Return-to-Sport Clinical Decision Making in Orthopaedic and Sports Medicine Physical Therapy: A Survey of Practicing Clinicians

OBJECTIVE: To investigate whether a physical therapist’s (1) prelicensure professional entry-level degree or certification or (b) years of clinical experience in orthopedic or sports medicine practice was associated with the accuracy of return-to-sport decision making when presented with cases that may require withholding unrestricted sport participation. DESIGN: Survey-based comparative observational design. METHODS: Eight case studies provided synopses of musculoskeletal conditions. Each synopsis included psychometric and physical performance measures drawn from current literature. Respondents indicated whether they “would” or “would not” advise the athlete to return to sport. A score of 1 was assigned when a respondent’s return-to-sport decision aligned with the group consensus based on established criteria for each case; a score of 0 was given when it did not. Demographics included professional entry-level physical therapy education, years of experience, completion of postprofessional education (eg, academic doctoral degree [PhD, EdD, DSc] or residency/fellowship training) or postprofessional credentials such as an American Board of Physical Therapy Specialties (ABPTS) specialist certification. Two-way analysis of variance tested the effects of professional entry-level education and clinical experience on correct response rates; t tests compared outcomes between those with advanced credentials and those without. RESULTS: Among 242 responses, the mean consensus score was 5.2/8. Professional entry-level physical therapy education, clinical experience, and their interaction showed no significant effect ( P<.05). Respondents with academic doctorates had a mean score of 5.8/8, and those with ABPTS scored 5.3/8. Respondents without additional credentials had a mean score of 4.6/8. CONCLUSION: Postprofessional education and physical therapy specialty certification were significantly associated with return-to-sport decision-making accuracy among physical therapists. Years of experience and prelicensure professional entry-level degree or certification were not associated with decision accuracy. JOSPT Open 2025;3(4):1-9. Epub 20 August 2025. doi:10.2519/josptopen.2025.0163