Using a Bayesian network to classify time to return to sport based on football injury epidemiological data

The return-to-sport (RTS) process is multifaceted and complex, as multiple variables may interact and influence the time to RTS. These variables include intrinsic factors related the player, such as anthropometrics and playing position, or extrinsic factors, such as competitive pressure. Providing an individualised estimation of time to return to play is often challenging, and clinical decision support tools are not common in sports medicine. This study uses epidemiological data to demonstrate a Bayesian Network (BN). We applied a BN that integrated clinical, non-clinical factors, and expert knowledge to classify time day to RTS and injury severity (minimal, mild, moderate and severe) for individual players. Retrospective injury data of 3374 player seasons and 6143 time-loss injuries from seven seasons of the professional German football league (Bundesliga, 2014/2015 through 2020/2021) were collected from public databases and media resources. A total of twelve variables from three categories (player's characteristics and anthropometrics, match information and injury information) were included. The response variables were 1) days to RTS (1-3, 4-7, 8-14, 15-28, 29-60, > 60, and 2) injury severity (minimal, mild, moderate, and severe). The sensitivity of the model for days to RTS was 0.24-0.97, while for severity categories it was 0.73-1.00. The user's accuracy of the model for days to RTS was 0.52-0.83, while for severity categories, it was 0.67-1.00. The BN can help to integrate different data types to model the probability of an outcome, such as days to return to sport. In our study, the BN may support coaches and players in 1) predicting days to RTS given an injury, 2) team planning via assessment of scenarios based on players' characteristics and injury risk, and 3) understanding the relationships between injury risk factors and RTS. This study demonstrates the how a Bayesian network may aid clinical decision making for RTS.