Validating the three-step return-to-play decision model

The purpose of this study was to validate a recently proposed return-to-play (RTP) decision model that simplifies the complex process into three underlying constructs: injury type and severity, sport injury risk, and factors unrelated to injury risk (decision modifiers). We used a cross-over design and provided clinical vignettes to clinicians involved in RTP decision making through an online survey. Each vignette included examples changing injury severity, sport risk (e.g. different positions), and non-injury risk factors (e.g. financial considerations). As the three-step model suggests, clinicians increased restrictions as injury severity increased, and also changed RTP decisions when factors related to sport risk and factors unrelated to sport risk were changed. The effect was different for different injury severities and clinical cases, suggesting context dependency. The model was also consistent with recommendations made by subgroups of clinicians: sport medicine physicians, non-sport medicine physicians, and allied health care workers.