The purpose of the project was to identify and reach consensus (≥70% agreement) regarding return to contact criteria and assessment modalities following traumatic anterior glenohumeral joint dislocations in rugby union players.
A three-round online Delphi consensus study was conducted. The questionnaire used was based on a systematic review of return to sport protocols, a scoping review of assessment modalities in rugby and a survey in a related population. This was piloted in four practitioners before being used in Round 1.
Thirty-three health and sport practitioners participated in Round 1 with 28 and 26 completing Round 2 and 3 respectively. The multidisciplinary panel included 15 physiotherapists. 11 orthopaedic surgeons, three sports physicians, two practitioners in biokinetics and two practitioners in exercise science. Practitioners had experience working in South Africa or Zimbabwe. Thirty criteria reached consensus for inclusion. These criteria included time frames, subjective ratings (including pain, apprehension, and player readiness) and clinical criteria (including clinical stability). Functional criteria such as range of motion, muscle function and proprioception of the glenohumeral joint and fitness along with rugby specific skill assessments were also recommended for inclusion. Assessment modalities such as Visual Analogue Scale Pain ratings, the anterior apprehension and relocation test and the observation of functional movements were among the assessment modalities recommended by over 70% of participants.
A comprehensive range of criteria were recommended to facilitate decision-making during return to contact following traumatic anterior glenohumeral joint dislocations. This may reflect the multifactorial nature of these decisions. Time frames should be used in conjunction with these criteria to guide the process, however, there is a lack of consensus regarding the optimal duration prior to return to contact. We therefore recommend that time frames should not be used in isolation. Although a broad range of criteria were recommended, the most appropriate assessment modalities and outcome measures to evaluate these criteria, particularly for the subjective, functional and rugby skills’ assessments require further development. A player-centred approach to return to contact should be emphasised with player’s feedback incorporated throughout the process.
The criteria and assessment modalities recommended should help to promote a holistic assessment of players alongside time frames. The involvement of a multidisciplinary team to facilitate shared decision making is recommended. The return to contact criteria and assessment modalities may also guide physiotherapists’ clinical decisions and priorities during management plans.
rugby
shoulder dislocations
