How Well Do Athletic Trainers Recognize and Evaluate the Female Athlete Triad? A Survey of Athletic Trainers in the Practicing United States

Abstract

Background: The Female Athlete Triad is the connection between energy deficiency with or without an eating disorder, menstrual disturbances, and bone loss that is found in female athletes. Affected women can have significant short- and long-term health consequences, such as decreased athletic performance, infertility, and osteoporosis. These sequelae can be minimized with early intervention, which requires both an understanding of the Female Athlete Triad and screening practices. Athletic trainers (ATs) are an important part of the athlete's care team with frequent interactions with patients. This cross-sectional study investigates the understanding and screening of the Female Athlete Triad in ATs. Materials and Methods: A cross-sectional survey was developed to assess certified athletic trainers' demographics, knowledge, and screening practices regarding the female athlete triad. Survey content was based on the 2007 ACSM position stand, the 2014 Female Athlete Triad Coalition consensus statement, and prior studies evaluating awareness among coaches. Knowledge was assessed using a 7-point Likert scale, and screening practices were assessed using a 5-point Likert scale. The survey was distributed via email to certified members of the National Athletic Trainers' Association (NATA). Participation was voluntary. IRB exemption was granted by both NATA and Daemen University. Results: One hundred and sixteen ATs with varying gender, practice setting, and years of experience completed this study's survey assessing knowledge of the Female Athlete Triad and subsequent screening practices. ATs showed limited knowledge of the Female Athlete Triad and were rarely screened for it. Female trainers, those who worked with majority female athletes, and Division 1 trainers had better knowledge of the Female Athlete Triad compared with their respective counterparts. Years of experience did not significantly impact knowledge scores. Practice setting and years of experience did significantly impact screening scores. High school trainers and those with <10 years of experience also had the best screening scores. Conclusions: Female ATs, those who worked with female athletes, and trainers who took care of higher-level athletes demonstrated superior understanding of the Female Athlete Triad. Improved awareness, training, and more frequent, focused screening should be implemented for ATs to bridge remaining gaps.

Keywords: embryonic implantation dysfunction; endometrial receptivity; menstrual blood-derived mesenchymal stem cells; repeated implantation failure.