Topics in Sports MedicineThe American Chiropractic Board of Sports Physicians Position Statement on Pre-Participation Examinations: An Expert Consensus
Introduction
As sport participation increases, so does the incidence of sport-related morbidity.1 One proposed method for reducing sport-related health problems is the use of the pre-participation examination (PPE). 2 Over 7 million young athletes participate in high school level sport annually.3 There are concerns that the burden of performing PPEs for this growing population may overextend the health care system and that health care providers do not uniformly follow current best practices when performing them.4
Pre-participation examinations are conducted to protect the health and welfare of individuals who participate in sport. Although there is a lack of consensus on screening strategies, the goals of the PPE are generally consistent which includes establishing safe participation for the athletes, and identification of risk factors and health problems that could lead to future incidents.5 The critical end point of the PPE is the clearance decision, but providers must also determine necessity of follow-up examination.
The American Chiropractic Board of Sports Physicians (ACBSP) recognizes that no health care provider has specialization in all aspects of medical practice and advocates co-management with physicians who specialize in the involved organ system for any case in which there is clinical concern that sport participation may be restricted or contraindicated. At present, there is no current, evidence-based position statement for doctors of chiropractic on preparticipation examinations for sport. Therefore, the ACBSP resolved to develop a position statement on this topic.
The purpose of this paper is to describe the PPE healthcare provide qualifications, examination performance and management issues specific to the following areas:
- 1.
Qualifications of doctors of chiropractic to perform a PPE.
- 2.
Identification of PPE performance standards.
- 3.
Best practices to obtain and synthesize the athlete health history and physical examination to formulate a clearance to participate in sport decision.
Another purpose of this position statement is to describe the roles and standards for qualified health care providers, including doctors of chiropractic, when performing the PPE.
Section snippets
Methods
In 2014, the Board of Directors identified a need to review and update the ACBSP position statements and practice guidelines in order to maintain consistency with evolving best practices. The ACBSP Board of Directors appointed a position paper committee of 5 ACBSP certificants. The purpose of the ACBSP Position Paper Committee was to review current ACBSP position papers to provide recommendations for consideration of revision or re-approval. The topic of the pre-participation evaluation was
Chiropractic PPE Qualifications
The ACBSP’s position on PPE is the following:
- 1.
Doctors of chiropractic with post graduate education and current ACBSP (DACBSP or CCSP) certification are qualified to perform PPEs and make clearance decisions in any patient population.6, 7
- 2.
Doctors of chiropractic without sports medicine certification may evaluate, diagnose, and manage a broad range of conditions, which may qualify them to perform PPEs based upon their individual clinical expertise, education, clinical acumen, and additional
PPE Performance Standards
The ACBSP’s position on PPE is the following:
General Physical Examination
The description of the general physical examination is depicted in Fig 1.
Clearance for Sport Participation
The decision to clear an athlete for sport participation is multifactorial:
- 1.
Co-management with a specialist in the organ system in question is recommended for cases in which there is clinical concern that sport participation may be contraindicated.
- 2.
Classification of sport type based on contact and cardiac demand should be considered when making clearance decisions.14
- 3.
Athletes presenting with underlying disabilities may be cleared for sport; however, additional evaluation may be required for
Discussion
This position paper provides an evidence-based overview for the performance of a pre-participation examination (PPE) and clarifies ACBSP’s stance that doctors of chiropractic with DACBSP or CCSP certifications are qualified to perform PPEs and make clearance decisions.
Chiropractic is the third largest health care profession in the United States and chiropractic education leads to a Doctor of Chiropractic (DC) degree.27, 28 The World Health Organization requires DC programs to engage students in
Limitations
This position statement was formed by expert consensus, and therefore is vulnerable to all flaws associated with expert consensus. A systematic review was not performed. The literature review is limited by the variable methodological quality of the included studies. Publication bias cannot be excluded.
Conclusion
The pre-participation examination is an important component of health care for the athletic population. Doctors of chiropractic with post graduate education and current ACBSP (DACBSP or CCSP) certification are qualified to perform PPEs. All health care providers should use evidence based practices such as described in this document when performing pre-participation examinations.
Funding Sources and Conflicts of Interest
No funding sources were reported for this study. The authors are members and board members of the ACBSP.
Acknowledgements
The authors thank Rebekah Vint and Nikki Skifstad for administrative support and the ACBSP Board of Directors for project oversight.
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