Defining Return to Sport: A Systematic Review

Joshua Doege, Jack M Ayres, Matthew J Mackay, Armin Tarakemeh, Symone M Brown, Bryan G Vopat, Mary K Mulcahey, Joshua Doege, Jack M Ayres, Matthew J Mackay, Armin Tarakemeh, Symone M Brown, Bryan G Vopat, Mary K Mulcahey

Abstract

Background: Return to sport (RTS) commonly serves as a measure for assessment of clinical outcomes in orthopaedic sports medicine surgery. Unfortunately, while RTS is commonly utilized in research for this purpose, currently there is no widely accepted or standardized definition for when an athlete has officially returned to his or her sport.

Purpose: To conduct a systematic review to evaluate and report the differences in specific definitions of RTS utilized in the orthopaedic surgery literature.

Study design: Systematic review; Level of evidence, 4.

Methods: A systematic review was performed using PubMed, EMBASE, and Cochrane Trials databases per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Search terms consisted of variations of "RTS" combined with variations of "orthopedic surgery" and "define" to capture as many relevant articles as possible. The definition of RTS was recorded and analyzed.

Results: A total of 718 articles were identified in the initial search, 29 of which met eligibility criteria, providing a clear definition of RTS. Of the 29 studies included, 20 (69.0%) defined RTS as an athlete competing in a game or other competitive play. Three (10.3%) defined this as the athlete competing in a game or other competitive play but with an explicitly stated competition-level modifier of the athlete returning to his or her preinjury level of competition. Two articles (6.9%) included returning to training or practice, and the remaining 4 articles (13.8%) used terminology other than the standard RTS.

Conclusion: There is variability in the definition of RTS used in orthopaedic sports medicine literature. Most studies refer to the athlete competing in a game or other competitive play. Other variants include returning to practice/training and explicitly defined competition levels and objectives. Future studies should aim to standardize the definition of RTS to facilitate more precise assessment of outcome after sports medicine surgery. Using terminology that describes components of the recovery and rehabilitation process, such as "return to participation" and "return to performance," in addition to RTS will allow us to more clearly understand the athlete's recovery and associated level of competition or performance.

Keywords: athletic training; medical aspect of sports; physical therapy/rehabilitation; return to play; return to sport.

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: B.G.V. has received consulting fees from DePuy, research support from Stryker, education payments from Titan Surgical Group, and hospitality payments from Smith & Nephew. M.K.M. has received speaking fees from Arthrex; education payments from Arthrex, Alon Medical Technology, and Quest Medical; and hospitality payments from Zimmer Biomet. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

© The Author(s) 2021.

Figures

Figure 1.
Figure 1.
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram.
Figure 2.
Figure 2.
Return-to-sport continuum. Image adapted from Ardern et al with permission from BMJ Publishing Group Limited.

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Source: PubMed

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