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

Michelle D Smith¹, Bill Vicenzino², Roald Bahr^{3

4}, Thomas Bandholm^{5

6}, Rosalyn Cooke⁷, Luciana De Michelis Mendonça^{8

9}, François Fourchet^{10

11}, Philip Glasgow^{12

13}, Phillip A Gribble¹⁴, Lee Herrington^{7

15}, Claire E Hiller¹⁶, Sae Yong Lee^{17

18}, Andrea Macaluso^{19

20}, Romain Meeusen²¹, Oluwatoyosi B A Owoeye^{22

23}, Duncan Reid²⁴, Bruno Tassignon²¹, Masafumi Terada²⁵, Kristian Thorborg^{26

27}, Evert Verhagen²⁸, Jo Verschueren²¹, Dan Wang²⁹, Rod Whiteley^{4

30}, Erik A Wikstrom³¹, Eamonn Delahunt^{32

33}

Affiliations

¹ School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia m.smith5@uq.edu.au.
² School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
³ Oslo Sports Trauma Research Centre, Norwegian School of Sports Sciences, Oslo, Norway.
⁴ Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
⁵ Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Department of Physical and Occupational Therapy and Department of Clinical Research, Copenhagen University Hospital, Copenhagen, Denmark.
⁶ Department of Orthopedic Surgery, Copenhagen University Hospital, Copenhagen, Denmark.
⁷ English Institute of Sport, Manchester Institute for Health and Performance, Manchester, UK.
⁸ Physical Therapy Department, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil.
⁹ Graduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil.
¹⁰ Physiotherapy Department, Hôpital de La Tour, Meyrin, Switzerland.
¹¹ Laboratoire Interuniversitaire de Biologie de la Motricité, UJM-Saint-Etienne, University of Lyon, Lyon, France.
¹² High Performance Unit, Irish Rugby Football Union, Dublin, Ireland.
¹³ School of Sport, Ulster University, Jordanstown, UK.
¹⁴ Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, Kentucky, USA.
¹⁵ Centre for Health, Sport and Rehabilitation Sciences, University of Salford, Salford, UK.
¹⁶ Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.
¹⁷ Department of Physical Education, Yonsei University, Seoul, South Korea.
¹⁸ Yonsei Institute of Sports Science and Exercise Medicine, Yonsei University, Seoul, South Korea.
¹⁹ Department of Movement, Human and Health Sciences, University of Rome 'Foro Italico', Roma, Italy.
²⁰ Villa Stuart Sport Clinic, FIFA Medical Centre of Excellence, Roma, Italy.
²¹ Human Physiology and Sports Physiotherapy Research Group, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
²² Department of Physical Therapy and Athletic Training, Doisy College of Health Sciences, Saint Louis University, Saint Louis, Missouri, USA.
²³ Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.
²⁴ Faculty of Health and Environmental Sciences, School of Clinical Sciences, AUT University, Auckland, New Zealand.
²⁵ College of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga, Japan.
²⁶ Sports Orthopedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Amager-Hvidovre University Hospital, Copenhagen, Denmark.
²⁷ Physical Medicine Rehabilitation Research-Copenhagen (PMR-C), Amager-Hvidovre University Hospital, Copenhagen, Denmark.
²⁸ Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, VUmc site, Amsterdam, Netherlands.
²⁹ School of Physical Education and Sport Training, Shanghai University of Sport, Shanghai, China.
³⁰ School of Human Movement & Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia.
³¹ Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
³² School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
³³ Institute for Sport and Health, University College Dublin, Dublin, Ireland.

PMID: 34158354
DOI: 10.1136/bjsports-2021-104087

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

Michelle D Smith et al. Br J Sports Med. 2021 Nov.

. 2021 Nov;55(22):1270-1276.

doi: 10.1136/bjsports-2021-104087. Epub 2021 Jun 22.

Authors

Affiliations

¹ School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia m.smith5@uq.edu.au.
² School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
³ Oslo Sports Trauma Research Centre, Norwegian School of Sports Sciences, Oslo, Norway.
⁴ Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
⁵ Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Department of Physical and Occupational Therapy and Department of Clinical Research, Copenhagen University Hospital, Copenhagen, Denmark.
⁶ Department of Orthopedic Surgery, Copenhagen University Hospital, Copenhagen, Denmark.
⁷ English Institute of Sport, Manchester Institute for Health and Performance, Manchester, UK.
⁸ Physical Therapy Department, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil.
⁹ Graduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil.
¹⁰ Physiotherapy Department, Hôpital de La Tour, Meyrin, Switzerland.
¹¹ Laboratoire Interuniversitaire de Biologie de la Motricité, UJM-Saint-Etienne, University of Lyon, Lyon, France.
¹² High Performance Unit, Irish Rugby Football Union, Dublin, Ireland.
¹³ School of Sport, Ulster University, Jordanstown, UK.
¹⁴ Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, Kentucky, USA.
¹⁵ Centre for Health, Sport and Rehabilitation Sciences, University of Salford, Salford, UK.
¹⁶ Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.
¹⁷ Department of Physical Education, Yonsei University, Seoul, South Korea.
¹⁸ Yonsei Institute of Sports Science and Exercise Medicine, Yonsei University, Seoul, South Korea.
¹⁹ Department of Movement, Human and Health Sciences, University of Rome 'Foro Italico', Roma, Italy.
²⁰ Villa Stuart Sport Clinic, FIFA Medical Centre of Excellence, Roma, Italy.
²¹ Human Physiology and Sports Physiotherapy Research Group, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
²² Department of Physical Therapy and Athletic Training, Doisy College of Health Sciences, Saint Louis University, Saint Louis, Missouri, USA.
²³ Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.
²⁴ Faculty of Health and Environmental Sciences, School of Clinical Sciences, AUT University, Auckland, New Zealand.
²⁵ College of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga, Japan.
²⁶ Sports Orthopedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Amager-Hvidovre University Hospital, Copenhagen, Denmark.
²⁷ Physical Medicine Rehabilitation Research-Copenhagen (PMR-C), Amager-Hvidovre University Hospital, Copenhagen, Denmark.
²⁸ Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, VUmc site, Amsterdam, Netherlands.
²⁹ School of Physical Education and Sport Training, Shanghai University of Sport, Shanghai, China.
³⁰ School of Human Movement & Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia.
³¹ Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
³² School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
³³ Institute for Sport and Health, University College Dublin, Dublin, Ireland.

PMID: 34158354
DOI: 10.1136/bjsports-2021-104087

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: Pain (during sport participation and over the last 24 hours), Ankle impairments (range of motion; muscle strength, endurance and power), Athlete perception (perceived ankle confidence/reassurance and stability; psychological readiness), Sensorimotor control (proprioception; dynamic postural control/balance), Sport/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.

Keywords: ankle; athletes; consensus; sport; sprains and strains.

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Conflict of interest statement

Competing interests: KT, TB, OBAO, ED and EV are on the BJSM Editorial Board.

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

MeSH terms

LinkOut - more resources

Full Text Sources