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Realist synthesis in sport and exercise medicine: ‘time to get real’
  1. Adam Gledhill1,
  2. Dale Forsdyke2
  1. 1 Carnegie School of Sport, Leeds Beckett University, Leeds, UK
  2. 2 Applied Human Sciences, York St John University, York, North Yorkshire, UK
  1. Correspondence to Dr Adam Gledhill, Carnegie School of Sport, Leeds Beckett University, Leeds LS6 3QS, UK; adam.gledhill{at}

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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.

What is a realist synthesis review and how does it differ from SRs?

Realist syntheses …

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  • Twitter @gleds13, @forsdyke_dale

  • Contributors AG produced the concept for the editorial, drawn from his and DF’s existing work. DF provided critical debate and revisions on the first version of the work. Both authors produced the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AG is an associate editor with British Journal of Sports Medicine.

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