Abstract
Objectives:
Literature is scarce regarding the influence of psychological readiness on return-to-play (RTP) after shoulder instability surgery. The shoulder instability-Return to Sport after Injury (SIRSI) score is a tool designed to predict whether patients are psychologically ready to return to sports after glenohumeral stabilization surgery. The objective of this study is to correlate SIRSI, and traditional measures including strength testing and Western Ontario Shoulder Instability Index (WOSI) survey with patient’s self-reported Single Assessment Numeric Evaluation (SANE) score during rehabilitation and at the time of RTP.
Methods:
All patients who participated in athletics who underwent arthroscopic labral repair for shoulder instability from June 2021 to December 2022 with a fellowship trained orthopaedic surgeon were eligible to participate. SIRSI and WOSI scores and strength testing (Biodex testing) were administered at 4 months postoperatively and every 2 months until clearance based on functional testing battery (>90% limb symmetry, strength, rate of force development, shoulder stability and endurance). Pearson Correlation coefficients were calculated for survey metrics between SANE with SIRSI, WOSI, and strength testing at final follow up. Strength of correlation coefficients was reported as very strong >0.80, strong (0.60-0.79), moderate (0.40-0.59), weak (0.20-0.39), and very weak (0.00-0.19).
Results:
Overall, 22 patients who cleared objective functional testing criteria and completed appropriate surveys at return to sport. There was a mean age of 19.8 years (range 11-44 years), with 12 males and 10 females, and the mean follow up was 11 months (6-24 months). The mean final SANE scores at these time points were 79.12 (25-100). Pearson correlation between SANE and SIRSI, WOSI at time of return-to-play was 0.92, and 0.67 respectively.
The correlation coefficients for strength testing at varying positions including closed kinetic chain upper extremity stability test, posterior shoulder endurance test LSI, and peak force in Y, T, I positions LSI were weak to moderate (0.20-0.59).
Conclusions:
The SIRSI had a stronger correlation than WOSI to patients self-reported return to baseline (SANE scores). This finding highlights the importance of psychological readiness in return to sport compared to traditional measures of strength testing and WOSI scores. SIRSI should be incorporated into functional test batteries for shoulder instability.