Prasanna J Gamage, Saran Seker, Jessica Orchard, David Humphries, Kylie Fitzgerald, Jane Fitzpatrick. Insights into the complexity of presentation and management of patients: the Sport and Exercise Physician’s perspective. BMJ Open Sport & Exercise Medicine 2021;7:e001228. doi: 10.1136/bmjsem-2021-001228

You can find the full paper here

Tell us more about yourself and the author team

The authorship group is representative of the Australasian College of Sport and Exercise Physicians across the spectrum of members from associated researchers, prospective registrars and both early year and senior Fellows within the College. We are dedicated to ensuring the best standard of care for both our athletic population and the mainstay of our specialist practice population – you, the active people we aim to help every day.

What is the story behind your study?

Australia is known as the ‘land-of-the-long-weekend’ with sport a central component of the Australian lifestyle. The myriad of injuries and the increasing role of exercise as part of the management of chronic conditions means there is a range of health professionals engaged in this area. Within the field of Sport and Exercise Medicine, there is a recognition of the role that Physicians play in looking after elite athletes. Talking to Physicians on a daily basis, we found that they spend more of their time looking after the less elite but equally active population who have musculoskeletal injuries whilst trying to remain fit and active. In addition, the population who have chronic conditions such as diabetes or who are overweight and trying to regain mobility and function. This led us to explore what the workload is for a Specialist Sport and Exercise Physician in an effort to see what kind of impact we have on the Australian population and better define our role in the healthcare sector.

In your own words, what did you find?

Consistent with our suspicion, only 12% of patients were professional athletes. Patients seen by Sport and Exercise Physicians are much more complex than anticipated, requiring specialised and multidisciplinary care for long-standing predominantly musculoskeletal conditions. This complexity was demonstrated by the finding that more than half the patients had their diagnosis revised. More than three-quarters of patients in this study received exercise-based interventions in line with evidence for this in many chronic conditions. Patients were referred to many types of medical specialists and allied health practitioners recognizing that Sport and Exercise Physicians manage patients within a vibrant multidisciplinary hub offering care to a wide range of people from the young to the very old; representing the whole population not just the sporting community.

What was the main challenge you faced in your study?

The physicians contributed consecutive data over a three-month period capturing all new and review consultations during that time. We captured many patient experiences before and after their visits to the Sport and Exercise Physician but as not all patients choose to respond, this is a valuable snapshot of the patient experience. The biggest challenge was attempting a cost analysis for services including previous medical and allied health consultation visits, investigations and treatment. This would provide a cost-benefit insight but is complicated by many factors including limited access to previous records, lack of systematic recording of patient services and cost, and complexity of patient care that involve multidisciplinary services.

If there is one take-home message from your study, what would that be?

Around 90% of patients Sports physicians see are not elite athletes but come from the normal population across all age groups from the young to the very old. The patients present with a complex range of musculoskeletal and other issues, requiring multidisciplinary care. Sport and Exercise Physicians are well placed to provide this care and work in a dynamic hub including teams from other medical specialties and allied health practitioners. Government policymakers are encouraged to take these findings into account in making policy decisions regarding the provision of sport and exercise medicine services to the community.