Return to sport criteria for musculoskeletal injuries in high-performance athletes: a qualitative analysis

The aim of this study was to explore criteria for return to sport (RTS) across physical, psychological, social, and contextual domains from the perspectives of key decision-makers. In-depth semi-structured interviews were conducted with 15 clinicians [9 physiotherapists, 6 Sport and Exercise Medicine (SEM) doctors] working in elite-level clubs across Europe and Asia, averaging 70 minutes per interview. Data were transcribed, thematically analysed using the framework method, and triangulated with participants. Three core themes were identified: 1) definitions of RTS, 2) actors and processes, and 3) criteria for RTS. SEM doctors and physiotherapists were viewed as pivotal decision-makers, with athletes' preferences central. Findings support defining RTS as a continuum of phases and adopting a biopsychosocial, criteria-based, and shared decision-making approach. Consensus on relevant factors and athlete preferences is needed to guide future research, including trials and longitudinal studies assessing the efficacy of RTS protocols for musculoskeletal injuries.