Consensus meetings and statements are flawed by design

A narrative review with suggestions for improvements

Abstract

Consensus statements from the sport and exercise medicine community are now fairly common. More recently, the statements appear more prescriptive, strongly recommending particular approaches to research or treatment. The most recent statement on methods for reporting sport injury surveillance studies included an extension to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) reporting guidelines; STROBE guidelines are now official requirements for many journals. This suggests that investigators who use methods outside of these guidelines may have difficulty publishing their results. The challenge is that by definition, consensus is not unanimity. Therefore, consensus recommendations are sometimes considered flawed at a later date. This is expected if we gain new knowledge. However, the consensus methods themselves may also inadvertently lead to a suppression of contrary but valid opinions. The purpose of this narrative review it to propose a different model for consensus meetings and statements that embraces dissenting opinions, leading to increased transparency. In brief, the method is based on how Supreme Courts functions, allowing for both majority and one or more minority opinions. I illustrate how a consensus statement might be written using examples from four previous sport and exercise medicine consensus statements between 2005 and 2020. Such an approach will help ensure that clinicians, researchers and journals are not inappropriately influenced by recommendations from consensus statements, where experts continue to have important disagreements about the strength and interpretation of the evidence.