A General Framework for Exploring Ethical and Legal Issues in Sports Medicine.

BACKGROUND: Medicolegal dilemmas faced by Sports Medicine providers differ from those of other primary care physicians in type and frequency. Exotic, high-profile challenges are widely covered in the literature and offer guidance on how to navigate challenging situations. However, there is a gap in the literature on how to approach more mundane, but nevertheless common, medicolegal dilemmas. PURPOSE: The purpose of this article is to provide Sports Medicine providers simple tools for determining whether a course of action is legal or ethical and offer Sports Medicine educators a model for teaching these skills. METHODS: We searched U.S. federal and state law using the LexisNexis® database for laws regulating Sports Medicine practice, and PubMed for articles related to physician approaches to Sports Medicine legal and ethical challenges. Searches started with the term sports medicine, and included winnowing terms of ethics, ethical practice, ethical guidelines, law, and legal guidelines. We used current ethical practice guidelines followed by the American Medical Association and described in detail by Beauchamp and Childress. RESULTS: We offer a framework for how to approach legal challenges in Sports Medicine and apply it to four common scenarios that Sports Medicine physicians often face. We further suggest that the profession formally address this literature gap with a standardized curriculum in Sports Medicine law. CONCLUSION: A curriculum using this framework and clinical vignettes provides learners and practitioners with familiarity and confidence when legal and ethical challenges arise in Sports Medicine.

Is the Preparticipation Physical Examination Replacing the Annual Well Child Examination among Student Athletes?

BACKGROUND: The goal of the preparticipation physical examination (PPE) is to promote health and safety during competition by screening athletes for injuries and illness. Historically it has been reported that the PPE may be the only medical evaluation that many student athletes receive. Our objective was to evaluate whether student athletes who have participated in our PPEs also receive routine well child care. In addition, we investigated parental perspectives regarding what should be included during the PPE. METHODS: A 29-question survey was distributed to parents of student athletes during 6 PPE sessions sponsored and hosted at local school districts. Descriptive statistics were used to characterize and summarize the data set. RESULTS: A total of 288 surveys were completed. All our student athletes had a primary care provider (100%), with the overwhelming majority of student athletes (90.9%) having both a well child examination and a PPE annually. Approximately 89% of parents believed that electrocardiograms prevented sudden cardiac death in sports. The majority of parents believed the PPE was an appropriate setting to discuss mental health and substance abuse. CONCLUSION: The majority of student athletes complete both a well child examination and a PPE annually. Parents believe screening electrocardiograms are effective in preventing sudden cardiac death and that the PPE can prevent injuries from occurring. Parents also believe the PPE can serve as an opportunity to discuss mental health and substance abuse, which is consistent with the most recent PPE monogram. An educational handout should be provided to parents regarding the goals of the PPE.

Reliability, Validity, and Injury Predictive Value of the Functional Movement Screen: A Systematic Review and Meta-analysis.

BACKGROUND: The Functional Movement Screen (FMS) is utilized by professional and collegiate sports teams and the military for the prevention of musculoskeletal injuries. HYPOTHESIS: The FMS demonstrates good interrater and intrarater reliability and validity and has predictive value for musculoskeletal injuries. STUDY DESIGN: Systematic review and meta-analysis. METHODS: A systematic review and meta-analysis were conducted using a computerized search of the electronic databases MEDLINE and ScienceDirect in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Extracted relevant data from each included study were recorded on a standardized form. The Cochran Q statistic was utilized to evaluate study heterogeneity. Pooled quantitative synthesis was performed to measure the intraclass correlation coefficient (ICC) for interrater and intrarater reliability, along with 95% CIs, and odds ratios with 95% CIs for the injury predictive value for a score of ≤14. RESULTS: Eleven studies for reliability, 5 studies for validity, and 9 studies for the injury predictive value were identified that met inclusion and exclusion criteria; of these, 6 studies for reliability and 9 studies for the injury predictive value were pooled for quantitative synthesis. The ICC for intrarater reliability was 0.81 (95% CI, 0.69-0.92) and for interrater reliability was 0.81 (95% CI, 0.70-0.92). The odds of sustaining an injury were 2.74 times with an FMS score of ≤14 (95% CI, 1.70-4.43). Studies for validity demonstrated flaws in both internal and external validity of the FMS. CONCLUSION: The FMS has excellent interrater and intrarater reliability. Participants with composite scores of ≤14 had a significantly higher likelihood of an injury compared with those with higher scores, demonstrating the injury predictive value of the test. Significant concerns remain regarding the validity of the FMS.

The physical therapy prescription.

Physical therapy was first noted in the time of Hippocrates. The physical therapy visit includes a complete history, physical examination, and development of a treatment plan. Health care providers usually initiate a referral based on physical examination, symptoms, or a specific diagnosis. Physical therapy has been shown to be particularly helpful for musculoskeletal ailments, and has a growing body of evidence for use.

Evaluation and treatment of cervical radiculopathy.

The evaluation and treatment options for cervical radiculopathy continue to evolve as it becomes better defined and gaps in the literature are identified. This article provides a current synopsis of the definition, history, physical examination, imaging, and treatment options available.