High- and low-value care in sport and exercise medicine: Areas for consideration

Abstract

High-value care and low-value care are concepts failing to receive attention in sport and exercise medicine. High-value care refers to an intervention that provides a benefit or where the probable benefit exceeds the risk of harm. Low-value care refers to an intervention that provides little-to-no benefit or where the risk of harm exceeds the probable benefit. To start the conversation, we apply the concepts of high- and low-value care to the use of imaging, opioids, injections, surgery, and exercise therapy in sport and exercise medicine. We conclude with suggestions to help sport and exercise medicine clinicians replace low-value care with high-value care. In summary: (a) Only order imaging if you suspect findings that will positively guide the direction of treatment; (b) To reduce opioid use, ensure an adequate trial of non-pharmacological and non-opioid treatments; (c) Only provide injections when an adequate trial of non-pharmacological treatments has failed, and the short-term benefits outweigh the risk of long-term harms; (d) Consider initial non-surgical management for cases where evidence suggests early surgery is not necessary (eg, anterior cruciate ligament tears); and (e) Promote independence with exercise therapy (instead of extensive supervision) when feasible, acceptable, and evidence suggests it has equivalent outcomes (eg, post-surgery).