Return-to-play decisions: are they the team physician's responsibility?

Area of Science:

• Sports Medicine
• Clinical Decision Making
• Evidence-Based Practice

Background:

• Return-to-play (RTP) decisions are critical for team physicians but lack literature support.
• A 3-step model for RTP medical decision-making was previously proposed.
• This study systematically reviewed the literature to assess evidence for this model.

Purpose of the Study:

• To determine the level of scientific evidence supporting a 3-step model for return-to-play medical decision-making.
• To identify research gaps in the literature regarding RTP decisions.
• To highlight the importance of team physician roles in RTP.

Main Methods:

• Systematic literature review of PubMed, Web of Science, and CINAHL.
• Included articles discussing components of the 3-step RTP decision model.
• Excluded articles on specific injuries (concussion, head/neck), illnesses, or preparticipation evaluations.

Main Results:

• 148 articles were included; only 13 focused on RTP decision-making.
• Most articles (141) addressed Step 1 (Medical Factors), fewer addressed Step 2 (Sport Risk Modifiers) (26) and Step 3 (Decision Modifiers) (20).
• The majority of articles mentioned RTP anecdotally, with limited original research on the decision-making process.

Conclusions:

• The literature provides limited direct evidence for a comprehensive 3-step RTP decision-making model.
• Further research is essential, particularly focusing on Step 3 (Decision Modifiers) and the team physician's role.
• Return-to-play decisions require more dedicated research and thought leadership.