Factor Structure of the Shoulder Instability Return to Sport After Injury Scale: Performance Confidence, Reinjury Fear and Risk, Emotions, Rehabilitation and Surgery

Abstract

Background: Rates of return to play after shoulder dislocation vary between 48% and 96%, and there has been scant attention given to the psychosocial factors that influence return to play after a shoulder injury. Purpose: To establish the factor structure of the Shoulder Return to Sport after Injury (SI-RSI) scale and examine how the SI-RSI is associated with the Western Ontario Shoulder Instability Index (WOSI). Study Design: Cross-sectional study; Level of evidence, 3. Methods: The SI-RSI is designed to measure psychological readiness to return to play after shoulder dislocation and was administered to participants who had at least 1 episode of shoulder dislocation and were planning or had returned to sports. The WOSI was also completed by the participants, and descriptive data were gathered. Reliability (Cronbach α) and factor analysis of the SI-RSI were undertaken. Correlations between the SI-RSI and WOSI were made, and differences between various patient subgroups (first-time dislocations vs multiple episodes of instability, surgery vs no surgery, return to sports vs no return) were analyzed. Results: The SI-RSI had high internal consistency (Cronbach α = 0.84) and was shown to have 4 distinct factors that represented the following constructs: performance confidence, reinjury fear and risk, emotions, and rehabilitation and surgery. Moderate correlations were seen between SI-RSI and WOSI scores. Participants who had undergone surgery scored significantly lower on the reinjury fear and risk subscale of the SI-RSI ( P = .04). Those who had sustained multiple dislocations were significantly more concerned about having to undergo rehabilitation and surgery again ( P = .007). Participants who had returned to sports had significantly greater fear and thought they were more at risk of reinjury ( P = .02). Conclusion: Athletes return to sports after a shoulder dislocation despite reporting high levels of fear and concern for their shoulder. High levels of fear and concern may underpin why rates of recurrent shoulder instability are so high. Four distinct elements of psychological readiness appeared to be present in this patient group.

Relationship of the SIRSI Score to Return to Sports After Surgical Stabilization of Glenohumeral Instability

“…12,14 Drawing from the ACL-RSI score, 35 Gerometta et al 12 proposed and validated the Shoulder Instability-Return to Sport after Injury (SIRSI) score to quantify the psychological readiness of athletes to return to sports after shoulder instability. Although the SIRSI has been used in several studies, 5,12,[14][15][16]26 few have analyzed the results between athletes who returned to sports and those who did not. 5,12,14 Hurley et al 14 showed that patients who did not return to sports exhibited poor psychological readiness compared with those who returned to sports after ABR.…”

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“…Either kinesiophobia does not differ between traumatic and atraumatic instability and primary or recurrent instability, or current measures of kinesiophobia are not responsive in people with shoulder instability. More recent PROMs, such as the Shoulder Return to Sport after Injury scale, may be more relevant to assess fear of re-injury, confidence and emotions, for people with glenohumeral dislocations (Olds & Webster, 2021).…”

“…Lower emotional and mental health function were associated with initial pain and function in patients with rotator cuff tears (Coronado et al, 2018;Wylie et al, 2016) and those with chronic shoulder pain (Martinez-Calderon et al, 2018). Apprehension or fear of re-injury or pain is common following glenohumeral dislocations (Olds & Webster, 2021) and for patients with higher levels of pain (Lentz et al, 2009). Such fear or fear-avoidance beliefs can influence persistence of pain and disability (Gottlieb & Springer, 2021;Martinez-Calderon et al, 2018) and influence decisions for return to work, sports or recreational activities (Lädermann et al, 2016;Olds & Webster, 2021).…”

“…Apprehension or fear of re-injury or pain is common following glenohumeral dislocations (Olds & Webster, 2021) and for patients with higher levels of pain (Lentz et al, 2009). Such fear or fear-avoidance beliefs can influence persistence of pain and disability (Gottlieb & Springer, 2021;Martinez-Calderon et al, 2018) and influence decisions for return to work, sports or recreational activities (Lädermann et al, 2016;Olds & Webster, 2021). High levels of self-efficacy and higher patient expectations are associated with improved clinical outcomes for shoulder pain (Chester et al, 2018;Chester et al, 2019) and with lower levels of pain and disability (Martinez-Calderon et al, 2018).…”

Ultrasound Assessment of Anterior Humeral Head Translation in Patients With Anterior Shoulder Instability: Correlation With Demographic, Radiographic, and Clinical Data

“…According to the National Collegiate Athletic Association Injury Surveillance System, shoulder injury is the third most common injury after knee and ankle injuries, and glenohumeral instability accounts for 23% of total shoulder injuries. 23 Persistent shoulder instability limits the participation of athletes in their regular sports and physical activities 21 , 36 and is treated nonoperatively or surgically. 2 To objectively assess anterior humeral translation, the load and shift test or the anterior drawer test is used in clinical settings.…”