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Team Clinician Variability in Return-to-Play Decisions

Shultz, Rebecca PhD*,†; Bido, Jennifer BA*; Shrier, Ian MD, PhD; Meeuwisse, Willem H. MD, PhD§; Garza, Daniel MD; Matheson, Gordon O. MD, PhD*,†

Clinical Journal of Sport Medicine: November 2013 - Volume 23 - Issue 6 - p 456–461
doi: 10.1097/JSM.0b013e318295bb17
Original Research

Objective: To describe the variability in the return-to-play (RTP) decisions of experienced team clinicians and to assess their clinical opinion as to the relevance of 19 factors described in a RTP decision-making model.

Design: Survey questionnaire.

Setting: Advanced Team Physician Course.

Participants: Sixty-seven of 101 sports medicine clinicians completed the questionnaire.

Main Outcome Measures: Results were analyzed using descriptive statistics. For categorical variables, we report percentage and frequency. For continuous variables, we report mean (SD) if data were approximately normally distributed and frequencies for clinically relevant categories for skewed data.

Results: The average number of years of clinical sports medicine experience was 13.6 (9.8). Of the 62 clinicians who responded fully, 35% (n = 22) would “clear” (vs “not clear”) an athlete to participate in sport even if the risk of an acute reinjury or long-term sequelae is increased. When respondents were given 6 different RTP options rather than binary choices, there were increased discrepancies across some injury risk scenarios. For example, 8.1% to 16.1% of respondents who chose to clear an athlete when presented with binary choices, later chose to “not clear” an athlete when given 6 graded RTP options. The respondents often considered factors of potential importance to athletes as nonimportant to the RTP decision process if risk of reinjury was unaffected (range, n = 4 [10%] to n = 19 [45%]).

Conclusions: There is a high degree of variability in how different clinicians weight the different factors related to RTP decision making. More precise definitions decrease but do not eliminate this variability.

Supplemental Digital Content is Available in the Text.

*Department of Orthopaedic Surgery, Human Performance Laboratory, Stanford University School of Medicine, Palo Alto, California;

Division of Sports Medicine, Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, California;

Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; and

§Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.

Corresponding Author: Ian Shrier, MD, PhD, Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Ste-Catherine Rd, Montreal, Quebec H2T 2Y6, Canada (

The authors report no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received August 31, 2012

Accepted April 04, 2013

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