Practices of Athletic Trainers Using Weight Charts to Determine Hydration Status and Fluid-Intervention Strategies

Context: Determining an athlete's hydration status allows hydration-related concerns to be identified before significant medical or performance concerns arise. Weight charts are an accurate measure of hydration status changes, yet their clinical use by athletic trainers (ATs) is unknown. Objective: To investigate ATs' use of weight charts in athletic settings and describe their subsequent clinical decisions. Design: Cross-sectional survey. Setting: High schools and National Collegiate Athletic Association Divisions I, II, III and National Association Intercollegiate Athletics colleges. Patients or Other Participants: A total of 354 ATs (men = 162, women = 175; 17 respondents did not answer the demographic questions) responded across athletic settings (Division I [45.7%]; Division II, Division III, National Association Intercollegiate Athletics combined [n = 19.9%]; and high school [34.4%]). Main Outcome Measure(s): The 26-question online survey was developed by content experts and pilot tested before data collection. Participants answered questions focused on weight-chart use (implementation, timing, and calculations) and clinical decision processes (policies, interventions, and referral). Frequency statistics were calculated. Results: The majority of ATs (57.2%) did not use weight charts. Of those who did, most (76.0%) used charts with football, soccer (28%), and wrestling (6%) athletes. They calculated changes as either an absolute (42.2%) or percentage (36.7%) change from prepractice to postpractice; only 11.7% used a baseline weight for calculations. Of those who used the percentage change in body mass, 66.0% selected a threshold of -3% to -4% for an intervention. Most ATs (97.0%) intervened with verbal education, whereas only one-third (37.0%) provided specific fluid amounts based on body mass changes. Conclusions: Typically, ATs in athletic settings did not use weight charts. They considered a body mass change of -3% the indication for intervention but did not specify rehydration amounts for hypohydrated athletes. Educational workshops or technology applications could be developed to encourage ATs to use weight charts and calculate appropriate individual fluid interventions for their athletes.