Consistency and applicability of return to activity guidelines in tactical-athletes with exertional heat illness. A systematic review

Abstract

ABSTRACTObjectiveTo assess the consistency of return to sport and occupation recommendations following EHI provided in published clinical practice guidelines, consensus statements, position statements, and practice alerts. A secondary aim was to evaluate the consistency of medical policies governing the return to duty following EHI between the branches of the United States Armed Forces and the agreement with published recommendations.MethodsOvid MEDLINE, Web of Science, and CINAHL databases were searched for clinical practice guidelines and position statements published at any time that guided return to activity in individuals with EHI. Methodological quality was assessed and the specific recommendations for clinical management were extracted. Consistency of recommendations was evaluated.Agreement between published guidelines and the policies governing return to activity in military tactical athletes with heat injury were also evaluated.ResultsTwo professional societal guidelines provided recommendations pertaining to return to function following EHI. There was consistency between guidelines regarding recommendations that addressed abstinence from activity; medical follow-up; graded resumption of activity; and return to function. Pertaining to military policy, contemporary regulations published in recent years reflected the best evidence provided in the professional guidelines. The greatest incongruency was noted in older military policies.ConclusionsThis systematic review highlights the need for consistent recommendation across all branches of the military when it comes to returning servicemembers to duty after EHI.