Wearable technology in the sports medicine clinic to guide the return-to-play and performance protocols of athletes following a COVID-19 diagnosis

Figures

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  Figure 1.. The balance between sport-specific and local tissue capacity in healthy athletes and those return to play and performance following a positive COVID-19 diagnosis. In healthy athletes, the prescription of training load prioritizes the development of sport-specific and local tissue capacity to improve performance and minimize injury risk. For athletes diagnosed with COVID-19 and seeking a return to training and subsequent competition, the prescription of training load in this population prioritizes the development of local tissue loading to decrease pain and inhibition and increase function to mitigate injuries that may manifest from inopportune modulations in workload. Maintaining a balance between local tissue loading and sport-specific loading via the measurement of biomarkers, physiological markers, or movement-based markers is critical to quantify and complement athlete-reported outcome measures recorded by athletic trainers and physical therapists. Modified with permission from BMJ Publishing Group Ltd. 100

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  Figure 2.. Implementation of wearable technology for cardiopulmonary and musculoskeletal monitoring for athletes following a positive COVID-19 infection. Return to play assessment is left to the discretion of the medical staff for athletes who have moderate illness or initial cardiopulmonary symptoms. Figure adapted and modified from Kim et al., 65 Phelan et al., 69 Writing Committee et al., 71 Drezner et al., 146 and Phelan et al. 147

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  Figure 3.. Operational workflow detailing the implementation of wearable sensors into the clinic to enable the transition from the return to play to return to performance level. (1) Changes in vitals measured from wearable technology necessitate the athlete to get tested for COVID-19. A positive test coupled with the athlete reporting symptoms are reported to the team physician. (2) Following an extended quarantine period, the athletic trainer monitors the athlete's response to the workouts using wearable sensors until the athlete is able to make a meaningful improvement in overall performance by meeting a minimal clinically important difference (MCID) score which factors in any pain, functionality, and movement deficits during the rehabilitation sessions. The athlete will then be monitored until they meet acceptable internal and external workload thresholds compatible with other age- and sport-matched healthy controls (analogous to patient acceptable symptom state). (3) As the athlete is cleared to return to play, the tests are repeated and the athlete is assessed comparing their current performance to their prior healthy and competitive level of performance, in part analogous to achieving…