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

Abstract

Objective: To 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. Methods: Ovid 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. Results: Two 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 incongruence was noted in older military policies. Conclusions: This systematic review highlights the need for consistent recommendation across all branches of the military when it comes to returning service members to duty after EHI.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

The authors are military service member or employees of the U.S. Government. This work was prepared as part of their official duties. Title 17, U.S.C. SS105 provides that copyright protection under this title is not available for any work of the U.S. Government. Title 17, U.S.C. SS101 defines a U.S. Government work as work prepared by a military service member or employee of the U.S. Government as part of that person's official duties. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government. No external funding was received for this work.

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All data produced in the present work are contained in the manuscript.

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