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Substantial influence of psychological factors on return to sports after anterior shoulder instability surgery: a systematic review and meta-analysis

  • SHOULDER
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This systematic review and meta-analysis aimed to (1) determine the proportion of patients who underwent anterior shoulder instability surgery and did not return to sports for psychological reasons and (2) estimate differences in psychological readiness scores between patients who did and did not return to sports.

Methods

The EBSCOhost/SPORTDiscus, PubMed/Medline, Scopus, EMBASE and Cochrane Library databases were searched for relevant studies. The data synthesis included the proportion of patients who did not return to sports for psychological reasons and the mean differences in the psychological readiness of athletes who returned and those who did not return to sports. Non-binomial data were analysed using the inverse-variance approach and expressed as the mean difference with 95% confidence intervals.

Results

The search yielded 700 records, of which 13 (1093 patients) were included. Fourteen psychological factors were identified as potential causes for not returning to sports. The rates of return to sports at any level or to the preinjury level were 79.3% and 61.9%, respectively. A total of 55.9% of the patients cited psychological factors as the primary reason for not returning to sports. The pooled estimate showed that patients who returned to sports had a significantly higher Shoulder Instability-Return to Sport After Injury score (P < 0.00001) than those who did not, with a mean difference of 30.24 (95% CI 24.95–35.53; I2 = 0%; n.s.).

Conclusions

Psychological factors have a substantial impact on the rate of return to sports after anterior shoulder instability surgery. Patients who returned to sports had significantly higher psychological readiness than those who did not return to sports. Based on these results, healthcare professionals should include psychological and functional measurements when assessing athletes’ readiness to return to sports.

Level of evidence

Level IV.

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Data availability

The data supporting the findings of this study are available within the article and its supplementary materials. This research is a systematic literature review, and as such, it relies on previously published data. The sources of all data used in this study are cited in the references section.

Abbreviations

MINORS:

Methodological index for non-randomised studies

PERSiST:

Implementing PRISMA in Exercise, Rehabilitation, Sport medicine and SporTs science

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

RTS:

Return to sports

RTSA:

Return to sports at any level

RTSP:

Return to sports at the preinjury level

SIRSI:

Shoulder Instability-Return to Sport After Injury

TSK:

Tampa scale of kinesiophobia

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Clinica Universidad de los Andes, Av. Plaza 2501, Las Condes, 7620157, Santiago, Chile

    Ausberto Velasquez Garcia & Max Ekdahl

  2. Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA

    Ausberto Velasquez Garcia, Naoya Iida, Tomoyuki Kuroiwa, Kai-Lan Hsu, Rodrigo de Marinis & Glen Abdo

  3. Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile

    Rodrigo de Marinis

  4. Shoulder and Elbow Unit, Hospital Dr. Sótero del Rio, Santiago, Chile

    Rodrigo de Marinis

  5. Department of Graduate Medical Education, Internal Medicine Residence Program, St Mary’s General Hospital, Passaic, NJ, USA

    Glen Abdo

  6. Department of Basic Sciences, Touro College of Osteopathic Medicine, New York, NY, USA

    Glen Abdo

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  1. Ausberto Velasquez Garcia
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  2. Naoya Iida
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Correspondence to Ausberto Velasquez Garcia.

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Velasquez Garcia, A., Iida, N., Kuroiwa, T. et al. Substantial influence of psychological factors on return to sports after anterior shoulder instability surgery: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 31, 5913–5923 (2023). https://doi.org/10.1007/s00167-023-07652-0

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