Citation

Creighton DW, Shrier I, Shultz R, Meeuwisse WH, Matheson GO. Clin. J. Sport. Med. 2010; 20(5): 379-385.

Affiliation

From the *Division of Sports Medicine, Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, California; daggerCentre for Clinical Epidemiology and Community Studies, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; and double daggerSport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.

Copyright

(Copyright © 2010, Canadian Academy of Sport Medicine, Publisher Lippincott Williams and Wilkins)

DOI

10.1097/JSM.0b013e3181f3c0fe

PMID

20818198

Abstract

OBJECTIVE:: Return-to-play (RTP) decisions are fundamental to the practice of sports medicine but vary greatly for the same medical condition and circumstance. Although there are published articles that identify individual components that go into these decisions, there exists neither quantitative criteria nor a model for the sequence or weighting of these components within the medical decision-making process. Our objective was to develop a decision-based model for clinical use by sports medicine practitioners. DATA SOURCES:: English literature related to RTP decision making. MAIN RESULTS:: We developed a 3-step decision-based RTP model for an injury or illness that is specific to the individual practitioner making the RTP decision: health status, participation risk, and decision modification. In Step 1, the Health Status of the athlete is assessed through the evaluation of Medical Factors related to how much healing has occurred. In Step 2, the clinician evaluates the Participation Risk associated with participation, which is informed by not only the current health status but also by the Sport Risk Modifiers (eg, ability to protect the injury with padding, athlete position). Different individuals are expected to have different thresholds for "acceptable level of risk," and these thresholds will change based on context. In Step 3, Decision Modifiers are considered and the decision to RTP or not is made. CONCLUSIONS:: Our model helps clarify the processes that clinicians use consciously and subconsciously when making RTP decisions. Providing such a structure should decrease controversy, assist physicians, and identify important gaps in practice areas where research evidence is lacking.

Language: en