Objectives Research evidence is commonly compiled into expert-informed consensus guidelines intended to consolidate and distribute sports medicine knowledge. Between 2003 and 2018, 27 International Olympic Committee (IOC) consensus statements were produced. This study explored the policy and practice impact of the IOC Statements on athlete health and medical team management in two economically and contextually diverse countries.
Methods A qualitative case study design was adopted. Fourteen face-to-face interviews were conducted with purposively selected interviewees, seven participants from Australia (higher economic equality) and seven from South Africa (lower economic equality), representing their national medical commissions (doctors and physiotherapists of Olympic, Paralympic and Youth teams). A framework method was used to analyse interview transcripts and identify key themes.
Results Differences across resource settings were found, particularly in the perceived usefulness of the IOC Statements and their accessibility. Both settings were unsure about the purpose of the IOC Statements and their intended audience. However, both valued the existence of evidence-informed guidelines. In the Australian setting, there was less reliance on the resources developed by the IOC, preferring to use locally contextualised documents that are readily available.
Conclusion The IOC Statements are valuable evidence-informed resources that support translation of knowledge into clinical sports medicine practice. However, to be fully effective, they must be perceived as useful and relevant and should reach their target audiences with ready access. This study showed different contexts require different resources, levels of support and dissemination approaches. Future development and dissemination of IOC Statements should consider the perspectives and the diversity of contexts they are intended for.
- Sports medicine
- Qualitative Research
Data availability statement
No data are available. All data are published, and therefore there are no additional data available. The authors will consider request to access to the raw data, within the constraints of privacy and consent.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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What is already known on this topic?
With the aim to guide sports organisation in the protection of athlete health, the International Olympic Committee supported the development of 27 sports medicine consensus statements during the period of 2003–2018.
These Statements are well-cited resources in the peer-review literature, particularly by authors from the USA, Canada, Australia, UK and Western Europe.
What are the new findings?
This study found that different contexts require different resources, levels of support and dissemination approaches. To reach their goal of athlete health protection, the Statements must be perceived as useful, relevant and accessible for intended target audiences.
Challenges were described as a lack of clear audience and purpose, along with timeliness as evidence is rapidly out of date. It was not always possible for the Statement recommendations to be applied due to limited resources and structures for the provision of best evidence-based healthcare.
Positives of the IOC Statements were seen in the association of the Olympic brand, with an assumption that the consensus statements are the pinnacle of knowledge, underpinned by the best expertise.
How might it impact on clinical practice in the future?
Authorship teams of future Statements should first agree on the specific purpose and intended target audience of the statement.
Topical and contentious issues that had clear guidance with accompanying clinical decision-making tools were most valued.
Strategies for dissemination in multiple formats, and uniformity in these resources (eg, clearly stated authorship, audience and purpose) to support wider use are recommended.
Through its Medical and Scientific Commission, the International Olympic Committee (IOC) has a stated goal to guide sports organisations in relation to the protection of athlete health.1 One strategy adopted by the Commission has been to support the development and dissemination of sports medicine consensus statements (hereafter referred to as the IOC Statements). Between 2003 and 2018, 27 IOC Statements were published, covering a wide range of topics from the use of platelet-rich plasma to concussion management to youth athletic development.2
Our earlier research used bibliometric citation analysis to assess the academic impact and reach of the IOC Statements, concluding that these statements are well-cited resources in the peer-reviewed literature.3 The study noted a predominance of named statement authors also being authors of papers that cited the IOC Statements, many of whom were from regions of higher economic means (eg, Northern America, Western Europe, Scandinavia, UK and Australia) compared with lower economic settings. This finding raised a question about the value and relevance of the IOC Statements to sports medicine practitioners from other parts of the world, especially in regions where economic strengths are lower, and, in turn, healthcare resourcing is challenging. Further, being based solely on citations in peer-reviewed journals, the previous analysis of the reach and impact of the IOC Statements provided an assessment of their academic impact only.3 Accordingly, that study was unable to determine whether the IOC Statements have had a practical impact on sports medicine practice outside of the more traditional academic settings.
The development of consensus and guideline documents to support clinical sport and exercise medicine practice, such as those developed by the IOC, requires substantial time, resources and contributions from recognised experts. Before further investment in the development and dissemination of such resources, it is imperative to understand whether they provide useful guidance for the protection of athlete health that can be actioned by targeting all sports settings, organisations and practitioners. This information is important to help determine the scope of future topics, research approaches and formats for dissemination. Therefore, this study was designed to explore the policy and practice impacts of the IOC Statements from the perspective of health professionals working with Olympic/Paralympic committees. The primary aim was to understand awareness and use of the IOC Statements by health professionals connected to the National Olympic/Paralympic Committees of their country. A secondary aim was to explore the perceived relevance of the information for two countries that are contextually and economically diverse.
This paper reports the second stage of a comprehensive project to evaluate the broad impact of the IOC Statements on athlete health and well-being.
Equity, diversity and inclusion statement
The study addresses an issue of representation and clinical utility of the IOC consensus statements for two disparate socioeconomic settings (Australia and South Africa) and includes women and men as participants. Generalisability and limitations for geographically diverse settings are addressed in the discussion. The research team includes six women and three men who represent multiple disciplines, senior, mid-career and early-career investigators of different nationalities, currently working in five countries (Australia, New Zealand, Netherlands, South Africa and Canada).
Design and setting
An exploratory multiple case study design,4 with a pragmatic approach,5 6 was used. Case study research is a useful methodology to investigate complex issues within a bounded system (the case). In this way, case study research facilitates an in-depth understanding of behaviours, processes and practices within a certain context.5 6 A case study design was chosen, as a careful consideration of contextual factors was deemed integral to gaining an understanding of the phenomenon under study.
The study was situated in a pragmatic paradigm, drawing from the most practical methods available to answer a specific research question.4 7 This approach facilitates a comprehensive understanding of a phenomenon or process from the perspectives of the people involved, with the goal of providing practical solutions to real-world problems and information that can be fed back to those involved in the development of the IOC Statements.4 7
Two settings (ie, countries) with specifically different health and economic development levels were purposefully selected as cases. Based on feasibility and budgetary reasons, this study was restricted to the conduct of interviews in two settings linked to the location of the authorship team. Australia represented a setting with greater economic resources and health expenditure, while South Africa represented a setting with lower economic resources and notable health inequality. To understand the choice of these two settings and the possible influence on the results, key contextual differences, including economic and healthcare access issues, are summarised in table 1 (with more details also provided in online supplemental appendix 1).
Healthcare professionals (sports physicians and physiotherapists, both men and women) serving on a National Olympic, Paralympic or Youth Olympic Committee were identified and invited to participate in the study. Recruitment was facilitated by representatives from both the South African Sports Confederation and Olympic Committee (SASCOC) and the Australian Olympic Committee (AOC). In South Africa, a total of 10 participants were eligible and were contacted by the SASCOC representative and invited to participate, of which 7 agreed. In Australia, seven participants were recruited to match the South African sample number. The final sample included 14 interviewees, 7 from each country. As this was a small, select and potentially identifiable group based on their involvement in Olympic and Paralympic-level sport, demographic descriptions of the sample are not presented to protect the anonymity of participants.
Semistructured, open-ended questions were developed to explore interviewees’ perceptions of the IOC Statements through individualised face-to-face interviews. The questions and interview flow were pilot tested with one South African sports physician not included in the main study. All interviews were conducted in each country over 2 weeks each in 2019. Interviews were conducted conveniently for interviewees, averaged between 40 min and 60 min and were audio-recorded. Two authors working in sports medicine research (post-PhD) were present at all interviews, with an experienced interviewer (MB) leading the discussion and a second researcher (LVF) supporting. After discussing interviewees’ awareness of the IOC Statements, a list of the 27 IOC Statements topics published during 2003–2018 was shown to facilitate the discussion further and to give participants an idea of the topics covered by the IOC Statements, especially if the participant was not aware of all or some specific statements. A copy of the interview guide is included in online supplemental appendix 2.
Interview transcripts (the primary data source) were supplemented with a document analysis of organisational website information (IOC, AOC and SASCOC websites) and official policy documents sourced from these organisational websites. The goals of the document analysis were to (1) provide contextual information as well historical insight into these organisations; (2) to corroborate findings from the interviews and to (3) supplement information relevant to the study aim. The interviewees’ references to specific website resources during the interviews were also reviewed to better understand interviewees’ responses. These resources included those from the South African Sports Medicine Association, Sports Medicine Australia, Australian Institute of Sport, British Association of Sport and Exercise Medicine and Australasian College of Sport and Exercise Physicians websites, as well as academic journal websites including the British Journal of Sports Medicine and the Journal of Orthopaedic and Sports Physical Therapy.
Interview recordings were transcribed verbatim and organised in NVivo V.11. The framework method was used to analyse the data.8 A defining feature of this method is the development of a matrix of rows (cases), columns (codes) and ‘cells’ of summarised data. This approach provided a structure into which the data were systematically reduced to facilitate analysis and comparisons by case and by code.8 Interviews were independently coded by two authors (MB and CB), and any discrepancies were discussed and resolved in an iterative manner until both researchers were satisfied that a comprehensive working analytical framework had been developed. Transcripts were indexed according to the framework and charted into a matrix that summarised the data by category. The document analysis was conducted alongside the analysis of the interview transcripts in an iterative manner. The process involved an initial, superficial examination of all acquired documentation, coding sections related to the study aims.9 These codes were entered in the framework matrix. As the analysis progressed, an in-depth examination and interpretation of the documents were conducted, and relevant information was entered into the matrix to further develop understanding. Individual case summaries were developed for each setting from the interview coding, and relevant information was obtained from the document review and field notes. The matrix for each case facilitated the recognition of patterns and themes across the data set. Three authors reviewed and discussed initial themes and subthemes (MB, CB and LVF) until final themes were agreed on. Each case was analysed separately, and convergence and divergence towards themes were examined. A cross-case analysis was conducted iteratively to identify patterns and differences across the two settings. The final themes were reviewed by all researchers involved in data collection and analysis (MB, CB and LVF). This study focused on documenting the insights provided by the purposively selected interviewees (key informants) from a limited pool of eligible participants, rather than on reaching data saturation. Additional information related to rigour and trustworthiness of the study is contained in online supplemental appendix 2.
Four linked themes arose from the interviews: (1) contextual perceptions—setting the scene; (2) knowledge generation and identifying the custodians of knowledge; (3) dissemination, awareness and access pathways; and (4) consensus in practice. The overlapping nature of some of the key views expressed by interviews across themes adds weight to the importance of considering their implications. The key findings from the interviews are summarised visually in figure 1 and presented separately for each theme as follows.
Contextual perceptions: setting the scene
This theme describes the interviewees’ perceptions of their local context and its influence on their athlete health management. This information is particularly important as it sets the scene around their perceptions and interactions with the IOC Statements.
South African interviewees’ perceptions of their context were characterised by resource and organisational limitations, which restricted athletes’ structured, continuous, coherent management (table 2, quote 1). Most interviewees identified a perceived lack of control and management opportunities with athletes in the periods between Olympic and Paralympic Games. This was emphasised especially for screening opportunities that were considered only possible in the period immediately before the Games. Consequently, interviewees felt that athletes were not always ready to participate in major events (ie, Olympic or Paralympic Games). There was often not enough time to fully manage the athletes in their preparation as they considered necessary. This was also linked to views about South Africa’s inequitable healthcare system, affecting the care of athletes from lower socioeconomic backgrounds (table 2, quotes 2 and 3). Another expressed concern was that many sports federations in South Africa do not have an organised medical structure and are not always involved in athlete health in the periods between Games. This resulted in a perceived disconnect between the National Olympic Committee (NOC) and the federations and between individual coaches and athletes.
In contrast, the Australian context was characterised by multiple resources, including the availability of a range of human, financial and knowledge resources. These resources facilitated a highly structured system to manage athlete health (table 2, quotes 4 and 5). Sports medicine practitioners who have been consistently involved in specific sports for several years facilitated a sense of coherence with federations. However, it was noted that smaller sports, or federations with fewer resources, were likely to require more support (table 2, quote 6).
Knowledge generation and the custodians of knowledge
This theme describes interviewees’ perceptions of who is, or who should be, responsible for and involved in developing and translating knowledge concerning different topics of athlete health, from day-to-day management to leadership of bigger societal issues. No interviewees identified the IOC as their first port of call for knowledge around athlete health topics. Responses from interviewees in South Africa were characterised by limited awareness of the IOC’s investment in the development of knowledge, including the IOC Statements (table 3, quotes 1 and 2). A common belief was that the IOC Statements are focused on Olympic/Paralympic-level athlete management only.
Some of the Australian interviewees also reflected the perspective that IOC Statements were focused on the care of elite athletes. However, they were also more direct in asserting that they did not necessarily consider the IOC to be the most relevant source for their day-to-day knowledge needs (table 3, quote 3). Instead, these interviewees felt that there already was an abundance of resources in Australia developed by local agencies. These resources were more valuable due to their direct relevance to their context (table 3, quote 4). While the specific information presented in the IOC Statements was not deemed critical for the day-to-day management of athletes’ health, the bigger picture of topical coverage and strategy of the IOC was raised. Taking a key role to address broad and potentially contentious issues was a particular leadership opportunity for the IOC (table 3, quotes 5–8).
In both settings, it was identified that the IOC as custodian of the statements created a sense of reassurance of best practice, with the IOC regarded as an authoritative source with access to leading experts in the field (table 3, quotes 8–10). However, for some participants in the Australian setting, a sense of mistrust relating to the independence of authors, or accuracy of knowledge presented in the statements, was evident (table 3, quote 11 and 12).
The need for diverse representation among authors was a consistent theme in both settings, though more strongly presented by the South African interviewees (table 3, quotes 13 and 14). This meant the inclusion of authors from different genders, ethnicities, countries, skillsets and levels of experience. The inclusion of athletes in the process of developing knowledge was also considered important (table 3, quote 14).
Dissemination, awareness and access pathways
This theme describes how the IOC Statements are seen to be shared and accessed. Specifically, the interviewees describe their awareness of different topics covered and any barriers or enablers to accessing the IOC Statements.
There was no formal dissemination pathway to share the IOC Statements from the IOC to the NOC described by any participant. There was recognition that sharing the IOC Statements should be the role of the IOC, the NOC or other national professional sports medicine agencies. Yet equally, practitioners felt it was their own professional responsibility (whether as a committee member, physician, physiotherapist or other) to keep abreast of new and relevant information.
For the most part, the interviewees expressed a limited awareness of the IOC Statements and the scope of topics covered (table 4, quotes 1–4). Interviewees felt that their awareness of specific IOC Statements depended on the topic’s relevance in relation to their direct knowledge requirements or the type of conditions they were treating at that point in time (table 4, quotes 5 and 6). There was generally stronger awareness of IOC Statements covering contentious or topical issues such as concussion (table 4, quotes 7 and 8).
There was a reported abundance of knowledge resources to choose from in the Australian setting, with no restrictions to their access. Thus, the main challenge raised was prioritising knowledge gains, within the limited time available. Interviewees felt that having access to so many resources also meant they were potentially less likely to come across the IOC Statements (table 4, quotes 9 and 10). Alongside awareness of the IOC Statements, there were challenges navigating access, whether through an internet search or a specific search of the IOC website (table 4, quote 11). Generally, the IOC Statements were found by chance rather than by searching for them specifically. Once found, interviewees were not always clear that the publications were linked to the IOC specifically (table 4, quote 12).
In South Africa, perceived access barriers were strongly linked to the lack of a university/institutional affiliation that allowed a wide journal library or general (financial) difficulties accessing medical journal content (table 4, quote 13). South African interviewees were supportive of the need to drive awareness of these statements so that they could be better used. South African interviewees also felt a responsibility to know about and share these statements with colleagues both within South Africa and also in other African countries (table 4, quotes 14–16).
Positive examples of dissemination and access were also presented, whereby professional networks and communication among peers played a notable role. Interviewees with a recognised leadership position (inside or outside of the Olympic programme) were most aware of the current literature, including the IOC Statements. These leaders were generous with their colleagues and shared resources at meetings, through email and social media platforms (table 4, quotes 17–19).
Consensus in practice
This theme describes beliefs about the real-world application of the IOC Statements. Barriers and facilitators relating to the use of the IOC Statements reflected two major subthemes: the perceived value or benefit of the IOC Statements (table 5A) and their relevance for the intended audience impacting their usability (table 5B).
The IOC Statements were perceived to be ‘levelling the playing field’ by setting a minimum standard of care and removing ambiguity across settings (table 5A, quotes 1 and 2). The convenience of summarising best evidence, collated by experts, was noted (table 5A, quotes 3 and 4). This provided a sense of reassurance, especially when dealing with contentious or complex issues (table 5A, quotes 5 and 6). Similarly, interviewees felt that the impact was more tangible for topical IOC Statements. These IOC Statements changed how interviewees manage certain conditions, particularly topics linked to higher risk/fear, such as concussion (table 5A, quotes 5–9). Australian interviewees identified more value and need for these statements in low-income countries and smaller sports/federations (table 5A, quotes 10 and 11).
In general, interviewees in both settings were unsure about the overall impact of the IOC Statements on athlete health. In general, insufficient awareness of the IOC Statements was perceived to have hampered any potential influence on athlete health (table 5A quotes 11–14).
Relevance of the topic for interviewees’ current needs was positioned against time constraints to read everything (table 5B, quotes 15 and 18). This included clinical and practical relevance, whether the knowledge could be adapted to the interviewees’ context or if it was in line with their interest/background (table 5B, quotes 16–21). With relevance came a strong preference for the IOC Statements, particularly their conclusions, to have a clear and practical nature to support practitioners in evidence-based practice (table 5B, quotes 23 and 24). It was also noted that all consensus statements could become outdated, not just those from the IOC (table 5B, quote 25). Consistently and strongly noted in both settings was the lack of clarity on who the intended audience for each IOC Statement was (table 5B, quote 26–29). In South Africa specifically, there was a perception that more value is placed on consensus statements by those who were academically inclined (table 5B, quote 26).
Evidence-based resources, exemplified by the IOC Statements, are potentially valuable tools for translating knowledge into practice.10 As an internationally focused organisation leading guidance for sport and exercise medicine worldwide, it is important that resources developed by the IOC are relevant and accessible to all potential users. This paper presents an interview-based case study of members (doctors and physiotherapists) of the AOC and SASCOC in relation to their awareness and use of the IOC Statements, as well as their views about the relevance and impact of these statements for their athletes’ health needs. This study was unique in that it explored the awareness, uptake, relevance and perceived impact of the IOC Statements on athlete health and medical team management, from sports medicine practitioners in contextually diverse international settings. The findings are intended to inform future resource development and dissemination by the IOC to ensure this information exchange is most relevant and accessible to the widest possible international community’s needs.
Audience and purpose
The most stated view during the interviews was a perceived lack of clarity as to the purpose of the IOC Statements. This was commonly framed through questions from participants such as ‘who is the intended audience?’ and ‘what is the intention of the statements?’. These findings highlight a potential disconnect between the intended goal of the IOC Statements and stakeholders’ perceptions of them in both settings. This disconnect was also evident in interviewees’ questioning who should be responsible for (and involved in) the generation of knowledge, the content of this knowledge and the intended audience for its dissemination. Many participants asked about involvement of athletes in the selection of topics and forming of recommendations. Such findings resonate with other studies that have raised the importance of athletes’ inclusion and their voice in the decisions that eventually affect them.11–14
Application of the knowledge from the IOC Statements was also a space of confusion. Many interviewees considered the target of knowledge as Olympic/Paralympic athletes only. While elite athletes are the main focus of some topics, such as mental health,15 others address a broader range of ‘athletes’ with findings of relevance to, for example specifically in youth sports participants16 or to health in general populations.17
For their ongoing success, it will be important that discussion about the larger purpose behind, and target groups for, the IOC Statements is addressed by the IOC.
It was notable that in both settings, interviewees did not consider the IOC Statements as a first source when looking for information on athlete health. This is despite these participants being active stakeholders in the Olympic movement in their service to the NOCs. This finding suggests limited awareness of the IOC Statements as well as reflecting the discrepant views on the role of IOC in knowledge generation. Interviewees from Australia were less likely to look to the IOC for information, particularly on topics with rapidly changing or highly specific knowledge, such as management of knee injuries or asthma. This was because of the existing high-quality and region-specific resources already available to them, as has been previously reported.18 These localised resources are favoured because of their direct relevance and application. For these practitioners, a bigger challenge was stated to be navigating the vast information available in a time-efficient way to identify what is of most use to them.18 With specific knowledge needs already met, Australian interviewees stressed that the role of the IOC should lean more towards issues that are complex or need a big-picture view. Examples provided reflected integrity, ethics and policy needs across sport such as athlete inclusion and drug control. It must also be noted that within the Australian setting, a sense of mistrust in relation to the accuracy of knowledge or independence of consensus statement authors was reported. Future research should explore the underlying beliefs connected to these perceptions and the potential changes needed in the consensus statement process, for trust to be enhanced.
In contrast to the aforementioned data, South African participants placed higher value on IOC Statement availability with a strong desire to have information on both specific clinical topics and wider issues. This value was further reflected in the desire to share information broadly with colleagues across Africa. The IOC Statements have good potential to fill this need for sport and exercise medicine professionals for this purpose. However, perhaps implicitly, the IOC Statements have adopted a one-size-fits-all approach. Thus, recommendations within tend to reflect a best-case scenario with content and advice that are most useful for, and more readily actionable by, users from higher-resource settings. This application of findings has potentially occurred because of the dominant representation in authorship from the USA, Canada, Switzerland, Australia, the UK and Scandinavian countries.3 Importantly, the findings of our study have shown that the knowledge needs, as well as the actionable recommendations, are quite different even within the two countries of focus and the narrow field of sports medicine.
The contrasting findings in knowledge needs between the two case countries investigated, as well as general confusion on the purpose of the statements, suggests a need to include a wider group of stakeholders when determining topics to address, and ensuring a clear purpose and audience are identified in early stages of the IOC Statement development.
General lack of awareness and access
While recognising the value of the IOC Statements, without knowledge of their existence, the clinical guidance contained within cannot be adopted or used, no matter how relevant it is. Sharing of knowledge is an important component of knowledge management (the process of creating, sharing and distributing knowledge).19–21 The development of future statements and associated dissemination plans should explore the different requirements of diverse contexts in relation to knowledge availability more generally and specifically for those settings. This exploration should also give careful consideration to how knowledge can best be transferred between organisations (such as the IOC and Sports Medicine Commission (SMC)) within NOC and SMC. Finally, there is also a need for wider diffusion to individual stakeholders in the different settings and contexts.21 22 Many interviewees stressed the value of receiving information about the statements via their colleagues and peers, making use of WhatsApp (social platform) groups to share relevant research and resources. This tended to be ad hoc and dependent on existing professional networks. Establishing dissemination plans that clearly articulate the intended end users and target groups is critical for this to be a success.
Strengths and limitations
All interviewees were experienced sports and exercise medicine professionals affiliated with their Olympic/Paralympic/Youth Olympic committees in their respective countries. Despite this homogeneity, the findings reaffirmed the importance of context for knowledge translation23 24 and the importance of its consideration in both the development and dissemination of knowledge. It is not known if the views expressed by the interviewees from both South Africa and Australia are more broadly representative of those from other countries. Characterisation by resource level (eg, low, middle and high) does not necessarily reflect resource equity.25 Specifically, it should be recognised that South Africa is characterised by inequality, and only a proportion of the population benefits from economic prosperity and excellent healthcare access, including athletes in certain sports. In this sense, South Africa is comparatively well resourced in relation to many other countries of the African continent and globally. We recognise a need to assess the transferability of the study findings with a larger group of IOC stakeholders and healthcare practitioners, by more diverse authorship teams, in other sport contexts across the world.
Despite gaps in awareness, and a lack of clarity on purpose and intended audience, participants reported the IOC Statements had value for ‘levelling the playing field’ in terms of knowledge (especially in low-resource settings) and in providing reassurance for management of complex or contentious issues (for all settings). The statements reporting on issues of a contentious or topical nature were best known and perceived to have more impact on practice and policy. There is considerable opportunity to improve the IOC Statements through greater integration of end-user perspectives, as well as the diversity of contexts they represent. This includes prioritising the codevelopment of context-sensitive knowledge translation and dissemination plans in different settings. The unique leadership role of the IOC in sports medicine should be explored further so that future resources can be impactful and fit for purpose in all parts of the world. Considering the views and experiences of a wider group of stakeholders and settings than was the case in this study will be necessary for this.
Data availability statement
No data are available. All data are published, and therefore there are no additional data available. The authors will consider request to access to the raw data, within the constraints of privacy and consent.
Patient consent for publication
This study involves human participants and was approved by the ECU Human Research Ethics Committee (ethics number: 21497 FINCH) and Stellenbosch University Human Research Ethics Committee (ethics number: N19/04/045). Formal organisational support of two National Olympic Committees, the Australian Olympic Committee and South African Sports Confederation and Olympic Committee, was obtained to facilitate initial recruitment of committee members to the study. Participants gave informed consent to participate in the study before taking part.
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
LVF and MB are joint first authors.
Twitter @wderman, @CarolynAEmery, @Evertverhagen, @CarolineFinch
Contributors CFF and LVF designed the larger study that this research was aligned to with input from EV, KP, CE, MS and WD. LVF, MB and CB jointly developed the data collection and analysis approach. LVF, MB and CFF drafted the manuscript with critical input from all coauthors. All authors approved the final version for submission. LVF is study guarantor.
Competing interests Several authors have been contributors to the published IOC Statements referred to in this paper. CE coauthored the following statements: concussion and the developing youth athlete. WD coauthored the following statements: pain management in the elite athlete. WD and MS coauthored the prevention and management of chronic disease and the molecular basis of connective tissue and muscle injuries in sport. MS coauthored the following statements: periodic health evaluation of elite athletes, use of platelet-rich plasma in sports medicine and health consequences of a saturated sports calendar (parts 1 and 2).
Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.