title: A higher sport-related reinjury risk does not mean inadequate rehabilitation: the methodological challenge of choosing the correct comparison group.
abstract: Previous injury is a well-established predictor of subsequent injury in sports medicine. Some have interpreted this to mean that either our current methods of rehabilitation are inadequate or there is some permanent damage to the tissue and 100% rehabilitation is not possible. In 2011, we illustrated that these analyses and interpretations failed to account for the fact that some athletes are more prone to get injured, either physiologically, or because of their role/type of play. We suggested that the appropriate analysis would simply require using statistical methods that measured how each individual athlete's risk changed from preinjury to postinjury.In this paper, we revisit our recommendation and illustrate that it too would be flawed if the risk of injury changed over time independent of an injury ever occurring. This might be expected if general fitness were to decline over the season, or if the style of play changed between early season games and postseason championship games. Acknowledging that risk may change regardless of whether an injury occurred or not leads to three different general definitions of 100% rehabilitation: (1) a return to the baseline state, (2) a return to the immediate preinjury state and (3) a return to the state that would have been present had the initial injury never occurred. We guide the reader on how to estimate the risks for each definition and the assumptions that must be acknowledged.
authors.affiliation: Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Québec, Canada ian.shrier@mcgill.ca.
authors.forename: Ian
authors.initials: I
authors.lastname: Shrier
authors.affiliation: Department of Mathematics and Statistics, McGill University, Montreal, Quebec, Canada.
authors.forename: Meng
authors.initials: M
authors.lastname: Zhao
authors.affiliation: Department of Mathematics and Statistics, McGill University, Montreal, Quebec, Canada.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Piché
authors.affiliation: Department of Mathematics and Statistics, McGill University, Montreal, Quebec, Canada.
authors.forename: Pavel
authors.initials: P
authors.lastname: Slavchev
authors.affiliation: Department of Mathematics and Statistics, McGill University, Montreal, Quebec, Canada.
authors.forename: Russell J
authors.initials: RJ
authors.lastname: Steele
mesh_terms: D056352:Athletes; D001265:Athletic Injuries / Q000175:diagnosis* / Q000534:rehabilitation*; D000066491:Clinical Decision-Making; D006801:Humans; D012008:Recurrence; D000068958:Return to Sport; D012307:Risk Factors; D013177:Sports; D013178:Sports Medicine
keywords: analysis; epidemiololgy; recurrent injury; rehabilitation