In sport and exercise medicine (SEM), context is key. By context we mean: ‘What works?’ ‘for whom?’ ‘how?’ and under ‘what circumstances?’ These are four key questions for clinicians who aim to prevent injuries, treat patients and guide return to sport with athletes. To answer real-world challenges, clinicians will often bow to the Oxford levels of evidence and rely on findings of randomised controlled trials, (RCTs), systematic reviews (SRs) or meta-analyses. These methods are gold standards, recent debate1 notwithstanding. However, in dynamic, changeable and less-controlled sports environments (eg, soccer, rugby) where we strive to achieve optimal performance and health gains, we should challenge our own thinking and traditions to meet the demands of this unique environment. Recognising a shift to a greater need for implementation science,2 we should consider looking beyond the accepted gold standard. Typically, SRs focus on solely measuring and reporting intervention efficacy,3 they omit implementation context.4 The purpose of this editorial is to promote the value of realist synthesis—as a method that complements clinicians’ use of the traditional levels of evidence. Realist syntheses …

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运动和运动医学中的现实主义综合：“是时候变得真实了”

在运动和运动医学 (SEM) 中，背景是关键。就上下文而言，我们的意思是：“什么有效？” '为了谁？' '如何？' 在什么情况下？对于旨在预防伤害、治疗患者和指导运动员重返运动的临床医生而言，这是四个关键问题。为了应对现实世界的挑战，临床医生通常会屈服于牛津的证据水平，并依赖随机对照试验 (RCT)、系统评价 (SR) 或荟萃分析的结果。这些方法是黄金标准，尽管最近有争论1。然而，在动态、多变和控制较少的运动环境（例如足球、橄榄球）中，我们努力实现最佳表现和健康收益，我们应该挑战自己的思维和传统，以满足这种独特环境的需求。认识到对实施科学的更大需求的转变，2 我们应该考虑超越公认的黄金标准。通常情况下，SR 只关注测量和报告干预效果，3 他们忽略了实施背景。4 这篇社论的目的是提升现实主义综合的价值——作为一种补充临床医生使用传统证据水平的方法。现实主义合成…