loop of research interest and involvement in research was instrumental in my decision to pursue my doctorate degree.
How can your findings be used to guide athletic training medical practice?
I have various research irons in the fire with colleagues across the country. One common thread among those projects is the utilization of patient-rated outcome (PRO) scales. I believe in the utility of PROs and encourage our colleagues to incorporate them into their routine work. My doctor of health sciences research project was the development of a low back PRO for the athletic patient with the catchy name: the Athletic Low Back Outcome (ALBO) scale. Although I was not fortunate to publish it with graduation, I have presented it and encouraged others to continue to research it. The ALBO scale has been very useful with my athletes, physicians and coaches.
One of the greatest compliments I received in my career came as a result of one of my early papers pertaining to lateral meniscus injuries among NBA players. A high-profile NBA physician told me this was the paper he referred to in his lectures regarding meniscus injuries. The research certainly helped in the subsequent diagnosis of one or two of our players and others throughout the NBA.
What is the No. 1 advice you would give to another clinician interested in getting involved in a research study?
Many thoughts are tied for No. 1. In clinical positions, we sit on a proverbial gold mine of patient injury/illness data and information that could be studied. My suggestion would be to put on our epidemiologist hat and look over that data for any trend or something that can be studied. For example, any preseason, single-leg balance testing conducted as concussion baseline could be correlated to lumbopelvic injuries, if that has not been done already. Great clinical research doesn’t require ultra-high tech and expensive equipment, but it does require some elbow grease and the capacity to think outside of the box.
Once your decision is made, partner with a faculty member to guide you through the institutional review board (IRB) process and review the scope of your general idea. Completing the IRB process is more art than science and, for the first-timer, it can be a monster. Take pride in realizing your idea could catch on with other clinicians and advance our profession’s knowledge base.
There is concern that such integration of research with clinical practice may be too time consuming. What have you found helps you manage your time?
I understand this concern, but, in all honesty, the time I have invested in these sorts of projects is an enjoyable hobby, which keeps it fun. I know time is a premium for many of us, but it is investing in the time you have. When I was in the NBA, I did a fair amount of reading on team flights. Coaches had their scouting reports, and I was reading JAT or AJSM. The bottom line may be prioritizing your time. No matter what we do, if it is important enough, the time will be there.
What are the other major barriers to collecting data at the point of care? What strategies did you employ to address these barriers?
There are various hurdles that we can anticipate and hurdles that blindside us. At the professional or intercollegiate level, enthusiasm can wane among participants who consented to be a part of the study but give excuses to avoid it. In cases like this, a review of the study’s scope is warranted to ensure its viability. I know I have a tendency to think too big, and slowing down a bit helps.
Over this past year, I had three projects with colleagues interrupted because of college campuses shut down as a result of the COVID-19 pandemic. Hopefully, we will be able to restart these projects when the athletic training students and potential participants return to campuses. In a different project, I partnered with a physician and group of colleagues to study the relationship of overnight heart rate variability and concussion recovery among intercollegiate athletes. For better or worse, no one sustained a concussion during the research period, which did not bode well for our research!
We will always have the challenges of participants who drop out of the study or do not complete the research period. Again, taking a step back to make sure the project is not too broad or too time consuming is good. Retrospective chart reviews have fewer challenges and can give fascinating results, particularly if you have good data to work with. Qualitative analysis is fun and can lead into many directions.