Title : Six month Shoulder Instability-Return To Sport after Injury (SIRSI) scale predicts return to sport and Patient-Reported Outcomes (PROs) at 1-year after arthroscopic shoulder surgery in adolescent athletes
Abstract:
Background: Return To Sport (RTS) after shoulder stabilization surgery depends on both functional recovery and psychological readiness. The Shoulder Instability-Return to Sport after Injury (SIRSI) scale is a validated tool for assessing psychological readiness, but its role in predicting 1-year postoperative outcomes, including Patient-Reported Outcomes (PROs) and RTS success, has not been studied extensively.
Purpose: To evaluate the relationship between 6-month SIRSI scores and PROs and RTS at 1-year follow-up in adolescent patients after arthroscopic shoulder stabilization.
Study Design: Retrospective cohort study
Methods: Adolescent patients with shoulder instability who underwent arthroscopic shoulder surgery were included. SIRSI scores, which range from 0 to 100, were used to assess psychological readiness, with a score of 55 or higher indicating readiness for RTS. Additional PROs, including the American Shoulder and Elbow Surgeons (ASES) score, Tegner Activity Scale, QuickDASH, and Pediatric/Adolescent Shoulder Survey (PASS) score, were collected at 6 months and 1-year postoperatively. Spearman’s correlation was used to evaluate associations between 6-month SIRSI scores and 1-year PROs, while Mann-Whitney U tests compared SIRSI scores between RTS success and failure groups. Changes in PROs from 6 months to 1 year were assessed using the Wilcoxon signed-rank test.
Results: Twenty-three adolescent athletes (median age 16.99 years; 65.2% male) were included. Surgery was performed for anterior instability in 69.6% of patients. The dominant arm was involved in 69.6% of patients. Correlations were observed between 6-month SIRSI scores and 1-year ASES (ρ=0.42, 95% CI [0.01, 0.71]) and Tegner Activity Scale scores (ρ=0.51, 95% CI [0.12, 0.76]). The overall RTS rate was 73.9%. Athletes who returned to their primary sport had higher median 6-month SIRSI scores compared to those who did not return (78.3 % vs 46.7%, p=0.01). All participants showed statistically significant improvements in SIRSI, ASES, Tegner, QuickDASH, and PASS scores between 6 months and 1 year (p<0.05).
Conclusion: Psychological readiness assessed by SIRSI at 6 months is a significant predictor of 1-year functional recovery as demonstrated by patient-reported outcomes and RTS success. Athletes with SIRSI scores ≥55 were more likely to successfully return to sport, underscoring the scale’s utility in postoperative assessments.
Audience Take Away:
- At six months postoperatively, psychological readiness as measured by the SIRSI scale shows a significant association with return-to-sport outcomes and functional recovery metrics such as the ASES and Tegner Activity Scale at one year. This emphasizes the value of psychological assessments in addition to traditional functional evaluations.
- Six-month SIRSI scores may serve as an early predictor for athletes likely to achieve successful return to sport at one year, allowing clinicians to identify individuals who may benefit from additional targeted interventions during rehabilitation.
- By incorporating multidimensional tools such as SIRSI, ASES, Tegner, QuickDASH, and PASS, medical providers can gain a more comprehensive understanding of recovery trajectories and address both psychological and physical aspects of recovery to optimize outcomes in young athletes.
