Team Clinician Variability in Return-to-Play Decisions.
Shultz, Rebecca PhD *,+; Bido, Jennifer BA *; Shrier, Ian MD, PhD ++; Meeuwisse, Willem H. MD, PhD [S]; Garza, Daniel MD +; Matheson, Gordon O. MD, PhD *,+
Clinical Journal of Sport Medicine.
23(6):456-461, November 2013.
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Objective: To describe the variability in the return-to-play (RTP) decisions of experienced team clinicians and to assess their clinical opinion as to the relevance of 19 factors described in a RTP decision-making model.
Design: Survey questionnaire.
Setting: Advanced Team Physician Course.
Participants: Sixty-seven of 101 sports medicine clinicians completed the questionnaire.
Main Outcome Measures: Results were analyzed using descriptive statistics. For categorical variables, we report percentage and frequency. For continuous variables, we report mean (SD) if data were approximately normally distributed and frequencies for clinically relevant categories for skewed data.
Results: The average number of years of clinical sports medicine experience was 13.6 (9.8). Of the 62 clinicians who responded fully, 35% (n = 22) would "clear" (vs "not clear") an athlete to participate in sport even if the risk of an acute reinjury or long-term sequelae is increased. When respondents were given 6 different RTP options rather than binary choices, there were increased discrepancies across some injury risk scenarios. For example, 8.1% to 16.1% of respondents who chose to clear an athlete when presented with binary choices, later chose to "not clear" an athlete when given 6 graded RTP options. The respondents often considered factors of potential importance to athletes as nonimportant to the RTP decision process if risk of reinjury was unaffected (range, n = 4 [10%] to n = 19 [45%]).
Conclusions: There is a high degree of variability in how different clinicians weight the different factors related to RTP decision making. More precise definitions decrease but do not eliminate this variability.
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