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Return to sport decisions after an acute lateral ankle sprain injury : introducing the PAASS framework - an international multidisciplinary consensus

Smith, MD; Vicenzino, B; Bahr, R; Bandholm, T; Cooke, R; De Michellis Mendonça, L; Fourchet, F; Glasgow, P; Gribble, PA; Herrington, LC; Hiller, CE; Lee, SY; Macaluso, A; Meeusen, R; Owoeye, OBA; Reid, D; Tassignon, B; Terada, M; Thorborg, K; Verhagen, E; Verschueren, J; Wang, D; Whiteley, R; Wikstrom, EA; Delahunt, E

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Authors

MD Smith

B Vicenzino

R Bahr

T Bandholm

R Cooke

L De Michellis Mendonça

F Fourchet

P Glasgow

PA Gribble

CE Hiller

SY Lee

A Macaluso

R Meeusen

OBA Owoeye

D Reid

B Tassignon

M Terada

K Thorborg

E Verhagen

J Verschueren

D Wang

R Whiteley

EA Wikstrom

E Delahunt



Abstract

Background
Despite being the most commonly incurred sports injury with a high recurrence rate, there are no guidelines to inform return to sport (RTS) decisions following acute lateral ankle sprain injuries. We aimed to develop a list of assessment items to address this gap.

Methods
We used a three-round Delphi survey approach to develop consensus of opinion among 155 globally diverse health professionals working in elite field or court sports. This involved surveys that were structured in question format with both closed-response and open-response options. We asked panellists to indicate their agreement about whether or not assessment items should support the RTS decision after an acute lateral ankle sprain injury. The second and third round surveys included quantitative and qualitative feedback from the previous round. We defined a priori consensus being reached at >70% agree or disagree responses.

Results
Sixteen assessment items reached consensus to be included in the RTS decision after an acute lateral ankle sprain injury. They were mapped to five domains with 98% panellist agreement-PAASS: ain (during sport participation and over the last 24 hours), nkle impairments (range of motion; muscle strength, endurance and power), athlete perception (perceived ankle confidence/reassurance and stability; psychological readiness), ensorimotor control (proprioception; dynamic postural control/balance), port/functional performance (hopping, jumping and agility; sport-specific drills; ability to complete a full training session).

Conclusion
Expert opinion indicated that pain severity, ankle impairments, sensorimotor control, athlete perception/readiness and sport/functional performance should be assessed to inform the RTS decision following an acute lateral ankle sprain injury.

Trial registration number
ACTRN12619000522112.

[Abstract copyright: © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.]

Citation

Smith, M., Vicenzino, B., Bahr, R., Bandholm, T., Cooke, R., De Michellis Mendonça, L., …Delahunt, E. (2021). Return to sport decisions after an acute lateral ankle sprain injury : introducing the PAASS framework - an international multidisciplinary consensus. British Journal of Sports Medicine, 55(22), 1270-1276. https://doi.org/10.1136/bjsports-2021-104087

Journal Article Type Article
Acceptance Date Jun 7, 2021
Online Publication Date Jun 22, 2021
Publication Date Oct 27, 2021
Deposit Date Sep 1, 2021
Publicly Available Date Sep 1, 2021
Journal British Journal of Sports Medicine
Print ISSN 0306-3674
Electronic ISSN 1473-0480
Publisher BMJ Publishing Group
Volume 55
Issue 22
Pages 1270-1276
DOI https://doi.org/10.1136/bjsports-2021-104087
Publisher URL https://doi.org/10.1136/bjsports-2021-104087
Related Public URLs http://bjsm.bmj.com/
Additional Information Additional Information : ** From PubMed via Jisc Publications Router **Journal IDs: eissn 1473-0480 **Article IDs: pubmed: 34158354; pii: bjsports-2021-104087 **History: accepted 07-06-2021
Access Information : This article has been accepted for publication in British Journal of Sports Medicine (BJSM), 2021, following peer review, and the Version of Record can be accessed online at http://dx.doi.org/10.1136/bjsports-2021-104087. © Author(s) (or their employer(s)) 2021.

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