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Practice management of musculoskeletal injuries in active children
  1. Mathieu Boudier-Revéret1,2,3,
  2. Barbara Mazer1,2,3,
  3. Debbie Ehrmann Feldman2,4,
  4. Ian Shrier5
  1. 1School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
  2. 2Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Montréal, Quebec, Canada
  3. 3Jewish Rehabilitation Hospital, Laval, Quebec, Canada
  4. 4École de réadaptation, Université de Montréal, Montreal, Quebec, Canada
  5. 5Centre for Clinical Epidemiology and Community Studies, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
  1. Correspondence to Dr Ian Shrier, Department of Family Medicine, Centre for Clinical Epidemiology and Community Studies, McGill University, SMBD-Jewish General Hospital, 3755 Cote Ste-Catherine Road, Montreal, QC H3T 1E2, Canada; ian.shrier{at}


Background Although increasing participation in physical activities has significant health benefits, there are no guidelines to help professionals decide when it is safe to return to activity after injury.

Objective To examine the specific criteria (eg, strength, pain) that expert sport medicine clinicians use for return to activity decisions in children with musculoskeletal injuries.

Methods The authors conducted an online cross-sectional survey of certified Canadian sport medicine doctors (MDs) and sport rehabilitation specialists (physiotherapists (PTs) or athletic therapists (ATs)). The authors asked how they would measure each of the following signs in the context of a knee injury: sport-specific skills, pain, swelling, strength, range of motion (ROM) and balance. Clinicians also ranked the importance of each sign with respect to influencing their recommendations for each of five clinical vignettes.

Results The overall response rate was 33.6% (464/1380) with similar rates for each profession. For each clinical sign, all three professions preferred the same measure to determine readiness to return to play: standardised testing for sport-specific skills, impact on function for pain, palpation for swelling, manual muscle testing for strength, visual inspection for ROM and standing on one leg with eyes closed for balance. Regarding importance of specific signs for return to activity, all professions had similar responses for one vignette, but MDs differed from PTs and ATs for the remaining four. Finally, pain was ranked as the no 1 or 2 most important sign in all five vignettes by 41.0% of MDs, 18.1% of ATs and 11.3% of PTs, whereas sport-specific skills was chosen by 9.6% MDs, 12.0% ATs and 16.1% PTs.

Conclusion Our results provide the foundation for future work leading towards the development of interdisciplinary consensus guidelines.

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  • Funding This study was funded by the Réseau provincial de recherche en adaptation-réadaptation. IS is funded by a Senior Clinical Investigator Award from the Fonds de la Recherche en Santé du Québec (FRSQ). DEF is currently funded by FRSQ Junior II programme.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.