For Doctors in a Hurry
- Clinicians lack standardized tools to manage the uncertain risks associated with playing football during pregnancy for amateur and professional athletes.
- Researchers used the knowledge-to-action cycle and intervention mapping to develop a clinical decision aid through a five-step validation process.
- Expert review yielded 100 percent approval, while a case study demonstrated 94 percent respondent proficiency in using the tool.
- The study concludes this decision aid supports informed participation choices for football players and their multidisciplinary medical teams during pregnancy.
- Physicians can utilize this validated framework to conduct health screenings and facilitate shared decision-making with pregnant athletes regarding sport safety.
Navigating Athletic Participation and Maternal Health
Pregnancy introduces complex physiological and anatomical shifts that require precise clinical navigation, particularly when managing active patients who face unique environmental risks [1]. While global health metrics indicate a steady decline in age-standardized disability rates among younger populations, the management of specific life stages like pregnancy remains a high-priority area for primary care and sports medicine [2]. Standardized reporting and evidence-based protocols are essential for ensuring that clinical advice remains consistent, transparent, and reproducible across different healthcare settings [3, 4]. However, the absence of sport-specific frameworks often leaves clinicians to rely on generalized exercise guidelines that may not account for the specific mechanical and contact risks associated with team sports. To address this clinical gap, researchers have developed a structured decision aid to evaluate the safety of football participation throughout the gestational period.
A Systematic Framework for Clinical Guidance
The primary objective of the study was to develop and validate a clinical decision aid designed to support informed football participation during pregnancy. To ensure the tool was both evidence-based and clinically applicable, the researchers founded its development on the knowledge-to-action cycle (a theoretical framework used to translate complex research findings into practical clinical protocols). Furthermore, the team applied intervention mapping and a knowledge transfer scheme, which is a systematic process designed to build health education programs and ensure that critical safety information effectively reaches relevant stakeholders. The development process followed a structured five-step methodology to ensure comprehensive coverage of the clinical and athletic needs of the players. First, the researchers conducted a scientific literature review to establish the current state of evidence regarding maternal and fetal health in contact sports. Second, they focused on identifying participation barriers and facilitators for pregnant football players, allowing the team to address the specific social, physical, and institutional factors that influence a patient's decision to continue or cease activity. Third, the authors concentrated on developing the objective and approach for the decision aid, ensuring the tool provided a clear pathway for shared decision-making in the clinic. Fourth, the team worked on identifying the key health screening components for the tool, providing the specific clinical metrics necessary for care teams to assess individual risk profiles.
Expert Validation and Clinical Proficiency
The final phase of the framework's development centered on an external review by a panel of experts currently active in the football environment. This multidisciplinary group included physicians, physiotherapists, and coaches, ensuring that the tool met the practical demands of both the clinical setting and the athletic field. To confirm the tool's clinical utility, the researchers conducted a preliminary usability, content, and criterion-validity assessment (a formal evaluation process to determine if the tool is user-friendly, covers all necessary medical considerations, and aligns with established standards for health screening). The validation results demonstrated a high level of consensus among the evaluators, as the decision aid received 100% approval from the expert reviewers. Beyond theoretical agreement, the researchers tested the tool's practical application through a case study to measure how effectively clinicians could apply the framework to real-world scenarios. This evaluation affirmed that 94% of respondents demonstrated proficiency in using the decision aid to navigate complex pregnancy management decisions. To further refine the instrument for daily practice, the authors utilized qualitative feedback from the respondents to enhance the clarity of the decision aid. This iterative refinement ensures that the final framework provides unambiguous guidance for medical professionals when balancing maternal and fetal safety with the physical requirements of competitive football.
Implementation Across the Multidisciplinary Team
The clinical utility of this decision aid extends across the entire spectrum of competitive play, as the researchers designed the framework to be applicable for amateur to professional-level football players. This broad scope ensures that clinicians can apply the same evidence-based standards whether they are treating a recreational athlete or an elite professional whose career depends on high-intensity physical performance. By standardizing the approach for all levels of competition, the tool addresses the historical lack of clear guidance for pregnant athletes, providing a structured pathway to evaluate the specific physical demands and contact risks inherent to the sport at various intensities. Effective management of the pregnant athlete requires a collaborative effort, and the tool is specifically intended for use by multidisciplinary teams. These teams, which typically include physicians, physiotherapists, and coaches, utilize the framework to support informed and quality decision-making regarding football participation during pregnancy. By involving multiple stakeholders, the decision aid facilitates a shared decision-making process that balances the patient's athletic goals with clinical safety. For the practicing physician, this structured communication ensures that all members of the care team are aligned on the risks and benefits, ultimately improving the quality of care and supporting patient autonomy throughout the gestational period.
References
1. Allotey J, Fernandez S, Bonet M, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ. 2020. doi:10.1136/bmj.m3320
2. Vos T, Lim SS, Abbafati C, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 2020. doi:10.1016/s0140-6736(20)30925-9
3. Page MJ, Moher D, Bossuyt PM, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021. doi:10.1136/bmj.n160
4. Moher D, Hopewell S, Schulz KF, et al. CONSORT 2010 Explanation and Elaboration: updated guidelines for reporting parallel group randomised trials. Journal of Clinical Epidemiology. 2010. doi:10.1016/j.jclinepi.2010.03.004
