











































MANUSCRIPT TYPE


EDITORIAL  

 
1 

Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 6 – Issue 2 – September 2023 
 

Connecting Patient-Centered Care Research into Athletic Training 
Clinical Practice  
Lindsey E. Eberman, PhD, LAT, ATC*; Zachary K. Winkelmann, PhD, SCAT, ATC, CHSE‡ 
*Indiana State University, Terre Haute, IN; ‡University of South Carolina, Columbia, SC 

 
Correspondence 
Dr. Lindsey E. Eberman, 567 N 5th St, Terre Haute, IN 47809. 
Email: Lindsey.Eberman@indstate.edu   
Twitter: @isuathltrain  
 
Full Citation 
Eberman LE, Winkelmann ZK. Connecting patient-centered care research into athletic training clinical practice. Clin Pract 
Athl Train. 2023;6(2): 1-14. https://doi.org/10.31622/2023/0006.02.1.  
 

 
EDITORIAL 

The Prioritized Research Agenda for the Athletic Training Profession identified five research priorities for 
athletic training, using a multi-layered approach, including a cross-sectional survey to ensure athletic trainers 
endorsed the research priorities and initiatives that would be addressed through a comprehensive research 
agenda.1 Overwhelmingly, respondents indicated they agreed or strongly agreed (n=3590/3963, 90.6%) 
that examining the extent to which athletic trainers provide patient-centered care would benefit the 
profession.1 However, the concept of patient-centered care emerged decades ago in 1986 from Harvey 
and Jean Picker.2 Jean was experiencing long-term health issues and recognized that the care was innovative 
and evidence-based. Still, it lacked humanism and was not responsive to the sensitive needs of the patients 
themselves and their support system.2 The Pickers developed a non-profit organization for developing 
patient-centered care, spreading their eight principles2 to the United States in 1994:  

• Respect for patients’ values, preferences, and expressed needs 
• Coordination and integration of care 
• Information, communication, and education 
• Physical comfort 
• Emotional support and alleviation of fear and anxiety 
• Involvement of family and friends 
• Continuity and transition 
• Access to care 

 
Since then, the profession of athlete training has been slow to adopt the concept. The post-professional 
educational competencies embodied patient-centered care since 2013,3 but professional education did not 
specifically state “patient-centered care” until the CAATE 2020 Professional Standards,4 leaving decades 
of athletic trainers with a gap in their training.  

Thus, our research team has spent the last several years engaged in studies evaluating the extent to which 
athletic trainers offer patient-centered care. The data in Table 15-26 provides an overview of our 
collaborations, including those where we served as first or senior authors with many post-professional 
graduate students and colleagues across the nation. The data suggest that most student-athletes have high 
levels of health literacy and believe their athletic trainers are using patient-centered principles during care 
delivery. However, student-athletes and athletic trainers differ somewhat in how they define patient-
centered care and place value on that care. The concepts of “best” and “individualized” care emerge from 

mailto:Lindsey.Eberman@indstate.edu
https://doi.org/10.31622/2023/0006.02.1


Connecting Patient-Centered Care Research into Athletic Training Clinical Practice 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 6 – Issue 2 – September 2023 

student-athletes when asked to describe patient-centered care, while athletic trainers value patient 
preferences and respect. Specifically, athletic trainers express a desire to respect a patient’s identity during 
care, acknowledging that marginalized populations like those with minoritized gender identities, races, 
ethnicities, religions, sexual orientations, and abilities should be acknowledged and supported. Although 
there is a misconception that patient-centered care is only for these minoritized populations, patient-centered 
care is an individualized process that every person should have the opportunity to experience in healthcare. 

Athletic trainers believe they are patient-centered and value the concept in their daily practice; however, 
as we know through the data, there seem to be marked discrepancies in the application of patient-centered 
care in practice. Our studies on the disablement model identified that athletic trainers expressly desire to 
provide whole-person patient care. Yet, they neither have the knowledge nor the skills to explore holistic 
care during a patient interaction. In essence, athletic trainers are in the range between the precontemplative 
stage and the preparation stage of change within the transtheoretical model of change,27 whereby they 
have “bought in” to the concept but have not yet resolved their knowledge, practice, and confidence gaps 
and taken action. As the preparation of athletic trainers has evolved, concepts like the social determinants 
of health, health literacy, and disablement models have emerged, but many practicing athletic trainers 
trained over three years ago have knowledge, practice, and confidence gaps relative to patient-centered 
care.  

Patient-centered care was often considered treating others the same way you wish to be treated – the 
mantra of being a good person or the age-old “golden rule.”28 While fundamentally embracing respect, 
the concept often forgoes empathy for a patient’s lived experiences. The dynamics of a person’s 
biopsychosocial response to injury and illness must be considered beyond our own experiences, values, and 
biases, which may prohibit us from embracing the patient’s wants and desires.28 This begins with 
communication through history taking, patient-reported outcome measures, and interviewing, followed by 
respecting the response of someone being diagnosed with a new injury, their rehabilitation plan, and 
reintegration into activity or their termination of sport and physical activity. Thus, allowing the patient to 
lead the care guided by their healthcare team.  

The foundation of patient-centered care is rooted in shared decision-making. The concepts we have studied 
over the past five years have highlighted that both sides of the table (patient and provider) believe in 
patient-centered care principles, want to do it, and believe it is helpful. But an expressed desire is not 
enough. We must resolve our knowledge, practice, and confidence gaps by engaging in ongoing education 
and professional development to embrace a culture that allows people to explore their patient-centeredness 
through skill development, learning about new cultures, and creating connections with support systems. Too 
often, we seek to blame others when a patient’s case is not improving; introspective reflection is necessary 
to take responsibility for our contributions to the care. We challenge athletic trainers and other providers of 
athletic health care to embrace a ‘just culture’ that emphasizes shared accountability in our collaborative 
relationships with patients and their support systems.  

Moving forward, athletic trainers should focus on connecting goal setting and communication by building 
more focused care plans. Athletic trainers should focus on micro-skills to develop rapport and trust. High-
quality patient care focuses on collecting data and creating patient-centered versus clinician-centered goals 
(e.g., improving the ability to reach the top shelf vs. increasing the range of motion by 20 degrees). Shifting 
your practice to use patient-reported data can ultimately lead to these positive outcomes by collecting the 
data we need to know we are being patient-centered in our practice.  



Connecting Patient-Centered Care Research into Athletic Training Clinical Practice 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 6 – Issue 2 – September 2023 

We can move from precontemplation/contemplation/preparation into action! This begins with challenging 
our own thinking and questioning our assumptions. Creating patient-centered interactions requires us to 
unlearn our habits of gathering only data that serves us as clinicians but fails to acknowledge the patient 
experience. Instead, the integration of a clinician-centered examination and patient-centered interviewing, 
followed by patient education that explores all intervention options, including the possibility of doing nothing, 
and describing the likely consequences for each option. Then, the patient should be given the time and space 
to make informed decisions about their interventions. In essence, the focus should be on the “Platinum Rule,” 
or treating others how they wish to be treated.  

The current body of evidence regarding patient-centered care is detailed throughout Table 1 – integrate 
this evidence to create small changes while thinking big. We recommend exploring tools, scripts, and 
measures to guide this practice (Figure 1).1,5-26,29-31 Beyond this call to action for providers, we also call to 
action researchers in athletic health care to expand implementation science studies that evaluate effective 
strategies to resolve knowledge, practice, and confidence gaps in credentialed athletic trainers. A 
constructive collaboration between education, research, and clinical practice is essential to accomplish 
patient-centered care in athletic training.  

  



Connecting Patient-Centered Care Research into Athletic Training Clinical Practice 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 6 – Issue 2 – September 2023 

Figure 1. Tools and Techniques to Improve Patient-Centered Care8,10-14,25,26,29-31  

 

 

Feedback
Global Perceptions of Patient-

Centered Care
Background, Affect, Trouble, 
Handling, Empathy (BATHE) 

Interview (Patient satisfaction)
Improvement Guide

Goal Setting & Care Planning

Patient-Specific Functional 
Scale (PSFS) Shared decision-making Establishing therapeutic 

alliance

Data Gathering

Clinical ExaminationTransparency in describing 
findings and rational

Patient teach back about 
what they have learned

Initial Encounters
Focused History Script

(Social determinants of health)
Ideas, Concerns, Expectations (ICE) Interview

(Perceptions of current situation)

Pre-participation Interactions
Test of Functional Health Literacy Assessment (TOFHLA)

(Screen for health literacy)



Connecting Patient-Centered Care Research into Athletic Training Clinical Practice 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 6 – Issue 2 – September 2023 

Table 1. Contemporary Evidence for the Delivery of Patient-Centered Care in Athletic Training 

Study Purpose Key Findings 
Respect for patient's values, preferences, and expressed needs. 
Eberman, et al. (2021)7 To gain more in-depth 

information about athletic 
trainers' knowledge and 
experiences regarding the 
health care needs of 
transgender student-athletes. 

Participants described 
knowledge deficiencies in 
themselves, health care 
providers within their units, and 
providers able to provide safe 
transition care. The athletic 
trainers demonstrated 
misconceptions when defining 
transgender and transitioning 
and describing how the body 
responds to hormone 
replacement therapy. They 
expressed concern for the 
mental health and wellness, self-
image, and potential cost of 
transgender health care for 
transgender student-athletes. 
However, participants also 
described efforts to create 
safety within their units by 
validating transgender patients, 
instilling trust, adjusting the 
physical environment, and 
engaging in professional 
development to improve their 
knowledge. 

Eberman, et al. (2023)6 To explore primary care sports 
medicine physicians' comfort, 
competence, education, and 
scope of training in caring for 
transgender and gender 
nonconforming patients/athletes. 

Previous care relationships with 
transgender and gender 
nonconforming patients/athletes 
strongly influence the comfort 
and perceived competence of 
primary care sports medicine 
physicians. Training from 
unbiased peer-reviewed data 
sources is critical to improving 
care for transgender and 
gender-nonconforming 
patients/athletes. 

Schulman, et al. (2022)15 To assess how a curriculum, 
including a standardized patient 
encounter, influenced attitudes 
and skills in working with sexual 
health and gender minorities. 

The curriculum and standardized 
patient encounters influenced 
knowledge, attitudes, and 
comfort when working with 
gender minorities and screening 
for sexual health. 

Shaughnessy et al. (2021)16 To explore the education, 
comfort, and experience of 
professional athletic training 
students and program directors 

Few students reportedly practice 
patient-centered care during 
clinical education. Both groups 
perceived deficiencies in 
competence related to 



Connecting Patient-Centered Care Research into Athletic Training Clinical Practice 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 6 – Issue 2 – September 2023 

on patient-centered care and 
transgender patient care. 

transgender patient care. We 
suggest program directors 
integrate transgender health 
care into their curriculum and 
seek professional development 
to create meaningful educational 
experiences. 

Walen et al. (2020)18 To measure athletic trainers' (1) 
perceived definition of 
transgender, (2) comfort and 
competence working with 
transgender student-athletes, (3) 
sources of education, (4) 
perceived legal concerns, and 
(5) perception of competitive 
advantage. 

Although collegiate athletic 
trainers generally felt competent 
in treating transgender patients, 
they did not feel capable of 
addressing specific aspects of 
transgender patients' healthcare 
needs. Regardless of the 
resulting perceived unfair 
advantage, athletic trainers must 
know the regulations and 
therapeutic effects associated 
with hormone-related therapy 
for transgender student-athletes. 

Coordination and integration of care 
Torres, et al. (2023)26 To explore the lived experiences 

of college student-athletes and 
the development of the 
therapeutic alliance with athletic 
trainers. 

We identified three domains 
regarding collegiate student-
athletes’ perceptions of the 
athletic trainers' mindset, 
behaviors, and actions that 
aided in developing their 
therapeutic alliance: 
empowerment, transparency, 
and intentionality. Efforts by the 
AT that allowed the patient to 
feel empowered during their 
care included shared decision-
making, clinician flexibility, and 
education for comprehension. 
During the 

Mendoza, et al. (2023)10 To explore the degree to which 
secondary school athletic trainers 
perceive they are integrating the 
principles of patient-centered 
care and the biopsychosocial 
model in their practice. 

Secondary school athletic 
trainers perceive they effectively 
integrate the principles of 
patient-centered care and the 
biopsychosocial model of health 
into their practice. 

Redinger, et al. (2021)13 To identify collegiate student-
athletes’ definitions of patient-
centered care and measure their 
perceived level of patient-
centered care from an athletic 
trainer. 

The qualitative analysis revealed 
13 topics, the most used being 
individual, priority, and best. 
Other issues needed to be more 
consistent with how the medical 
community has defined patient-
centered care. On the Global 
Perceptions of Athletic Trainer 
patient-centered care tool, the 
participants strongly agreed 
with 12 of the 15 statements. 



Connecting Patient-Centered Care Research into Athletic Training Clinical Practice 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 6 – Issue 2 – September 2023 

Participants said that the athletic 
trainer was completely (mode = 
4) patient-centered for all 
dimensions during their most 
recent encounter with the Patient 
Perception of Patient-
Centeredness instrument. 
However, patient-centered care 
behaviors defined by the 
medical community may not be 
directly expressed according to 
collegiate student-athletes. 

Wilson, et al. (2022)19 To determine how athletic 
trainers place importance on 
patient-centered care principles 
and examine the context of their 
viewpoints. 

Overall, athletic trainers value 
patient's preferences and 
respect. However, a need for 
more importance was identified 
for incorporating the 
disablement model, a core 
competency adopted by the 
athletic training profession. 

Information, communication, and education 
Niles et al. (2022)12 To assess collegiate student-

athletes digital health literacy 
and musculoskeletal health 
literacy levels. 

Most student-athletes possess 
adequate digital health literacy 
and musculoskeletal health 
literacy. The findings directly 
impact patient education as 
student-athletes use their phones 
to access health-related 
information they feel 
comfortable with. Still, they may 
need to find out if the source is 
trustworthy. 

Roberts et al. (2022)14 To investigate the health literacy 
levels of collegiate student-
athletes 

All participants displayed 
adequate health literacy, 
regardless of race, using the 
Short Test of Functional Health 
Literacy Assessment. 

Physical comfort 
Haffey, et al. (2023)9 To investigate athletic trainers’ 

recognition and use of 
disablement frameworks in 
current clinical practice 

The first three domains were 
related to the application of 
disablement model frameworks: 
(1) patient-centered care, (2) 
limitations and impairments, and 
(3) environment and support. 
Participants described varying 
degrees of consciousness 
regarding these domains, 
including expressed desire, 
conscious competence, conscious 
incompetence, and unconscious 
incompetence. The fourth domain 
related to participants' exposure 
to disablement model 



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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 6 – Issue 2 – September 2023 

frameworks through formal or 
informal experiences. We 
characterized the data using the 
competence hierarchy, whereby 
conscious competence was 
demonstrated when participants 
accurately acknowledged or 
implemented a domain related 
to the disablement model 
framework used. Findings 
suggest that athletic trainers 
demonstrate unconscious 
incompetence in using 
disablement frameworks in 
clinical practice. 

Millet, et al. (2023)11 To examine athletic trainers’ 
familiarity, knowledge, 
application, and implementation 
of the international classification 
of functioning, disability, and 
health framework 

Familiarity, knowledge, 
application, and implementation 
deficits related to the 
international classification of 
functioning, disability, and health 
framework exist. Athletic trainers 
reported low implementation 
across all ICF categories.  

Emotional support and alleviation of fear and anxiety 
Chandler, et al. (2022)5 To examine collegiate athletic 

trainers' use of behavioral health 
screening tools 

Approximately 49% of 
participants used behavioral 
health screening tools in their 
practice; the most used tools 
were PHQ-9 (56.6%) and GAD-
7 (27.3%). Practice integration 
considerations and practice 
advancements occurred due to 
behavioral health screening. 

Young, et al. (2022)23 To explore National Collegiate 
Athletic Association Division 1 
student-athletes' experiences 
with mental health, access to and 
experience with mental health 
resources at their university. 

Two domains: “increased 
expectations” and “resources 
and management” were 
identified. The participants 
shared balancing life as a 
college student, academic 
stressors, performance 
expectations, and a sport-first 
mindset they perceived from 
coaches and support staff. The 
participants discussed their 
experience with an internal 
support network of coaches, the 
athletic department, and sports 
psychology. Participants 
remarked on their external 
support network, which included 
their family, friends, and 
psychology services. The 
resources available at their 



Connecting Patient-Centered Care Research into Athletic Training Clinical Practice 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 6 – Issue 2 – September 2023 

institutions and the accessibility 
were perceived positively and 
negatively. Collegiate student-
athletes described resources as 
helpful, whereas other 
participants described a lack of 
timeliness for appointments, lack 
of advertisement, 
incomprehension of counselors to 
athlete demands, and no sport-
specific counseling as barriers. 

Involvement of family and friends 
Stanton, et al. (2022)17 To investigate the experiences of 

secondary school athletic trainers 
who provided care to patients 
who were non-native English 
speakers or communicated with 
their non-native English speaker 
support systems. 

Four domains emerged from the 
data: (1) communication, (2) 
welcoming environment, (3) 
cultural agility, and (4) 
resourcefulness. Participants 
enhanced communication by 
relying on nonverbal 
communication, translated 
resources, and interpreters. The 
ATs discussed a difference in 
care delivery based on fluency. 
Respondents explained efforts to 
create a welcoming environment 
by speaking in the non-native 
English speaker's native 
language, increasing comfort, 
and serving as an advocate 
within the health care system. 
Acknowledging customs, 
demonstrating respect, and 
understanding potential fear, 
shame, or both associated with 
language barriers were 
discussed as ways to increase 
cultural agility. The ATs 
identified a need for more 
formal training, which increased 
their on-the-job training and 
health information technology 
use. Participants perceived 
spending increased amounts of 
initiation, effort, and time on 
adaptability while caring for 
and communicating with non-
native English speakers. 

Winkelmann, et al. (2023)24 To describe the perceptions and 
practices of family-centered 
care across secondary school 
athletic trainers 

The total mean score for the 
currently practiced scale was 
significantly lower than the 
perceived need. All family-
centered care subscales 
compared between current 



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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
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practice and perceived lack 
were very different, with each 
being of higher importance than 
current practice in athletic 
training. Data analysis revealed 
four themes related to enhancing 
family-centered care in 
secondary schools: limited 
education and resources, staffing 
and space concerns, non-
technical skills, and social 
determinants of health. 

Continuity and transition 
Giorgi, et al. (2023)8 To validate a focused history 

script designed to facilitate 
social determinants of health 
conversations between clinicians 
and adolescents through the 
Delphi method.  

After seven rounds of feedback 
from six individuals (1 clinician 
and five educators/researchers), 
the focused history script 
achieved content validity, with 
100% of panelists agreeing on 
the final 40-item script. A 
concentrated history script for 
the social determinants of health 
was validated to aid 
conversations between 
healthcare providers and 
adolescent patients on factors 
affecting their lives, school, and 
play. Addressing social 
determinants of health with 
adolescent patients will improve 
cultural proficiency and family-
centered care delivered by 
school healthcare professionals. 

Moll et al. (Accepted) To explore athletic training 
students' abilities to screen for 
factors via standardized patient 
encounters and to describe the 
screening experience for social 
determinants of health factors. 

A focused history script 
increased the screening of social 
determinants of health factors 
but decreased the students’ self-
confidence. When students were 
not required to use the 
concentrated history script to 
screen for the social 
determinants of health, most 
athletic training students failed 
to elicit information about the 
social determinants of health 
factors or performed poorly 
during the screening. We 
identified a confidence gap for 
social determinants of health 
screening abilities, with athletic 
training students having a high 
self-confidence in their ability to 



Connecting Patient-Centered Care Research into Athletic Training Clinical Practice 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 6 – Issue 2 – September 2023 

screen compared to their actual 
performance. 

Winkelmann, et al. (2022)21 To determine whether 
infographics as a continuing 
professional development 
method changed patient-
centered screening 
considerations and familiarities 
with the social determinants of 
health. 

A significant change-score 
improvement was identified for 
the intervention group relative to 
providing whole-person health 
care and recognizing the social 
determinants of health. No 
statistical differences were noted 
for screening and practices 
between the groups. However, 
familiarity with screening for 
four social determinants of 
health areas improved for the 
intervention group, including 
access to primary care, poverty, 
environmental conditions, and 
social cohesion. 

Access to care 
Winkelmann, et al. (2020)22 To investigate healthcare 

professionals' perceptions of and 
experiences with telemedicine. 

The interviews described the 
clinicians as telemedicine 
adopters (n = 14) or 
nonadopters (n = 8). The 
adopters reported higher levels 
of agreement on the Theory of 
Planned Behavior and 
Technology Acceptance Model 
tool than nonadopters for all 
constructs. When comparing 
adoption status, we identified a 
significant difference with 
nonadopters reporting a low 
level of agreement for the 
subjective norm construct. The 
interviews revealed five 
domains: integration challenges, 
integration opportunities, 
collaborative practice, 
anticipatory socialization to 
future use, and benefits of 
integration. The participants 
indicated that integration 
challenges centered on “buy-in,” 
whereas opportunities aligned 
with the patient's condition and 
technology ease of use. They 
reflected that the telemedicine 
encounters required more 
preparation, allowing for 
cooperative behaviors between 
clinicians. The benefits of 
telemedicine included 
convenience and scheduling 



Connecting Patient-Centered Care Research into Athletic Training Clinical Practice 

 

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All rights reserved. ISSN Online 2577-8188                                                                     Volume 6 – Issue 2 – September 2023 

preferences that encouraged 
future use. 

Winkelmann, et al. (2020)20 To investigate athletic training 
students' ability to transfer 
telemedicine skills confidently 
and accurately in a 
standardized patient encounter. 

Exposure to telemedicine via a 
standardized patient encounter 
improved confidence in 
performing the tech-based 
evaluation. Athletic training 
students demonstrated 
communication/interpersonal 
skills and patient education well, 
yet needed to improve their 
data gathering and telemedicine 
skills. Overall, participants 
accurately diagnosed a 
musculoskeletal condition using 
telemedicine. 

 

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All rights reserved. ISSN Online 2577-8188                                                                     Volume 6 – Issue 2 – September 2023 

11. Millet NJ, Snyder Valier AR, Eberman LE, Rivera MJ, Winkelmann ZK. The Knowledge and Use of 
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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 6 – Issue 2 – September 2023 

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