Return to play (RTP) is the process of returning an athlete to participate in his/her/their sport. Return to sport (RTS) is applicable to all sports and athletes. For the purposes of this consensus statement, RTS will be used to include both the process and the decision, focused on non-game-day RTS. It is important for the team physician to recognize RTS represents a continuum: return to participation, RTS, and return to performance. This progression can be applied for any sport, athlete, or injury/illness. The RTS decision is ongoing, is context dependent, and may change over time. The team physician has the central role in not only protecting the athlete`s health, but also protecting the athlete from coercion to participate. The final RTS decision should be led by the team physician as part of a shared decision-making process (SDM). This model remains the best practice in making the RTS decision. The process is dynamic, and decision points may change over time based on evolving information and risk. SDM is a model of patient-centered care that enables and encourages patients to participate in medical decisions that affect their health. It operates under two premises: - Patients empowered with information will participate in the medical decision-making process by asking informed questions and expressing personal values and opinions about their conditions and treatment options. - Physicians respect patients` goals and preferences and use them to guide recommendations and treatments. For the team physician, an athlete plays a central role in SDM, providing input and direction for the RTS decision. Other stakeholders may be involved in the process. SDM goals achieve athlete-centered care with these objectives: - Present the science and unknowns regarding the diagnosis - Summarize individual athlete risk profiles - Discuss evidence-based options and plans considering the athlete`s values and preferences Injury and illness are common in sport, and RTS decisions are made using a variety of established frameworks and criteria. The decision requires understanding the nature of the injury/illness and athlete- and sport-specific factors in the context of SDM. Challenges include the level of existing and evolving science and the lack of consensus in the clinical community. Age, sex, sport, time of season, athlete risk tolerance, and psychological readiness are other factors to consider in the RTS process. Physician and organizational risk tolerance and medicolegal issues should also be considered, along with existing policies and consensus recommendations
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