Discussion
There is a large volume of published research and strong clinical expertise in sport and exercise medicine practice globally. Much of this knowledge and expertise has been compiled into consensus statements and guidelines informed by context-specific expert groups, such as those coordinated by the IOC. This is the first study to assess the citation impact and reach of the IOC statements. The first main finding is that the IOC statements have been highly cited in the orthopaedic and sports medicine peer-reviewed literature, many at levels well above the field publication averages indicating that the statements can be regarded as having had a strong citation impact. The second main finding is that the academic reach of the IOC statements in terms of their citing literature is largely within the same countries of authorship as the original IOC statements.
Increasingly, the IOC has actively supported the publication of their consensus statements in peer-reviewed journals. This publication strategy has two main benefits. First, it provides additional assurance of quality, with the requirement for the statement to have undergone peer review processes. Second, it directly informs the sport and exercise medicine community, especially those who belong to the societies that have publishing agreements with the relevant journals. While such journals certainly have international reach, it is also the case that there are many parts of the world where ready access to such items is not possible due to a lack of resources and infrastructure. Publishing the IOC statements as open access can help to overcome this barrier to a degree; the IOC statements that were published open access were cited more (14 times higher than the world average of comparator publications from that year and area of research) than those not published open access (twice the world average). Open access also enables ease of distribution and sharing compared with the copyright and licensing restrictions imposed by the publisher for closed publications. For example, printed copies of open access publications can be freely distributed to those without reliable internet access, and not having to pay to obtain publications removes one barrier to access.
The choice of journal for publishing the IOC statements has been limited to a small number of journals, most notably the BJSM, which probably reflects the IOC’s formal commitment to supporting the publishing of targeted issues in that journal (see bjsm.bmj.com/pages/about). Increasingly, the IOC has also encouraged copublication across specialist journals as one way to further enhance their reach.
The FWCI data presented in this paper demonstrate that some of the IOC statements have achieved exceptionally high citation counts relative to other papers published in the same field and time of publication internationally. Even the IOC statements with the lowest FWCI values have citation counts above the expected world average of comparator publications from that year and area of research. The IOC statements with the greatest impact in the scientific literature, as measured by the FWCI, cover sports medicine topics of relevance beyond just the direct IOC stakeholders or competitive setting, but to sports medicine more broadly, such as load management and concussion. Overall, the IOC statements appear to have had a strong citation impact, with citations to them suggesting value for research. However, it is important to recognise that citation counts are only one tool for evaluation and are not without controversy and caution for their use as a measure of impact.8 9
The purpose of the IOC statements is to inform, support and guide sports medicine clinical practice. Social marketing theory and health promotion frameworks argue that before people will act, they first need to be aware of the advice, deem it relevant to them and need to be able to act on it.10–16 The IOC statements can only achieve this if their target audiences (sport and exercise medicine practitioners) are fully aware of them and deem them directly relevant to themselves and their real-world sports medicine clinical practice contexts. Our analysis has highlighted that there may be some challenges in this respect, particularly with authorship representation.
The authorship of the statements has been largely restricted to experts from well-resourced areas such as Northern America (the USA and Canada), Western Europe, Scandinavia, the UK and Australia. Moreover, several authors have contributed to multiple statements. There is a noticeable lack of contributors from many parts of the world, including Asia, Africa (excluding South Africa), the Middle East and Oceania. Our analysis also showed low citation of the statements outside of North America, Europe, UK and Australia. It is possible that the absence of perspectives, advice and considerations arising from expert contributors in these regions could suggest to sports medicine practitioners in those areas that the IOC statements are not relevant to them, or this finding might reflect publishing patterns more generally. The fact that the citing papers are being published in the same journals as the original IOC statements could suggest a similar audience for both, limiting their reach. It could also result from self-citation by the IOC statement authors or certain countries being better resourced for access to peer-reviewed sports medicine resources than others. It is recommended that for future statements, the IOC extends opportunities for contributions to the IOC statement to experts from outside of western Europe, North America, the UK and Scandinavia, to ensure that they truly do have international relevance. This inclusion will need to be balanced with expert views and might include contextualisation or translation of key concepts.
Not every sports medicine practitioner reads scientific journals, and even fewer write clinical or scientific papers in peer-reviewed journals that reference other papers they contain. The measure of citation impact presented in this paper was obtained from a bibliometric analysis of the scholarly peer-reviewed literature and so is based on reactions from a specific subset of the international sports medicine community only.
There were initially some challenges in identifying available documents for some IOC statements, even when there was a journal publication in a peer-reviewed journal. This was partly because of inconsistent terminology and branding of the statements, which reduced the value of search strings in search engines to identify them. Multiple sources of documents were explored to minimise the likelihood of overlooking any key documents. However, there is still the possibility that some of the relevant documents relating to a given IOC statement may have been missed. While this is a limitation of the research reported here, this issue reflects broader challenges that sports medicine practitioners may have when trying to source this information. There would be value in consistent terminology and branding being used by the IOC in the future to enable ready recognition of the IOC statements.
This study relied on a single publicly available citation database (ie, Scopus) to identify citations of the IOC statements only from peer-reviewed literature contained within the same citation database. While the information on the source and authorship country affiliation of the literature that had cited the ‘core’ IOC statements was summarised, it was beyond the scope of this study to explore details of citation patterns from that literature or to look further into details of gender, professional standing, or expertise of the authors. As noted in the introduction, the second goal of this work was the compilation of documents in readiness for evaluating practice and policy impacts through separately conducted studies.
