2017 ISAKOS Biennial Congress ePoster #2007

 

Psychological Factors Affecting the Return-to-Sport Following a Shoulder Instability Episode: Validation of the SIRSI (Shoulder Instability - Return to Sport after Injury) Scale

Yoann Bohu, MD, Paris FRANCE
Shahnaz Klouche, MD, Paris FRANCE
Nicolas Lefevre, MD, Paris FRANCE
Serge Herman, MD, Paris FRANCE
Antoine Gerometta, MD, Paris FRANCE

Clinique du Sport, Paris, FRANCE

FDA Status Cleared

Summary

The SIRSI (Shoulder Instability-Return to Sport after Injury) scale is a valid scale, reproducible and can identify patients psychologically ready to resume their usual sport after an episode of shoulder instability, either after surgery or conservative treatment.

Abstract

Introduction

Among patients who don't return to sport after a surgical or conservative treatment of a shoulder dislocation or subluxation, some athletes had no subjective symptoms of instability. They are inhibited by fear of further injury or a lack of confidence in their shoulder. These psychological factors have been widely explored after anterior cruciate ligament (ACL) reconstruction. The ACL-RSI (ACL-Return to Sport after Injury) scale is a useful screening tool for patients who are not psychologically ready to return to sport after surgery. The main objective of the study was to propose and validate a scale to assess the impact of psychological factors on the return to sport after a shoulder instability episode whatever the treatment chosen.

Material And Methods

From the ACL-RSI scale, the term "knee" has been replaced by the term "shoulder". This beta version of Shoulder Instability-Return to Sport after Injury (SIRSI) was tested by a group of 10 athletes patients who underwent surgery for chronic post-traumatic anterior shoulder instability and adapted to the remarks of the test population. The final version was then validated according to international methodology COSMIN (consensus based standards for the selection of health status Measurement Instruments). A retrospective study included all rugby players licensed in the national rugby union who reporting a shoulder instability episode occurred on a rugby field during a match or training during the sports season 2012-2013. The scales used as reference questionnaires were WOSI and Walch-Duplay. At last follow-up, patients completed the 3 questionnaires online. The SIRSI scale was filled twice within few days. Statistical tests assessed the construct validity by a "r" correlation test of Pearson, the discriminant validity by a Mann-Whitney test, the internal consistency by Cronbach's alpha, the reliability by intraclass correlation coefficient "?" and the feasibility by the percentage of missing answers and the floor and ceiling effects.

Results

62 patients were randomly selected, mean age 26±5.2 years, 5 women/57 men, 70.9% professional players or competitors, with a mean follow-up of 4.6±1.6 years after the first episode of the shoulder instability. 30/62 (48.4%) underwent surgical shoulder stabilization at an average time of 1.6±1.2 years after this episode. The SIRSI was highly correlated to reference questionnaires (r=0.80, p <10-5). The average SIRSI score was significantly higher in case of return to rugby (60.9±26.6% vs 38.1±25.6%, p=0.001). Internal consistency of the scale was high (alpha=0.96). The reproducibility of the scale by the test-retest was excellent (?=0.93, 95%CI [0.89-0.96], p<10-5). All items were filled and the floor and ceiling effects were low (3.2%).

Conclusion

The SIRSI (Shoulder Instability-Return to Sport after Injury) scale is a valid scale, reproducible and can identify patients psychologically ready to resume their usual sport after an episode of shoulder instability, either after surgery or conservative treatment.