Return-to-play in sport: a decision-based model.
OBJECTIVE
Return-to-play (RTP) decisions are fundamental to the practice of sports medicine but vary greatly for the same medical condition and circumstance. Although there are published articles that identify individual components that go into these decisions, there exists neither quantitative criteria nor a model for the sequence or weighting of these components within the medical decision-making process. Our objective was to develop a decision-based model for clinical use by sports medicine practitioners.


METHODS
English literature related to RTP decision making.


RESULTS
We developed a 3-step decision-based RTP model for an injury or illness that is specific to the individual practitioner making the RTP decision: health status, participation risk, and decision modification. In Step 1, the Health Status of the athlete is assessed through the evaluation of Medical Factors related to how much healing has occurred. In Step 2, the clinician evaluates the Participation Risk associated with participation, which is informed by not only the current health status but also by the Sport Risk Modifiers (eg, ability to protect the injury with padding, athlete position). Different individuals are expected to have different thresholds for "acceptable level of risk," and these thresholds will change based on context. In Step 3, Decision Modifiers are considered and the decision to RTP or not is made.


CONCLUSIONS
Our model helps clarify the processes that clinicians use consciously and subconsciously when making RTP decisions. Providing such a structure should decrease controversy, assist physicians, and identify important gaps in practice areas where research evidence is lacking.
Creighton
David W
DW
Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, CA, USA.
Shrier
Ian
I
Shultz
Rebecca
R
Meeuwisse
Willem H
WH
Matheson
Gordon O
GO
D001265:Athletic Injuries / Q000534:rehabilitation*; D003657:Decision Making; D003661:Decision Support Techniques; D006304:Health Status; D006801:Humans; D011379:Prognosis; D018570:Risk Assessment; D013178:Sports Medicine / Q000379:methods*; D013997:Time Factors