Return to sport has become a proxy for outcome for athletes after an injury, but does what you think mean what it means?
It is understandable why return to sport has become a widely used outcome measure for athletes after injury, as it is usually the motivating factor for surgery or rehab.
Unfortunately there is no standardization or generally accepted definition of when an athlete has returned to their sport which leads to inaccurate comparisons of interventions as well as challenges in dealing with athletes' expectations.
Entry into sports physiotherapy
There is also a tendency for return to sport to be given as a binary measure – returned to sport or not. This does not reflect the complex clinical course after injury and begs the question of whether a spectrum or continuum should be a better way to achieve a return to sport?
A new systematic review published in the Orthopedic Journal of Sports Medicine aimed to assess the differences in the specific definitions and meaning of "return to sport" in the orthopedic sports literature and to report. So let's look at what was found.
Methods – Is that a good systematic overview?
This systematic review (SR) corresponded to the PRISMA guidelines of 2020, but was not pre-registered on PROSPERO, which means that there may be some reporting bias in the review.
The databases searched were PubMed, EMBASE and Cochrane Trials, which should be sufficient to obtain broad coverage of most of the published literature, but this could be improved by including a sports database such as SportDISCUS.
It is not clear when the search took place and the full search strategy is not available, but there is a full description of the keywords used and their combinations, explosions and Boolean operators.
"Back to sport" ("Back to play", "RTS", "RTP", "Back to sporting activities", "Back to sporting activities", "Resuming sporting activity" and "Resuming" Sports activities ")," orthopedic interventions "(" orthopedic interventions "," orthopedic surgery "," orthopedic operations ", postoperative *, surgical *," surgical "," reconstruction ", arthroscopic * and" orthopedic ") and" defined "( "Defined", "definition", "defined" and "definition")
Only articles published in English were included in the review and only abstracts were searched, meaning that articles that included the return to sport (or its variants) would not have been included in the review, but this is one practical restriction, since this would be the case, was otherwise overwhelming.
Articles were included when examining athletes who had undergone orthopedic surgery for a sports injury, but it does not explicitly state which study design is included, but rather a long list of studies that were excluded.
Two authors conducted the search independently, with a third available to ensure consensus on no disagreement throughout the search process. Since the aim of the study was to describe the range of variation of the term “return to sport” and not to carry out any data analysis, no analysis of quality or bias was carried out.
Overall, this is an “ok” systematic review with limitations that are likely due to resource and time constraints, but there should be a lack of full reporting on a clear search strategy for each database.
What does return to sport mean?
A total of 29 studies were included in the descriptive overview, and a full breakdown of these articles is fully available. The articles included in the review dealt with a variety of sports including hockey, football, baseball, basketball, American football, and throwing sports across multiple levels of participation and ages.
The operations reported included arthroscopic labral repairs for FAI, ACL reconstruction, Achilles tendon reconstruction, hindfoot arthroscopy, shoulder impingement arthroscopy, Lisfranc repair, clavicle fixation and hand and finger tendon repair. This diversity in both sports and injury repair suggests that the broad approach of the search strategy was effective.
Brief summary of What does "return to sport" mean?
There are too many variations in the terminology of "return to sport" and the definition of what it means to the athlete
Currently, the term can mean anything from participating in training to completing a full season
The proposed definition and terminology is a continuum of return to participation -> return to sport -> return to performance in line with Ardern et al.
The variability in the terminology used to describe a return to practice or a return to play was surprising with the following terms used:
Back to the sport
Back to playing
Back to physical activity
Back to the competitive game
Return to sports activities
Favorable return to the sports result
There is even more variability in the meaning and definition of these terms, with return to exercise meaning anything from the following list:
Participation in at least 1 game of the sports sport in the first game after the operation
Played the first regular season after surgery
The first pre-season or regular game after the operation
The first regular or post-season game after the operation
Specification of the competition level
Back to training
Which term and which definition should be used instead?
D the authors of the systematic review advocate the use of the continuum of the return to sport, that of Ardern et al. and explicitly indicates the athlete's recovery status. This continuum reflects the variable course of the return of an athlete to sport more precisely.
In looking at this model, there are some implications to consider, such as the definition of performance is largely subjective and is often determined by the athlete as an objective measure.
Also, if this model is widely adopted as a standardized approach by researchers, this model will give a higher number of athletes returning to sport, but it will provide context as fewer returning to performance. Hence this offers more clarity and context and is a more reliable measure of the “return to sport”.
