Choosing Wisely after a sport and exercise-related injury

Joshua R Zadro; Ian A Harris; Christina Abdelshaheed; Carolyn Broderick; Christian J Barton; James Linklater; Christopher G Maher

doi:10.1016/j.berh.2019.02.002

Choosing Wisely after a sport and exercise-related injury

Best Pract Res Clin Rheumatol. 2019 Feb;33(1):16-32. doi: 10.1016/j.berh.2019.02.002. Epub 2019 Feb 22.

Authors

Joshua R Zadro¹, Ian A Harris², Christina Abdelshaheed³, Carolyn Broderick⁴, Christian J Barton⁵, James Linklater⁶, Christopher G Maher⁷

Affiliations

¹ School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Institute for Musculoskeletal Health, Sydney, NSW, Australia. Electronic address: joshua.zadro@sydney.edu.au.
² School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Institute for Musculoskeletal Health, Sydney, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia. Electronic address: iaharris1@gmail.com.
³ School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Institute for Musculoskeletal Health, Sydney, NSW, Australia. Electronic address: christina.abdelshaheed@sydney.edu.au.
⁴ School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia. Electronic address: c.broderick@unsw.edu.au.
⁵ La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia. Electronic address: christian@completesportscare.com.au.
⁶ Discipline of Medicine, The University of Sydney, Sydney, NSW, Australia; UNSW Medicine, University of New South Wales, Sydney, NSW, Australia. Electronic address: linklj@bigpond.com.
⁷ School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Institute for Musculoskeletal Health, Sydney, NSW, Australia. Electronic address: christopher.maher@sydney.edu.au.

PMID: 31431270
DOI: 10.1016/j.berh.2019.02.002

Abstract

Low-value care is receiving substantial attention in many fields of medicine but little-to-none in sports medicine. Common interventions for sport and exercise-related injuries include medical imaging, medication, surgery and rehabilitation, but there is emerging evidence of the inappropriate use of these interventions. This chapter aims to increase awareness of low-value care in sports medicine by answering four key clinical questions: Does my patient need imaging? When is it appropriate to prescribe opioids? Does my patient need surgery? Does it matter how rehabilitation is delivered? Increasing awareness of low-value care in sports medicine will ensure patients with sport or exercise-related injuries avoid care that provides little-to-no benefit or causes harm and receive care that is evidence based and truly necessary. There are many situations when imaging, opioids, surgery and supervised rehabilitation are entirely appropriate. However, this chapter considers contexts where use of these interventions could be considered unnecessary and potentially harmful.

Keywords: Choosing wisely; Exercise-related injuries; Imaging; Low-value care; Opioids; Rehabilitation; Sports injuries; Sports medicine; Surgery.

Publication types

Review

MeSH terms

Athletic Injuries / diagnostic imaging
Athletic Injuries / psychology*
Exercise / psychology*
Humans