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Review
. 2023 Nov 29;11(11):23259671231207649.
doi: 10.1177/23259671231207649. eCollection 2023 Nov.

Psychological Factors That Affect Return to Sport After Surgical Intervention for Shoulder Instability: A Systematic Review

David Gibbs  1   2 , Noah Mallory  1   2 , Connor Hoge  1 , Grant Jones  1 , Julie Bishop  1 , Gregory Cvetanovich  1 , Ryan Rauck  1
Affiliations
Review

Psychological Factors That Affect Return to Sport After Surgical Intervention for Shoulder Instability: A Systematic Review

David Gibbs et al. Orthop J Sports Med. .

Abstract

Background: Recent advances have begun to identify the nonphysical factors facilitating successful return to sport (RTS) after shoulder instability surgery, yet little is currently known regarding psychological factors and RTS.

Purpose/hypothesis: The purposes of this study were to (1) identify psychological factors associated with RTS, (2) evaluate the prognostic utility of various psychological factors, and (3) evaluate the available metrics used to assess psychological RTS readiness. It was hypothesized that psychological factors would be identified as critical elements influencing a patient's RTS.

Study design: Systematic review; Level of evidence, 4.

Methods: Clinical studies reporting on the psychological determinants of RTS for patients who had surgery for shoulder instability between 1996 and 2022 were identified from MEDLINE, Embase, and Cochrane databases. Demographic, clinical, and psychometric properties were extracted for pooled weighted analysis.

Results: Of the 969 studies screened, 24 (2.5%) met inclusion criteria. Overall, 2135 patients were included (mean age, 26.0 years; range, 17.4-35.5 years; 84.7% male). The mean time to RTS was 6.8 months (range, 3.7-11.9 months). There was a 76.3% rate of any RTS; of the 1212 patients who reported level of play at return, 305 (25.2%) were unable to perform at their prior level. Psychological reasons were cited by 85% (n = 360) of patients who did not RTS. Fear of reinjury was the most common reason (n = 154; 42.8%); other psychological factors included lack of confidence (n = 46; 12.8%), anxiety (n = 45; 12.5%), depression (n = 44; 12.2%), psychosocial factors (n = 48; 13.3%), and lack of motivation (n = 23; 6.4%). The Shoulder Instability Return to Sport after Injury, Western Ontario Shoulder Instability Index, Quick Inventory of Depressive Symptoms Self Report, Degree of Shoulder Involvement in Sports, Tampa Scale of Kinesiophobia-11, and Veterans Rand 12-Item Health Survey were reported measures for assessing psychology and RTS.

Conclusion: Fear of reinjury was found to be the most commonly reported impediment to RTS. The psychological characteristics identified through this review may be incorporated into future RTS protocols seeking to address resilience and nonphysical factors associated with RTS.

Keywords: psychological readiness; return to play; return to sport; shoulder instability; sport psychology.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: C.H. has received honoraria from Musculoskeletal Transplant Foundation. G.J. has received honoraria from MTF Biologics. J.B. has received consulting fees from Stryker and Linvatec, nonconsulting fees from Smith & Nephew, and hospitality payments from Stryker. G.C. has received education payments from Arthrex and Smith & Nephew. R.R. has received education payments from Smith & Nephew and hospitality payments from Smith & Nephew. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of study inclusion and exclusion.
Figure 2.
Figure 2.
Results of meta-analysis of the included studies that (A) assessed for any return to sport and (B) assessed for return to prior activity level.
See this image and copyright information in PMC

References

    1. Abdul-Rassoul H, Galvin JW, Curry EJ, Simon J, Li X. Return to sport after surgical treatment for anterior shoulder instability: a systematic review. Am J Sports Med. 2019;47(6):1507-1515. doi:10.1177/0363546518780934 - DOI - PubMed
    1. Blonna D, Bellato E, Bonasia DE, et al.. Design and testing of the Degree of Shoulder Involvement in Sports (DOSIS) scale. Am J Sports Med. 2015;43(10):2423-2430. doi:10.1177/0363546515597485 - DOI - PubMed
    1. Bohu Y, Abadie P, van Rooij F, Nover L, Berhouet J, Hardy A. Latarjet procedure enables 73% to return to play within 8 months depending on preoperative SIRSI and Rowe scores. Knee Surg Sports Traumatol Arthrosc. 2021;29(8):2606-2615. doi:10.1007/s00167-021-06475-1 - DOI - PMC - PubMed
    1. Buckup J, Welsch F, Gramlich Y, et al.. Back to sports after arthroscopic revision Bankart repair. Orthop J Sports Med. 2018;6(2):2325967118755452. doi:10.1177/2325967118755452 - DOI - PMC - PubMed
    1. Burland JP, Toonstra JL, Howard JS. Psychosocial barriers after anterior cruciate ligament reconstruction: a clinical review of factors influencing postoperative success. Sports Health. 2019;11(6):528-534. doi:10.1177/1941738119869333 - DOI - PMC - PubMed

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