UNDERSTANDING HOW CLINICIANS AND ATHLETES MAKE RETURN TO PLAY DECISIONS – TOWARDS PREVENTING RE INJURIES

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Abstract

Background

Clinicians and athletes do not always agree when return to play (RTP) is advisable. A better understanding of how RTP decisions are made could help prevent re injury.

Objective

To describe and compare risk assessments from sport medicine physicians, physiotherapists and athletes during routine care of injured athletes, and to elicit if there were factors that influenced their risk tolerance.

Design

Feasibility study to establish this method of examining the way athletes and clinicians make RTP decisions.

Setting

Specialized orthopedic and sports medicine hospital in Doha, Qatar.

Patients

We recruited the physician, the physiotherapist, and the athlete they were caring for (“triplet”) to participate. Triplets were recruited from an acute groin injury study and an acute hamstring injury study. Of the 15 athletes approached, 5 were excluded because we obtained risk estimates from only 1 stakeholder. Of the remaining 10 cases, we obtained risk estimates from 7 triplets and 3 doublets.

Outcome measures

Participants provided their own estimated probability distribution for risk of re-injury within the subsequent 2 months after RTP, based on the available knowledge. In addition, we asked participants about factors that influenced their risk tolerance for the particular case.

Results

The figure shows the risk estimations in 2 of the 10 cases, illustrating that there were clear and considerable differences in risk estimates.

Results

Factors that modified risk tolerance in at least three participants were “timing and season”, “pressure from athlete” and “external pressure”. Overall, risk modifiers influenced the decision in 13 of 27 possible cases.

Conclusion

Clinicians and athletes with access to the same information can have considerably different estimates for the risk of reinjury. Risk tolerance in the real world is sometimes modified by external factors.

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