2025 ISAKOS Biennial Congress ePoster
Validation of a Scale for Assessing Psychological Readiness to Return to Sport After Proximal Hamstring Tendon Tears
Svenja Höger, MD, Munich, BY GERMANY
Phillip Schulz, Cand. med., Munich GERMANY
Philipp Wilhelm Winkler, MD, Assoc. Prof., Linz AUSTRIA
Tilman Bondzio, M.Sc., Prien am Chiemsee, Bavaria GERMANY
Jose Fernando Sanchez Carbonel , MD, München GERMANY
Sebastian Siebenlist, MD, MHBA, Prof., Munich, Bavaria GERMANY
Lucca Lacheta, MD, München GERMANY
Maximilian Hinz, MD, Munich GERMANY
Department of Sports Orthopaedics, Technical University of Munich, Munich, Bavaria, GERMANY
FDA Status Not Applicable
Summary
This study validated the PHT-RSI scale for assessing psychological readiness to return to sport after proximal hamstring tendon tears, demonstrating its reliability and strong correlations with functional scores and pain, suggesting it can be a useful tool to examine which athletes need support regarding their psychological readiness to return to sport.
ePosters will be available shortly before Congress
Abstract
Purpose
The purpose of the present study was to introduce and validate the Proximal Hamstring Tendon–Return to Sport after Injury (PHT-RSI) scale, adapted from the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale, to assess psychological readiness for return to sport following proximal hamstring tendon (PHT) tears. It was hypothesized that the PHT-RSI scale would be a valid and reliable tool to assess athletes’ emotions, confidence, and risk appraisal when returning to sports following either non-operative or operative treatment of PHT tears.
Methods
Patients who underwent non-operative or operative treatment for PHT tears between 01/2012 and 12/2020 were eligible for inclusion in this study. Minimum 1 year postoperatively, patient-reported outcome measures, including the PHT-RSI, Perth Hamstring Assessment Tool [PHAT], Lower Extremity Functional Scale [LEFS], modified Harris Hip Score (mHHS), Tegner Activity Scale (TAS) and Visual Analog Scale (VAS) for pain at rest and during activity, were assessed. The internal consistency of the PHT-RSI scale was assessed using Cronbach’s alpha. Floor and ceiling effects were identified when 15% or more of the participants scored the minimum (0 points) or maximum (100 points) of the total score, respectively. Construct validity was determined by comparing the PHT-RSI scale with the LEFS, PHAT, and mHHS scores via Spearman’s rank correlation coefficients. Test–retest reliability of the PHT-RSI scale was determined by calculating the intraclass correlation coefficient (ICC) with 95% confidence intervals between the first and second administration of the scale. The ability to discriminate between patients who returned to sport and those who had not returned to sport was assessed using the Mann–Whitney U test.
Results
Thirty-nine patients were included in this study (mean age: 47.6 ± 14.8 years; 54% male). Twenty-nine patients (74%) returned to their preinjury TAS or higher. The PHT-RSI score had excellent reliability (Cronbach’s alpha = 0.99). Regarding construct validity, there was a positive correlation of the PHT-RSI with total points of LEFS (r=0.705, p<.01), PHAT (r=0.605, p≤0.01), and mHHS (r=0.660, p≤0.01). There was a negative correlation with pain at rest (r=-0.734, p≤0.01) and pain during activity (r=-0.734, p≤0.01). Participants who did not return to their previous levels of sport scored significantly lower on the PHT-RSI scale compared to those who returned to sport (no return to sport: 78.0 ± 12.8 points vs. return to sport: 86.0 ± 15.0 points; p=0.036).
Conclusion
The PHT-RSI scale is a valid tool for evaluating psychological readiness for return to sports after both non-operative and operative treatment of PHT tears. The PHT-RSI provides a standardized, objective tool for both clinicians and athletes to assess the appropriate timing for safely resuming sports activities following a PHT tear.