Integrated guidelines for return-to-play decision-making after musculoskeletal injury in rugby union
Background: Re-injuries in rugby union have become a factor of major concern. The severity of these injuries is usually far greater than that of new injuries. Since no standardized protocol for RTP decision-making in rugby union exists in literature, decisions are often made subjectively according to the practitioners’ expertise and experience. Aims: The main objective of this study is to create a set of guidelines to assist practitioners in rugby union with the RTP decision-making process. The guidelines will form the basis of further research in RTP decision-making in order to accurately quantify the process. Method: The exploratory mixed-method design is used in this study which equipped the researcher with information relevant to RTP decision-making in rugby union and it forms the basis for the formulation of RTP guidelines for rugby union. Literature was synthesised to develop an e-Delphi questionnaire. The e-Delphi questionnaire was then sent to the medical teams of Currie Cup rugby union across South Africa. Results: Three steps of integrated guidelines for RTP decision-making in rugby union were established. Step 1: Evaluation of Health Status included: Pain, Instability, Personal Medical History (including age), Strength, Range of Motion, Functional tests, Psychological state, Potential Seriousness and the Orthopaedic Surgeon’s opinion. Step 2: Evaluation of Participation Risk included: Position Played, Competitive level and the Ability to Protect. Step 3: Decision Modifiers include: Timing and Season, Masking of the Injury, Conflict of Interest and the Fear of Litigation. Numerical weights were given to each of the factors. The need for such guidelines was recognized in both the literature and by practitioners. Conclusions: The guidelines set forth in this study will help to direct practitioners in their decision-making process regarding RTP in rugby union. The guidelines however need more in-depth investigated to ultimately help reduce re-injuries in rugby union. Take home sentence: Even though rehabilitation should be focused on the injury, RTP decision-making should be more focussed on the demands that the player and per implication the injury, will have to face upon RTP.