competitive sport: return-to-play decision...

Competitive Sport: Return-to-Play Decision MakingCompetitive Sport: Return-to-Play Decision MakingCompetitive Sport: Return-to-Play Decision MakingCompetitive Sport: Return-to-Play Decision Making

Thank you for agreeing to complete this survey. It should take about 20 minutes. Please answer each question as accurately as possible. Your answers will be completely anonymous. The purpose of this survey is to evaluate the various components involved in medical decision making for returning an athlete to sport. There are three parts to this survey: PART 1: DEMOGRAPHICS - This section asks basic questions about your clinical experience and background in sports medicine. PART 2: UNDERSTANDING WHAT RETURN-TO-PLAY MEANS - This section probes your understanding of the components that factor into your return-to-play decisions. PART 3: COMPONENTS OF THE RETURN-TO-PLAY DECISION - This section asks you to think about the importance of various factors in your return-to-play decisions. Some questions will have the option of providing additional comments. In addition, there is a section at the end for general comments.

Instructions

Other


1. What is your gender?

2. What age group do you belong to?

3. What is your primary specialty?

4. Have you received additional formal training in sports medicine following the completion of your primary specialty?

5. What country did you complete the majority of your training in?

6. How many years have you been practicing sports medicine since you completed residency and fellowship? Please round to the nearest whole number.

Part 1 - Demographic Information

Years in sports medicine:

Male

Female

20-35 years old

36-49 years old

50+ years old

Family Medicine

Internal Medicine

Pediatrics

Physical Medicine and Rehabilitation

Emergency Medicine

Orthopedic Surgery

Other (please specify)

2 years of sports medicine fellowship

1 year of sports medicine fellowship

Less than 1 year of sports medicine fellowship

Other (please specify):

Other

Other

Other

Competitive Sport: Return-to-Play Decision MakingCompetitive Sport: Return-to-Play Decision MakingCompetitive Sport: Return-to-Play Decision MakingCompetitive Sport: Return-to-Play Decision Making7. Are you currently a practicing physician with a medical license?

8. Are you currently affiliated with an academic medical center?

9. How many papers have you published as a first or last author?

10. Over the last 5 years, how many invited lectures, presentations, seminars or papers have you presented at sports medicine conferences ON AVERAGE, PER YEAR?

11. What athletic patient populations do you primarily treat on a regular basis? (Check all that apply)

Yes, I am still practicing medicine

No, I just stopped practicing last year (within 12 months)

No, I stopped practicing 2-5 years ago

No, I stopped practicing more than 5 years ago

Yes, Full-time

Yes, Part-time

No

Less than 5

5-9

10-14

15 or more

0

1-2

3-5

More than 5

Elite athletes - Professional (paid salary)

Elite athletes - Olympic Level

Elite athletes - College/University

Competitive Recreational (intramural, clubs, high school and

above)

High school/Adolescent

Recreational


Other

Other

Other

Competitive Sport: Return-to-Play Decision MakingCompetitive Sport: Return-to-Play Decision MakingCompetitive Sport: Return-to-Play Decision MakingCompetitive Sport: Return-to-Play Decision Making12. Please indicate the sports for which you frequently make return-to-play decisions (Check all that apply):

Aquatics (Swimming, Diving)

Archery

Badminton

Baseball

Basketball

Biathlon

Boccia

Bowling

Boxing

Canoe-Kayak

Cheerleading

Cross-country running

Curling

Cycling

Equestrian

Fencing

Field Hockey

Figure Skating

American Football

Golf

Gymnastics

Ice Hockey

Lacrosse

Martial Arts (Judo, Karate, Taekwondo,

Wushu, etc)

Modern Pentathlon

Nordic Combined

Powerlifting

Racquetball

Rifle/Shooting

Roller Sports

Rowing/Crew

Rugby

Running

Sailing

Skiing (Alpine, Cross-country, Freestyle,

Ski Jumping)

Sliding Sports (Bobsleigh, Luge,

Skeleton)

Snowboarding

Soccer

Softball

Speed Skating

Squash

Table Tennis

Team Handball

Tennis

Ten Pin Bowling

Track and Field (Athletics)

Triathlon

Volleyball

Water Polo

Weight Lifting

Wrestling

None

Others (please specify)

Other

Other

Competitive Sport: Return-to-Play Decision MakingCompetitive Sport: Return-to-Play Decision MakingCompetitive Sport: Return-to-Play Decision MakingCompetitive Sport: Return-to-Play Decision Making13. Please indicate the sports you are Currently the team physician for:

Aquatics (Swimming, Diving)

Archery

Badminton

Baseball

Basketball

Biathlon

Boccia

Bowling

Boxing

Canoe-Kayak

Cheerleading

Cross-country running

Curling

Cycling

Equestrian

Fencing

Field Hockey

Figure Skating

American Football

Golf

Gymnastics

Ice Hockey

Lacrosse

Martial Arts (Judo, Karate, Taekwondo,

Wushu, etc)

Modern Pentathlon

Nordic Combined

Powerlifting

Racquetball

Rifle/Shooting

Roller Sports

Rowing/Crew

Rugby

Running

Sailing

Skiing (Alpine, Cross-country, Freestyle,

Ski Jumping)

Sliding Sports (Bobsleigh, Luge,

Skeleton)

Snowboarding

Soccer

Softball

Speed Skating

Squash

Table Tennis

Team Handball

Tennis

Ten Pin Bowling

Track and Field (Athletics)

Triathlon

Volleyball

Water Polo

Weight Lifting

Wrestling

None

Others (please specify)

Competitive Sport: Return-to-Play Decision MakingCompetitive Sport: Return-to-Play Decision MakingCompetitive Sport: Return-to-Play Decision MakingCompetitive Sport: Return-to-Play Decision Making14. Which of the following BEST describes your relationship with the primary team(s) you make return-to-play decisions for?

15. On average, how many hours per week do you spend treating sports medicine cases in clinics or in other medical venues in sport facilities, ie. training rooms.

16. On average, how many hours per month do you spend covering games, meets, or competitions where you make return-to-play decisions ("sideline")?

Sports medicine clinic time (in hours)

Sideline decisions time (in hours)

I volunteer my time

I volunteer my time but my involvement with the team results in referrals or surgical cases for which I am paid

I am paid by an institution which has a contract with the team to provide medical services (eg. student health or medical center)

I am paid directly by the team

Not applicable



In this section, we are trying to understand what you mean when you say an athlete is “cleared for return-to-play” or “cleared for participation”.

1. In general, please indicate if you use the word “Cleared" for return-to-play for these situations.

Part 2A - Understanding What Return-to-Play Means

Yes No

The athlete is asymptomatic with no elevated risk of re-injury and no risk of long-term sequelae

The athlete does have symptoms or signs, but they are not of sufficient concern to place the athlete at risk for either acute re-injury or long-terms sequelae

The athlete has an increased risk of acute re-injury but no appreciable increased risk of long-term sequelae

The athlete has no appreciable increased risk of acute re-injury but does have an increased risk of long-term sequelae

The athlete has an increased risk of both acute re-injury and long-term sequelae

Additional

Competitive Sport: Return-to-Play Decision MakingCompetitive Sport: Return-to-Play Decision MakingCompetitive Sport: Return-to-Play Decision MakingCompetitive Sport: Return-to-Play Decision Making2. For each row below, please select the box that BEST describes your return-to-play decision based on the health risk factors associated with the athlete you are treating.

No restrictions

Can compete but with modified role (e.g. change player

position

Cannot compete but can practice

Cannot compete but can practice with modified activity only

Cannot practice but can do strength and conditioning under direction of trainer / therapist

Unable to do any activity including strength and conditioning

The athlete is asymptomatic with no elevated risk of re-injury and no risk of long-term sequelae

The athlete does have symptoms or signs, but they are not of sufficient concern to place the athlete at risk for either acute re-injury or long-term sequelae

The athlete has an increased risk of acute re-injury but no increased risk of long-term sequalae

The athlete has no increased risk of acute re-injury but does have an increased risk of long-term sequelae

The athlete has an increased risk of both acute re-injury and long-term sequelae

Additional


The following questions refer to the situation where you would restrict some activities for an athlete while still allowing them to participate in others. For each question, please indicate which of the answers BEST describes what you do

1. How do you usually monitor progress until the athlete is unconditionally cleared for return-to-play with no restrictions?

2. How do you usually communicate restrictions to the athlete, coach, athletic trainer or physical therapist? Please choose the answer that BEST reflects your usual practice.

Part 2B

I hold the athlete out until they are 100%

I list specific activities to avoid

I permit participation in one area (such as training, strength and conditioning, or practice) but withhold participation in another (such as

competition)

I discuss general principles and let the specifics of participation be decided by someone else such as an athletic trainer or physical

therapist

I see the athlete for regular follow-up visits and prescribe increasing levels of participation (training, skill, contact) based on their progress

and continue this process until the athlete is ready for full participation


I discuss the suitability of specific activities directly with the athlete, coach, athletic trainer, or physical therapist at the time of the visit and

record them in the medical record.

I write down specific instructions and give them to the athlete, coach, athletic trainer, or physical therapist and include them in the

medical record.

I communicate specific instructions by phone or email to the coach, athletic trainer, or physical therapist and record these in the medical

record.

I only discuss general principles and answer questions about what I mean, leaving the decision regarding participation in specific

activities to the coach, athletic trainer or physical therapist


Competitive Sport: Return-to-Play Decision MakingCompetitive Sport: Return-to-Play Decision MakingCompetitive Sport: Return-to-Play Decision MakingCompetitive Sport: Return-to-Play Decision Making3. If you delegate the responsibility to monitor health status and make participation decisions on a day-to-day basis, who do you usually delegate this responsibility to?

4. How do you typically communicate with that person?

5. How often do you typically communicate with that person?

Not applicable, I always monitor patients myself

Athletic trainer or athletic therapist

Physical therapist

Strength and conditioning coach

Coach


Not applicable, I always monitor patients myself

I meet with them in person

By phone

Electronically (email)


Not applicable

Daily

4-6x a week

2-3x a week

Once a week

Right before each patient appointment


Competitive Sport: Return-to-Play Decision MakingCompetitive Sport: Return-to-Play Decision MakingCompetitive Sport: Return-to-Play Decision MakingCompetitive Sport: Return-to-Play Decision Making6. At your institution or with the team you cover, who has the authority to make a non-urgent (in clinic) return-to-play decision? (Check all that apply)

7. At your institution or with the team you cover, when faced with a same-day return-to-play decision on the field or sideline, who has the authority to make that decision? (Check all that apply)

8. When making a return-to-play decision in a non-urgent (in clinic) setting, who should NOT have the authority to make that decision? (Check all that apply)

Physician/Team Doctor

Physical Therapist

Athletic Trainer or Athletic Therapist

Strength and Conditioning Coach

Coach



Physical Therapist



Coach

Athlete



Physical Therapist



Coach


Competitive Sport: Return-to-Play Decision MakingCompetitive Sport: Return-to-Play Decision MakingCompetitive Sport: Return-to-Play Decision MakingCompetitive Sport: Return-to-Play Decision Making9. In the event of a disagreement, who SHOULD make the definitive/final return-to-play decision? (Choose one)


Physical Therapist



Coach

Other (please explain)


In this section, we are asking you to think about the importance of various factors in your return-to-play decision.

1. When evaluating health status and the medical factors that go into a return-to-play decision, please rank each of these factors from 1-8 based on the importance you attribute to them, using each number only once with 8 being the most important. Put 0 if you do not consider the factor important at all or not applicable.

2. When evaluating the sport-related factors that modify risk in the return-to-play decision, please rank each of these factors from 1-5 based on the importance you attribute to them, using each number only once with 5 being the most important. Put 0 if you do not consider the factor important at all or not applicable.

Part 3 - Components of the Return-to-Play Decision

Patient Demographics (e.g. age, sex)

Personal medical history (e.g. recurrent injury)

Symptoms (e.g. pain, giving way)

Signs (e.g. swelling, weakness)

Lab tests (e.g. x-ray, MRI)

Functional testing (eg. diagonal hop test)

Psychological State (e.g. depressed)

Potential seriousness of outcome (e.g. concussion, tennis elbow)

Competition Level (e.g. recreational, professional)

Ability to Protect (e.g. padding)

Position played (e.g goalie, foward)

Limb Dominance (e.g. MSK alignment)

Type of Sport (e.g. collision, non-contact)

Competitive Sport: Return-to-Play Decision MakingCompetitive Sport: Return-to-Play Decision MakingCompetitive Sport: Return-to-Play Decision MakingCompetitive Sport: Return-to-Play Decision Making3. For athletes with the same condition and same risk, return-to-play decisions may be modified by situational factors. When evaluating these factors, please rank each of them from 1-6 based on the importance you attribute to them, using each number only once with 6 being the most important. Put 0 if you do not consider the factor important at all or not applicable. Timing and Season (e.g. playoffs)

External pressure (e.g. coach, athlete family)

Pressure from Athlete (e.g. desire to compete)

Conflict of Interest (e.g. financial)

Fear of litigation (e.g. if restricted or permitted)

Masking the Injury (e.g. effective analgesia)


1. Do you have any additional comments about return to play decision making? If not, please leave blank.

2. Do you have any additional comments/feedback about the survey? If not, please leave blank.

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