Background of the project
Shared decision-making is a recommended collaborative process involving both clinicians and patients. In the context of return-to-sport, this process involves a broader range of stakeholders, such as doctors, physiotherapists, athletes, coaches, and management. The involvement of multiple stakeholders increases the risk of disagreement and conflicts possibly leading to a loss of trust, litigation, and ultimately even harm to athletes' health.
While studies often focus on developing and validating methods to measure factors that can support the return-to-sport decisions, the impact of implementing any measures on athlete health is limited if potential conflicts and divergences in the decision process are not identified, understood, and addressed.
Several key factors are considered when making return-to-sport decision, implying the need for input from multiple professionals (see the framework image from Shrier, 2015). As a result, the negotiation process for arriving at a return-to-sport decision becomes more complex due to the diverse roles, knowledge, experience, priorities, and legal liabilities of all individuals involved in athlete management.
Figure legend. The three-step return-to-sport framework (modified and redrawn from Shrier 2015). This framework groups factors responsible for return to sport according to the sociological source of the information (medical culture, sport culture, personal decision modifiers).
Project aims
The RUDDER project aims to understand the extent of discrepancies, in order to decrease conflicts among the stakeholders when making a return-to-sport decision.
This specific project aims to prospectively examine:
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The variability among stakeholder in reinjury risk perception/estimation.
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The variability among stakeholder in risk assessment.
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The variability in factors affecting risk tolerance.
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The accuracy of the risk estimation of the various stakeholders.
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The views and variability among stakeholders of the importance of different criteria when making an RTP decision.
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The occupations that are perceived as possessing the best ability to evaluate these criteria.
This will allow proposing solutions differentiated according to the nature of the potential conflicts.
Source of the discrepancy
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Training
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Scientific knowledge
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Personal and societal values
Solution
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Education
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Research and dissemination
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Honest discussions
The ultimate goal is to optimise the decision process for the overall benefit of the athlete.
This project is based on earlier original and feasibility studies (see list below) conducted by Dr. Ian Shrier from McGill University, Canada, who is also a co-investigator of the RUDDER project.
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Reference articles
- Shrier et al. (2017). Measuring heterogeneity of reinjury risk assessments at the time of clearance to return to play: A feasibility study. J Sci Med Sport, 20(3), 255–260. Request a PDF.
- Shrier et al. (2015). Validating the three-step return-to-play decision model. Scand J Med Sci Sports, 25(2), e231–e239.
- Shrier I. (2015). Strategic Assessment of Risk and Risk Tolerance (StARRT) framework for return-to-play decision-making. Br J Sports Med, 49(20), 1311–1315.
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- Shrier et al. (2014). Return to play following injury: whose decision should it be? Br J Sports Med, 48(5), 394–401.
- Shultz et al. (2013). Team clinician variability in return-to-play decisions. Clin J Sports Med, 23(6), 456–461. Request a PDF.
- Matheson et al. (2011). Return-to-play decisions: are they the team physician's responsibility? Clin J Sports Med, 21(1), 25–30. Request a PDF.
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How the study works
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You can participate in the study if you are either an athlete recently (within one week) cleared to return-to-sport or about to return to sport, or a professional (e.g. doctors, physiotherapists, coaches etc.) involved in the return-to-sport decision of an athlete.
Inclusion criteria
- You are an adult (18+).
- Involved in clearance to return to sport decisions (includes athlete, coach, professional, etc) for able-bodied athletes or athletes with impairment at any ability level in a competitive sport
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What your participation involves
The study will require participants to complete surveys (via Qualtrics) and a risk-estimation via a Shiny App.
There are two parts involved in your participation in this study.
Note: Support from the research assistant will be offered throughout the study. All activities can be completed from a location suitable for you using a smartphone or a computer.
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Part 1
Part one will be completed by anyone (practitioner or athlete) who has a role in the return-to-sport decision.
Here we will ask you to complete a survey on your demographics and the factors you consider important when making a return-to sport decision (10 minutes).
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Part 2
Part two will be completed immediately (within 7 days) after you are involved in a return-to-sport decision. Here we will ask you to:
- Complete a questionnaire about the injury for which the athlete is being cleared to return-to-sport (10 minutes)
- Utilise an online app (after receiving instructions and a 10-20-min training from the research assistant) that helps describe your perceived risk of reinjury over the upcoming 3 months (10 minutes to complete).
The online application used for expert elicitation is based on Sheffield Elicitation Framework (SHELF).
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Follow-up
Complete an additional questionnaire, three months after being cleared to return-to-sport to learn about any subsequent injury (if any) and your training (10 minutes to complete).
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Will I receive the results of the study?
Yes, all participants will receive a report with the results of the study as soon as they are available.
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Privacy
The data will be anonymised and protected.
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Ethics
This study has been approved in line with the University of Technology Sydney Human Research Ethics Committee [UTS HREC] guidelines.
Download the Patient Information Sheet and Consent Form (PDF, 239KB)
Research team and governance
AIS-UTS Steering Committee
- Tim Kelly (AIS)
- Paolo Menaspà (AIS)
- Franco M. Impellizzeri (UTS)
RUDDER Research Committee
- AIS-UTS Steering Committee
- Ian Shrier (McGill University)
- Emma Petancevski (UTS)
- Russell Steele (McGill University)
Extended Research Committee
- RUDDER Research Committee
- Nicola Mepstead (APA, Sports Exercise)
- Paula Peralta (AIS PT Network Lead)
- Larissa Trease (LASEM)
- Bruce Hamilton (ACSEP)
- Garry West-Bail (ASAPD)
- David Borg (AIS)
Abbreviations of the affiliations
UTS, University of Technology Sydney; AIS, Australian Institute of Sport; APA, Australian Physiotherapy Association; ACSEP, Australasian College of Sport and Exercise Physicians; ASAPD, Australian Sporting Alliance for People with a Disability; LASEM, LaTrobe Sport and Exercise Medicine Research Centre.
