Citation

Matheson GO, Shultz R, Bido J, Mitten MJ, Meeuwisse WH, Shrier I. Clin. J. Sport. Med. 2011; 21(1): 25-30.

Affiliation

Division of Sports Medicine, Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California; Research Alliance in Sport and Exercise Medicine; Human Performance Laboratory, Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California; Marquette University Law School, Milwaukee, Wisconsin; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; and Centre for Clinical Epidemiology and Community Studies, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.

Copyright

(Copyright © 2011, Canadian Academy of Sport Medicine, Publisher Lippincott Williams and Wilkins)

DOI

10.1097/JSM.0b013e3182095f92

PMID

21200167

Abstract

OBJECTIVE:: Return-to-play (RTP) decisions are a central component of the Team Physician's clinical work, yet there is little more than anecdotal reference to these in the literature. We recently published a 3-step model for return-to-play medical decision making and, in the current paper, undertook a systematic review of the literature to determine the level of evidence in support of this model. DATA SOURCES:: PubMed, Web of Science, and CINAHL electronic databases. Any article specifically related to concussion, head injuries, neck injuries, illness, medical conditions (including cardiovascular and renal), and preparticipation in sport or that reported RTP as a clinical outcome was excluded. Any article that contained a discussion on one of the components of the 3-step decision-based RTP model was included. RESULTS:: We reviewed 148 articles that met the criteria for inclusion and found 98 review articles, 39 original articles, 6 case reports, and 5 editorials. Of these, 141 articles mentioned Step 1 of the medical decision-making process for RTP (Medical Factors), 26 mentioned Step 2 (Sport Risk Modifiers), and 20 mentioned Step 3 (Decision Modifiers). Of the 148 articles in total, only 13 focused on RTP as the main subject and the remaining 135 mentioned RTP anecdotally. Of these 13 articles, 5 were reviews, 4 were editorials, and 4 were original research. CONCLUSIONS:: Although 148 articles we retrieved mention RTP in relation to a specific injury, medical condition, or specific topic, only 13 articles focused specifically on the RTP decision-making process, and 6 of 13 were restricted to Step 1 of the 3-step model (Medical Factors). Return-to-play is a fertile field for research and thought leadership beginning with a focus on the Team Physician's appropriate role in RTP decision making, particularly considering the factors identified in Step 3 (Decision Modification).

Language: en