Table 5

Substantiating quotes from interviews with Olympic stakeholders in Australia and South Africa relating to the theme of ‘consensus in practice’ (A) for value or benefit of the statements and (B) for relevance, audience and usability of the statements

Valuable as tool to level the playing field
1Because often, sports physicians are not on the same page. They're not current, so you can't speak the same language, because they're not updated yet, and the time to update with a colleague, there isn't always that time. So, at the Olympics, it was nice, because when we have these meetings where all the medical come together, they put it up there, and doctor reads it. Then it’s familiar to all of us, and I think they gave us a book of handouts and stuff. Because there’s too many personal opinions. That is just - it should be science. It should be facts or a consensus.South African interviewee 3
2I mean if they've got the information then it would follow that they would share the information. I mean it’s the greater good. You could then consider that all the countries are on a level playing field as well. Because if the IOC has a concussion policy or a concussion statement and then Australia get it and New Zealand get it, but America don't and South Africa don't, well then that’s, you know, so I think if the information is there at least making each of the national federations aware that it’s there and that it’s accessible, I think that follows and that’s logical.Australian
interviewee 3
Convenience and reassurance of having expertly collated evidence, especially for contentious topics
3Yes, I think the benefit is that - I mean there’s a group of experts who have come together to apply their minds, to how best to approach a specific problem, and therefore if you agree that there’s a problem and you agree to the approach there’s a certain comfort and confidence that clinically you're also subscribing to best practice. Also, that somebody has actually done the work for you in understanding and justifying that course of action.South African interviewee 1
4So, if I know it’s there and I've got a question on an athlete that - with mental health. I've got an issue, now I can quickly go and have a look, because I think a consensus is so intense and there’s so much research, they actually do the research for you, which is really brilliant.South African interviewee 6
5I think it gives you reassurance and especially maybe when you’re dealing into more the complicated decisions. Certainly, the cardiac stuff, the ECGs, and the monitoring of the athletes, I find it quite reassuring when I know that this is what’s generally out there and this is what’s accepted, and this is how you go about it. I find it reassuring and it helps me because I work very much alone.South African
interviewee 7
6I think everyone’s fearful of - there’s not evidence out there in concussion. But I think there’s sort of safety in numbers in you like. We’ve - most sports think if that they’re going by the international guidelines in that particular - management of that particular condition, then they’re not leaving themselves open to, you know, litigation and other issues down the track. Because even though we don’t know about neurodegenerative diseases and what the sequalae of concussion is long-term, we have a feeling that if you’re doing what’s best practice at the time as determined by a panel of experts, then that’s good enough.Australian
interviewee 4
Impact more tangible in highly topical statements
7I mean this group has certainly directed how we manage concussion so these kinds of statements and the fact that they're updated regularly, and they bring out new management tools for us to work with, I think those are continually evolving how we practice in relation to concussion. I think, as I said, I found the RED-S (Relative energy deficiency in sport) and disordered eating stuff helpful, but I think with so much of my day-to-day practice I'm using information acquired across a whole spectrum really.Australian
interviewee 2
8Facilitator: For instance the concussion consensus statement, do you find…
Interviewee: We use that (Concussion CS) black and white… because the rugby enforces it so much.
South African
interviewee 3
9It would be hard to say whether or not they have had impact I think, unless you were actually evaluating it. I think that they’ve at least created an awareness around concussion. That’s the one that’s probably changed the most over these, you know, three incarnations of it. I think that one is the one that would probably be best known out in the community…Australian
interviewee 4
Valuable for those who do not have as many resources
10For countries that are developing those skills and trying to develop the practitioners, to be able to reference these articles and get their students to read those resources I think is great. But I think for us they're only a small part of a massive wealth of information.Australian
interviewee 2
11Particularly I think they’re probably most beneficial for small sports that don’t have the infrastructure to do their own stuff around those things. So, for instance, in rugby league, we spent a lot of money looking at concussion and we do it in line with other contact sports in Australia primarily so that we’ve got some consistency across that. But in smaller sports, where they don’t have that - the resources to do that, I think that they’re ones that probably adopt the IOC - a lot of the IOC Statements as policy.Australian
interviewee 4
Extent of dissemination affects utility and potential impact
12The 2016 Concession Statement on Concussion, the Berlin Statement, is a good document for clinicians but what I would say is, if you were talking about what’s good for the community, I would say, how many people who are not, you know, pretty specialist doctors or physiotherapists or others, have actually read that position statement? How many people in the community have read that position statement and understood it? I would say not many. Whereas the easily digestible, downloadable resources for people in the community on concussion from that Berlin Statement, I don’t think that it’s anywhere. It’s a manuscript in a journal.Australian interviewee 5
13So clearly then we haven't succeeded in delivering the message because the problem still exists and so to a large extent it’s preventable.South African interviewee 1
14Yeah, so, I can’t say if they’ve had any impact, but I think that in some of them, the information has been disseminated and it’ll remain to be seen whether it has actually impacted health of athletes.Australian interviewee 4
15You know, what I would say the way I use them is it probably depends on what’s happening in my world at the moment. The most recent one that I looked at in the last fortnight was one on supplements because you may be aware, we had an Australian athlete who failed a drug test and so supplements, you know, they go up and down. Usually, they go up when there’s a crisis.Australian interviewee 5
16I think maybe half of them are going to be relevant to your clinical practice. So, I think that, for example, sex reassignment in sport, I'm not going to read that one because it’s just not relevant to my practice and I just don't have time. So, while it might be very interesting and thought provoking, in all honesty I've got 100 things to do, so that’s not one. Whereas some of the others might be more - concussion in sport, okay, I'd better read that one. Pregnancy in the elite athlete, I don't see pregnant women, so that’s probably down the order a bit. So, while it'd be great if you had the time to read them all, and your intention is, well, I'll get around to that, but the reality is often you don't.Australian
interviewee 1
17I would be selective in what I'm going to read that is relevant to me or not. I don't have the time to read all of them, so I will go and pick what’s relevant to me, and I think it’s going to be relevant to my sport or relevant to - for example, you get a patient with RED-S. So, I would like to go and see what is the management plan, not the consensus but out there. But I think people will be picky about what they read, whether it’s relevant for them or not, and for me, I come back to being practical. For me, I think I will actually skip medical advice that about connective tissue and injuries in sport, because it’s like why did it happen? But I'm more interested in how do I treat and prevent, number one - prevent something and treat something. I'm keen on prevention, so how do you prevent stuff coming up before a game? How do I prevent illness? How do I prevent stuff happening, and then if it does happen, what is the best way, evidence-based way of treating it?South African
interviewee 6
18I reckon the first one that really I got into was the eating disorders one I reckon. It was just because at that stage it seemed to be regarded as the go to article at that stage and that would be maybe 4 years ago, 5 years ago, I read the first one. I think there might have been an update since then…I used it as a conduit to getting these kids back into sport. I thought well, I need something that’s going to direct my, you know, an evidence-based way of directing how I manage these kids.Australian
interviewee 2
I think it’s probably in areas that we don’t have good policy ourselves, and areas that are relevant to our population and athletes.Australian
interviewee 4
Context and the extent of adaptability
19This is what the book tells you, there is my guidelines, there’s a Consensus Statement. I threw all that out the window to apply it on the day at the time. As much as these are guidelines and they are Statements, Consensus Statements, I think you can bend the rules to a certain extent, depending on circumstances. It’s individualised for you, for you and for me, you know?South African
interviewee 5
20We actually try and apply them to the best of our abilities. As you know, with certain criteria and certain - it’s a combination of first world standards and third world standards. That’s - and then it’s resources - resources based. Resources as in - for example, here in the country, with - our model is totally different.South African
interviewee 5
21I guess you're dealing with a population of people that have been in the field for probably 20 years, the guys who get to go to an Olympic Games. You're probably not going to develop your practice around a single protocol, it will be stuff that you've evolved over years.Australian
interviewee 2
22I think they’re - yeah, no. I do. It’s not that they’re not relevant to Australia. They’re just not as relevant to me, I’d say… But I think the topics overall are good ones…A lot of the things we do are probably not evidenced-based. As long as they’re doing no harm and you’ve tried all the evidence-based options first, I don’t see a problem with that. That’s, I think, in all sports medicine, when you’re at the professional level or the elite level, people want that - not just the cutting edge - but they want to be able to perform at important events and that doesn’t always lend itself to good evidence-based medicine.Australian
interviewee 4
Issues of clarity, providing clear guidance and being up to date
23My criticism of previous Concussion Statements would be that they - because there’s no clear-cut evidence - and evidence one way or the other - they don’t want to say something that’s not purely evidence-based. But that’s - the community needs guidance. They need clear - they need clarity.Australian
interviewee 5
24Some really don’t come up with any conclusion much at the end and it’s often because the evidence is too - or there’s not enough evidence out there for the consensus - for the topic they’re attempting to obtain a consensus for. But I think it gives you a very good overview of the literature in that area. So that even if there is no clear conclusion, you’re aware that, you know, there’s no specific direction you should have been going in. Again, a lot of them aren’t specific for treatment, they’re just sort of outlining the issue. It wouldn’t have any - I suppose in that instance, no practical advice. A lot of the Consensus Statements don’t have a lot of practical advice.Australian
interviewee 4
25See (interviewee is pointing to one of IOC statement topics), that’s old too, that’s been well and truly - that needs an update, I think.Australian
interviewee 6
Uncertainty around the target audience
26I think you’ll probably value the Consensus Statements if you’re more academically inclined to be very honest, I think. So, I’m trying to think back on all of them and how practically or clinically relevant they are because that’s what counts right.South African interviewee 1
27I think the question is, what is the IOC Consensus Statements for? Is it like when you travel with a team, or is it like the build-up in travel? Is it just normal athlete health? What is the role of a consensus? It would be nice just to read about it and when I treat athletes, but if I'm - that’s why I say, what is the reason for a consensus? What is the main focus of a Consensus Statement? Is it about treatment of a condition? That’s my question to you. What’s the reason for the IOC Consensus?South African
interviewee 6
28Well, who are they aimed at? I mean I think you need to just be clear. Is it aimed at the athletes, is it aimed at the clinician, or is it aimed at the coach, or is it aimed at everybody? Because I think depending on who it’s aimed at that should inform how you position it … Because it’s really long and practically speaking I know people don't read these but not this one at least. So, then it would be important for me to highlight (the main points).South African interviewee 1
29There should never be a position statement, in my opinion, from the IOC that doesn’t have a one-page infographic which is targeted at athletes, which takes all this complex and wonderful information from these 30, extremely talented doctors and physiotherapists and others, but condenses it into a one-page infographic that is meaningful for athletes. Because if we’re not doing that, I think it can be pointless. It can sit in a nice journal, and it can sit on a nice website, but never be seen by an athlete.Australian
Interviewee 5
  • IOC, International Olympic Committee.