The role of the sports and exercise medicine physician in the National Health Service: a questionnaire-based survey

Confusion among doctors regarding sports and exercise medicine as a specialty: an Australian multidisciplinary, cross-sectional survey

OBJECTIVES

This cross-sectional study aims to characterise the understanding and attitudes medical practitioners have towards sports and exercise medicine (SEM). By identifying knowledge gaps, misunderstandings and barriers to SEM referral, interventions may be suggested to improve the integration of SEM within a multidisciplinary approach to healthcare.

DESIGN

A survey was constructed with a multidisciplinary expert panel. Refinement and consensus were achieved through a modified Delphi method. Both quantitative and qualitative data were analysed and intergroup comparisons made using χ2 test of independence and post-hoc paired comparisons.

SETTING

The questionnaire was distributed across Australian public and private health sectors, in community and hospital-based settings.

PARTICIPANTS

Australian medical doctors practising in specialties likely to intersect with SEM were invited; including general practice, orthopaedics, emergency, rheumatology and anaesthetics/pain. Invitation was uncapped with no reportable response rate. A total of 120 complete responses were collected RESULTS: The minority (42.5%) of respondents understood the role and scope of sports and exercise physicians. SEM was poorly recognised and comprehended, with the most common misconception being that SEM is solely for elite athletes and performance. Few (20%) doctors were familiar with referral pathways to SEM services. Lack of awareness, clear scope and public presence were seen as major barriers. There was near unanimous (92.5%) agreement that 'exercise is medicine'. A strong majority felt SEM would be valuable to collaborate with more in their current practice (63.3%) and as a part of the Australian public health system (82.5%). There were some significant differences among subgroups, including that junior doctors were more likely to express confusion about SEM.

CONCLUSIONS

Among non-SEM doctors, there is significant lack of clarity regarding the role of SEM and its optimal integration. Interdisciplinary education and addressing misconceptions may improve the contribution of SEM to community healthcare.

Creating a Sport and Exercise Medicine Masters syllabus for doctors: a Delphi study

Objective

Sport and Exercise Medicine (SEM) Masters curricula vary. This Delphi study is aimed to create a consensus curriculum for doctors undertaking SEM Masters courses.

Methods

A modified Delphi survey was used. An expert panel was established of individuals deemed to have adequate knowledge of the field. The research group developed the initial draft of the curriculum by collating and reviewing previously published UK-based postgraduate SEM-related curricula. There were two phases. In phase 1 the expert group either accepted, rejected or modified each learning objective (LO). During phase 2 the expert group were asked to accept or reject each LO that did not get accepted outright previously. The research group analysed the levels of agreements and the comments given by the expert panel after each phase.

Results

The expert panel consisted of 45 individuals, with 35 completing phase 2 (78% retention rate). Of the 136 LOs initially collated: 71 (52%) were accepted outright, 60 (44%) were altered in some way and reincluded in phase 2, and 5 (4%) were removed after phase 1. The research group added 2 (1%) new LOs on reflection over comments made by the expert panel. The final curriculum contained 133 LOs, divided into 11 subthemes.

Conclusions

The findings will better inform educators when developing SEM Masters curricula and inform students what they should look for when considering an SEM Masters. This consensus curriculum is an important step in standardising postgraduate SEM education.

Integrating sport and exercise medicine clinics into the National Health Service: a qualitative study

OBJECTIVES

To explore the services National Health Service (NHS)-based sport and exercise medicine (SEM) clinics can offer, and the barriers to creating and integrating SEM services into the NHS.

METHODS

Semi-structured interviews were undertaken to collect data from identified 'stakeholders'. Stakeholders were identified as individuals who had experience and knowledge of the speciality of SEM and the NHS. An inductive thematic analysis approach was taken to analyse the data.

RESULTS

N=15 stakeholder interviews. The management of musculoskeletal (MSK) injuries (both acute and chronic) and concussion were highlighted as the two key services that SEM clinics can offer that would most benefit the NHS. MSK ultrasound was also mentioned by all stakeholders as a critical service that SEM clinics should provide. While exercise medicine is an integral part of SEM, SEM clinics should perhaps not have a heavy exercise medicine focus. The key barriers to setting up SEM clinics were stated to be convincing NHS management, conflict with other specialities and a lack of awareness of the speciality.

CONCLUSION

The management of acute MSK injuries and concussion should be the cornerstone of SEM services, ideally with the ability to provide MSK ultrasound. Education of others on the speciality of SEM, confirming consistent 'unique selling points' of SEM clinics and promoting how SEM can add value to the NHS is vital. If the successful integration of SEM into the NHS is not widely achieved, we risk the NHS not receiving all the benefits that SEM can provide to the healthcare system.

How effective is the integration of sport and exercise medicine in the English National Health Service for sport related injury treatment and health management?

BACKGROUND

Regular participation in sport, exercise and physical activity (PA) is associated with positive health outcomes and form a mainstay of British public health policies. However, regular participation in sport and exercise can result in sport related injury (SRI) which, in turn, is a key cause of exercise cessation. The integration of Sport and Exercise Medicine (SEM) in the English National Health Service (NHS) aims to provide a specialist service for public populations and thus reduce the impact of SRI on exercise cessation and associated negative health outcomes. More broadly it aims to both support PA health promotion policies and improve healthcare organisations efficiencies through providing the most condition-appropriate treatment.

METHODS

This qualitative interview study examines patients' (N.=19) experiences of accessing and receiving SEM treatment within the English NHS.

RESULTS

The research demonstrates that referral pathways into SEM were often prolonged, characterised by multiple general practitioner (GP) visits and referrals into other musculoskeletal services, demonstrating an inefficient use of healthcare resources. Prolonged pathways fostered only limited recovery back to previous PA levels and other negative health behaviours, yet on accessing the SEM clinic, patients experienced progressive rehabilitation back into sport and exercise participation.

CONCLUSIONS

This study highlights the importance of more fully integrating SEM services into public healthcare as a way of improving the organisational capacity of healthcare in treating SRI and ensuring that citizens comply with state interventions which orchestrate health management through raising PA levels across the population.

General practitioners' attitude to sport and exercise medicine services: a questionnaire-based survey

AIM

Sport and exercise medicine (SEM) aims to manage sporting injuries and promote physical activity. This study explores general practitioners' (GPs) awareness, understanding and utilisation of their local SEM services.

DESIGN

A questionnaire survey, including patient case scenarios, was administered between February and May 2011.

PARTICIPANTS AND SETTING

693 GPs working in Cardiff and Vale, Leicester and Tower Hamlets were invited to participate.

RESULTS

244 GPs responded to the questionnaire (35.2% response rate). Less than half (46%; 112/244) were aware of their nearest SEM service and only 38% (92/244) had a clear understanding on referral indications. The majority (82%; 199/244) felt confident advising less active patients about exercise. There were divergent management opinions about the case scenarios of patients who were SEM referral candidates. Overall, GPs were significantly more likely to refer younger patients and patients with sport-related problems rather than patients who would benefit from increasing their activity levels in order to prevent or manage chronic conditions (p<0.01). GPs with previous SEM training were significantly more likely to refer (p<0.01). The majority (62%; 151/244) had never referred patients to their local SEM clinics but of those who had 75% (70/93) rated the service as good.

CONCLUSIONS

There is a lack of awareness and understanding among GPs on the role of SEM within the National Health Service which may be resulting in suboptimal utilisation especially for patients who could benefit from increasing their activity levels.

Developing a strategic research framework for sport and exercise medicine

BACKGROUND/AIM

Sport and exercise medicine (SEM) is a young, fast growing discipline. The need to broaden its evidence base has been established. The aim of the study was to compile a research-based strategic framework for the development of a sustainable research programme in SEM at a South African university.

METHODS

A literature review, internal document analysis, semistructured interviews with role players within the university and a Delphi process utilising a panel of international and national experts in research and SEM, were applied. Results were analysed and categorised regarding foundational aspects and operational components to create a sustainable research programme in SEM.

RESULTS

The foundational level of the framework consists of points of departure, premises and resources. Points of departure regarding SEM, the university, management, research and sustainability were identified. The premises for the research programme are relevance, currency, flexibility, implementability and a scientific base. Internal, institutional and external resources required by the programme were identified. The operational level was developed according to the W.K. Kellogg programme logic model. It consists of academic and management inputs; a central hub of activities which drives the programme; desired financial, human and academic outputs, and long-term qualitative and quantitative outcomes. The third level represents a sustainable research programme which is constantly monitored and reviewed.

CONCLUSIONS

The strategic framework provides guidelines for the development and sustainable management of an SEM research programme. It will make a substantial contribution to the research, further development, and ultimately the status of SEM in South Africa.

Nonelite exercise-related injuries: participant reported frequency, management and perceptions of their consequences

This mixed methods study explored the frequency of sport/exercise-related injuries in nonelite sport, participant-reported management and perceptions of potential injury consequences. Focus group participants, who trained two to four times a week and had previously sustained musculoskeletal sports-related injuries, reported seeking medical advice secondary to advice from teammates or online research. General practitioners were viewed as gatekeepers to specialist secondary care and less able to effectively treat sport-related injuries. Participants displayed limited awareness of potential future implications of injury, and considered physical and psychological benefits of exercise more valuable than potential injury-associated risks. In the survey of physically active people, over half reported sustaining an exercise-related injury (562/1002, 56%). Previously injured respondents were less likely to consider consulting a health professional for injury-related advice than those with no injury history (45% vs 64%; P < 0.001) and more likely to continue exercising despite injury (51% vs 37%; P < 0.001). Concerns about injuries largely related to short-term issues; only 32% were concerned about possible long-term joint problems including osteoarthritis. Exercise-related injury was common in nonelite exercise participants. There was some dissatisfaction with care pathways for sports-related injuries and a lack of awareness about appropriate injury management and potential consequences of injury, particularly in the long-term.