The purpose of this study was to validate a recently proposed return-to-play (RTP) decision model that simplifies the complex process into three underlying constructs: injury type and severity, sport injury risk, and factors unrelated to injury risk (decision modifiers). We used a cross-over design and provided clinical vignettes to clinicians involved in RTP decision making through an online survey. Each vignette included examples changing injury severity, sport risk (e.g. different positions), and non-injury risk factors (e.g. financial considerations). As the three-step model suggests, clinicians increased restrictions as injury severity increased, and also changed RTP decisions when factors related to sport risk and factors unrelated to sport risk were changed. The effect was different for different injury severities and clinical cases, suggesting context dependency. The model was also consistent with recommendations made by subgroups of clinicians: sport medicine physicians, non-sport medicine physicians, and allied health care workers.
BackgroundA recent return to play decision-making (RTP-DM) model for sport medicine has organized the underlying concepts into 3 steps but has not yet been validated.ObjectiveTo examine the validity of the 3-step RTP-DM model recently proposed.DesignRepeated measures cross-over survey design.SettingWorld-wide.ParticipantsAmerican College of Sports Medicine clinicians involved in RTP-DM.Risk factor assessmentWe provided clinical vignettes of injuries and illnesses in athletes to participants through an online survey. Each vignette included examples of 3 factor types: increasing injury severity, changing risk associated with sport (e.g. different positions), and changing non-injury risk factors (e.g. financial considerations).Main Outcome MeasurementsFor each vignette, participants indicated the level of activity restriction they would recommend (6 options from No Restrictions to No Activity) in accordance with the risk they placed on continued participation. We analyzed the data using multiple regression, adjusting for the correlated participant outcomes, to measure how changes in factors affected individual participants.ResultsThe estimated participation rate for those involved in RTP decisions was 24.7%. As expected, we found that clinicians increase restrictions as injury severity increases. We also found that changing factors related to sport risk, and changing factors that are unrelated to sport risk will affect RTP decisions, although the effect is context-dependent and does not occur equally across all injury severities and clinical cases. The effect was also observed in each subgroup examined that included sex, age, specialty, region of training, academic status, and years of experience making RTP decisions.ConclusionsOur findings that clinicians from a wide variety of backgrounds will change RTP recommendations based on clinical vignettes with changing injury severity, sport risk modifiers and decision modifiers provides evidentiary support for the 3-step model for RTP decision making recently proposed.
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