Summary

The SIRSI score is a useful tool for predicting if patients are psychologically ready to return to sport after glenohumeral stabilization surgery.

Abstract

Background

Literature is scarce regarding the influence of psychological readiness in returning to sports after shoulder instability surgery.

Purpose

To evaluate the predictive ability of the SIRSI scale in measuring the effect of psychological readiness on return to sports and to compare it between athletes who returned to sports with athletes who did not return to sports.
Study Design: Prospective Cohort Study. Level of Evidence: II

Methods

A prospective analysis was performed of patients who underwent an arthroscopic Bankart repair or a Latarjet procedure between January 2019 and September 2020. Psychological readiness to return to play was evaluated using the SIRSI score. Preoperative and postoperative functional outcomes were measured by the ROWE, ASOSS, and WOSI scores. The predictive validity of the SIRSI scale was assessed by the use of receiver operating characteristic (ROC) curve statistics. The Youden index was calculated and used to determine a SIRSI scale cut-off point that best discriminate psychological readiness to return to sports. A logistic regression analysis was performed to evaluate the effect of psychological readiness on return to sports and return to pre-injury sports level.

Results

A total of 104 patients were included in this study. Overall, 79% returned to sports. The SIRSI scale had excellent predictive ability for return-to-sport outcomes (return to sports: area under ROC curve, 0.87 [95% CI, 0.80-0.93] return to pre-injury sports level: area under ROC curve, 0.96; [95% CI, 0.8- 0.9]). A cut-off level of = 55 was used to determine if an athlete was psychologically ready to return to sports and to return to pre-injury sports level (Youden index: 0.7 and 0.9, respectively) Of those who returned to sports, 99% were psychologically ready to return to play with a SIRSI median of 65 (IQR 35-41). In comparison, in the group that did not return to sports only 1% achieved psychological readiness with a SIRSI median of 38.5 (IQR 35-41) (p <0.001). Regression analysis for the SIRSI scale effect on return to sports was performed. For every 10-point increase in the SIRSI scale, the odds to return to sports is increased by 2.9 times Moreover, those who did not achieve their pre-injury sports level have shown poorer psychological readiness to return to play and SIRSI score results.

Conclusion

The SIRSI score is a useful tool for predicting if patients are psychologically ready to return to sport after glenohumeral stabilization surgery. Patients who returned to sports and those who returned to their pre-injury sports level were significantly more psychologically ready than those who did not return. Therefore, we believe that the SIRSI Score should be considered along with other criteria that are evaluated to decide if the patient is ready to return to sports.