The Shoulder Instability Return to Sports After Injury (SIRSI) Scale
A Comprehensive Review of Its Psychometric Properties, Clinical Utility, and Predictive Validity in Athletes Undergoing Surgical Stabilization
DOI:
https://doi.org/10.63403/re.v32i2.420Keywords:
Shoulder Instability, Psychological Readiness, Return to Sports, SIRSI Scale, Anterior Instability, Surgical Stabilization, Psychometric Properties, Predictive ValidityAbstract
The Shoulder Instability Return to Sports after Injury (SIRSI) scale assesses athletes’ psychological readiness to return to sports (RTS) following surgical treatment of anterior shoulder instability. Adapted from the ACL-RSI scale, SIRSI consists of twelve questions evaluating emotions, performance confidence, and risk assessment. Studies demonstrate SIRSI’s excellent internal consistency, test-retest reliability, and construct validity, effectively discriminating between athletes who successfully return to sports and those who don’t. A shortened five-item version (SIRSI-5) shows comparable properties while reducing patient burden. Research consistently reveals significant associations between SIRSI scores and RTS outcomes after shoulder instability surgery. Athletes with higher scores are more likely to return to sports, regain pre-injury performance levels, and experience better clinical outcomes. Additionally, the SIRSI scale correlates with recurrent instability risk, with psychologically unprepared athletes showing significantly higher recurrence rates. The scale provides a standardized method to quantify psychological readiness and supports comprehensive RTS decision-making that integrates physical, functional, and psychological aspects. Future research should explore SIRSI’s generalizability across different patient subgroups and surgical techniques, investigate its preoperative predictive value, and evaluate interventions aimed at improving psychological readiness. Incorporating SIRSI into clinical practice helps identify athletes who may benefit from additional psychological support, optimizing RTS rates and longterm outcomes after shoulder instability surgery.
This review aims to synthesize the current evidence on the SIRSI scale, exploring its psychometric properties, clinical utility, and predictive validity in athletes undergoing surgery for anterior shoulder instability.
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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 May;47(6):1507-1515. doi: https://www.doi.org/10.1177/0363546518780934. DOI: https://doi.org/10.1177/0363546518780934
Ialenti MN, Mulvihill JD, Feinstein M, Zhang AL, Feeley BT. Return to play following shoulder stabilization: a systematic review and meta-analysis. Orthop J Sports Med. 2017 Sep;5(9):2325967117726055. doi: https://www.doi.org/10.1177/2325967117726055. DOI: https://doi.org/10.1177/2325967117726055
Nwachukwu BU, Adjei J, Rauck RC, et al. How much do psychological factors affect lack of return to play after anterior cruciate ligament reconstruction? a systematic review. Orthop J Sports Med. 2019 May;7(5):2325967119845313. doi: https://www.doi.org/10.1177/2325967119845313. DOI: https://doi.org/10.1177/2325967119845313
Tjong VK, Devitt BM, Murnaghan ML, Ogilvie-Harris DJ, Theodoropoulos JS. A qualitative investigation of return to sport after arthroscopic bankart repair: beyond stability. Am J Sports Med. 2015 Aug;43(8):2005-2011. doi: https://www.doi.org/10.1177/0363546515590222.
Rossi LA, Tanoira I, Brandariz R, Pasqualini I, Ranalletta M. Reasons why athletes do not return to sports after arthroscopic Bankart repair: a comparative study of 208 athletes with minimum 2-year follow-up. Orthop J Sports Med. 2021 Jul;9(7):23259671211013394. doi:https://www.doi.org/10.1177/23259671211013394. DOI: https://doi.org/10.1177/23259671211013394
Gerometta A, Klouche S, Herman S, Lefevre N, Bohu Y. The Shoulder Instability-Return to Sport after Injury (SIRSI): a valid and reproducible scale to quantify psychological readiness to return to sport after traumatic shoulder instability. Knee Surg Sports Traumatol Arthrosc. 2018;26(1):203-211. doi: https://www.doi.org/10.1007/s00167-017-4645-0. DOI: https://doi.org/10.1007/s00167-017-4645-0
Webster KE, Feller JA, Lambros C. Development and preliminary validation of a scale to measure the psychological impact of returning to sport following anterior cruciate ligament reconstruction surgery. Phys Ther Sport. 2008 Feb;9(1):9-15. doi: https://www.doi.org/10.1016/j.ptsp.2007.09.003. DOI: https://doi.org/10.1016/j.ptsp.2007.09.003
Pasqualini I, Rossi LA, Brandariz R, Tanoira I, Fuentes N, Ranalletta M. The short, 5-Item shoulder instability-return to sport after injury score performs as well as the longer version in predicting psychological readiness to return to sport. Arthroscopy. 2023 May;39(5):1131-1138.e1. doi: https://www.doi.org/10.1016/j.arthro.2022.10.010. DOI: https://doi.org/10.1016/j.arthro.2022.10.010
Olds M, Webster KE. Factor structure of the shoulder instability return to sport after injury scale: performance confidence, reinjury fear and risk, emotions, rehabilitation and surgery. Am J Sports Med. 2021 Aug;49(10):2737-2742. doi: https://www.doi.org/10.1177/03635465211024924. DOI: https://doi.org/10.1177/03635465211024924
Hurley ET, Davey MS, Mojica ES, Montgomery C, Gaafar M, Jazrawi LM, et al. Analysis of patients unable to return to play following arthroscopic Bankart repair. Surgeon. 2022 Aug;20(4):e158-e162. doi: https://www.doi.org/10.1016/j.surge.2021.06.005. DOI: https://doi.org/10.1016/j.surge.2021.06.005
Rossi LA, Pasqualini I, Brandariz R, Fuentes N, Fieiras C, Tanoira I, et al. Relationship of the SIRSI score to return to sports after surgical stabilization of glenohumeral instability. Am J Sports Med. 2022 Oct;50(12):3318-3325. doi: https://www.doi.org/10.1177/03635465221118369. DOI: https://doi.org/10.1177/03635465221118369
Bohu Y, Abadie P, van Rooij F, Nover L; Société Française de Traumatologie du Sport; Berhouet J, et al. 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: https://www.doi.org/10.1007/s00167-021-06475-1. DOI: https://doi.org/10.1007/s00167-021-06475-1
Paul RW, Perez AR, Windsor JT, Osman A, Romeo AA, Erickson BJ. Analysis of reasons for failure to return to sport after Latarjet surgery: a systematic review. J Shoulder Elbow Surg. 2024 Jul;33(7):1642-1649. doi: https://www.doi.org/10.1016/j.jse.2023.11.006. DOI: https://doi.org/10.1016/j.jse.2023.11.006
Pasqualini I, Rossi LA, Hurley ET, Turan O, Tanoira I, Ranalletta M. Shoulder instability-return to sports after injury scale shows that lack of psychological readiness predicts outcomes and recurrence following surgical stabilization. Arthroscopy. 2024 Dec;40(12):2815-2824. doi: https://www.doi.org/10.1016/j.arthro.2024.04.030. DOI: https://doi.org/10.1016/j.arthro.2024.04.030
Tjong VK, Devitt BM, Murnaghan ML, Ogilvie-Harris DJ, Theodoropoulos JS. A qualitative investigation of return to sport after arthroscopic Bankart repair: beyond stability. Am J Sports Med. 2015 Aug;43(8):2005-2011. doi:https://www.doi.org/10.1177/0363546515590222. DOI: https://doi.org/10.1177/0363546515590222
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