Improving Comfort and Confidence in Certified Athletic Trainers Through a Structured Weight Management Program for Overweight and Obese Adolescents and Young Adults with Spina Bifida (SB) Using a Mobile Health App and Coaching

Background: Athletic trainers (AT) have reported they do not feel competent working with athletes with special needs1. Spina bifida (SB) is a congenital malformation characterized by incomplete closure of the neural tube of the spine resulting in lower extremity paralysis and leading to functional limitations2. Obesity is a significant cause of morbidity in patients with SB3. A novel weight management pilot with use of mobile health (mHealth) and virtual coaching by certified athletic trainers was developed. The primary aim was to evaluate the comfort and confidence of certified athletic trainers (ATs) in the development of a structured 3-month exercise program for overweight and obese adolescents and young adults with SB.

Methods: Participants 11-21 years identified as overweight and obese defined by BMI >85th percentile were recruited from the CHLA SB Clinic. Participants were provided individualized exercise plans based on their International Myelodysplasia Study Group (IMSG) 4 spina bifida functional level paired with coaching by a dedicated athletic trainer for 3 months. Three certified ATs participated in the structured weight management program. They assisted with delivery of prescribed exercises for non-ambulatory and ambulatory participants. An 18-question survey was administered to the certified ATs before and at the conclusion of the program to report their pre and post program comfort and competence in working with patients with disabilities. The survey included questions about demographics, prior experience working with patients with disabilities and program feedback; a Likert scale: -3 (not at all) to 3 (very) was used.

Results: There were a total of 3 certified ATs who participated in the survey with 2-10 years of certification. All ATs reported no prior exposure to persons with disabilities during their training. From pre to post assessment, the average change in rating was 2.6 for comfort and 2 for competence in working with patients with disabilities.

Conclusion: In this pilot study, the use of a mobile app and virtual coaching with a certified athletic trainer for a weight management program can change comfort and confidence in working with overweight/obese adolescents and young adults with spina bifida. This model could be a useful adjunct to classes or clinical training to promote inclusivity in athletic training exposure. Future directions could be partnership with AT training programs for expansion of this program to other children with disabilities such as cerebral palsy.