• review
• sports and exercise medicine
• sports medicine
• research

In sport and exercise medicine (SEM), context is key. By context we mean: ‘What works?’ ‘for whom?’ ‘how?’ and under ‘what circumstances?’ These are four key questions for clinicians who aim to prevent injuries, treat patients and guide return to sport with athletes.

To answer real-world challenges, clinicians will often bow to the Oxford levels of evidence and rely on findings of randomised controlled trials, (RCTs), systematic reviews (SRs) or meta-analyses. These methods are gold standards, recent debate1 notwithstanding. However, in dynamic, changeable and less-controlled sports environments (eg, soccer, rugby) where we strive to achieve optimal performance and health gains, we should challenge our own thinking and traditions to meet the demands of this unique environment.

Recognising a shift to a greater need for implementation science,2 we should consider looking beyond the accepted gold standard. Typically, SRs focus on solely measuring and reporting intervention efficacy,3 they omit implementation context.4 The purpose of this editorial is to promote the value of realist synthesis—as a method that complements clinicians’ use of the traditional levels of evidence.