Biopsychosocial Model Domains in Clinical Practice Guidelines for Return to Sport After ACL Injury: Systematic Review...

Area of Science:

• Orthopedics
• Rehabilitation Medicine
• Sports Medicine

Background:

• The International Classification of Functioning, Disability, and Health (ICF) provides a framework for understanding human functioning, emphasizing a biopsychosocial approach.
• Return-to-sport (RTS) decision-making after anterior cruciate ligament (ACL) injury should ideally integrate all domains of human functioning.

Approach:

• A systematic review was conducted to analyze the inclusion of biopsychosocial model domains within clinical practice guidelines (CPGs) for RTS after ACL injury.
• The quality of these CPGs was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) checklist.

Key Points:

• Seven CPGs were included, with the biopsychosocial model domains unevenly represented: body functions (37.77%), activity and participation (20.00%), body structure (13.33%), environmental factors (11.11%), and personal factors (8.88%).
• CPGs demonstrated significant weaknesses in rigor of development (37.86%) and applicability (49.29%), with 71.42% rated as low or moderate quality.

Conclusions:

• Current CPGs for RTS after ACL injury inadequately address the biopsychosocial model and do not fully incorporate the ICF framework.
• The quality of existing guidelines is limited, suggesting a need for improved development and implementation to better support a holistic approach to athlete recovery.