Psychological factors influencing return to sport after shoulder stabilization: assessment tools and intervention strategies-a narrative review.

Background and Objective: Glenohumeral instability is common in young, competitive athletes and is frequently treated with surgical stabilization. This population presents a unique challenge for the sports medicine provider, with the common goal of returning to prior levels of sport (RTSP) potentially conflicting with the stabilizing operation. In addition to traditionally assessed physical factors, psychological and psychosocial factors have emerged as potentially affecting athletes' RTSP outcomes after shoulder stabilization and warrant consideration throughout the rehabilitation process and in clearance decision-making. However, these factors may frequently go unassessed and unaddressed in current practice. Therefore, the purpose of this review was to describe psychological factors that may influence athletes' RTSP outcomes after shoulder stabilization, discuss currently available tools for assessment of and potential interventions to address these factors and support improved outcomes. Methods: A review of the current literature on the psychological aspects associated with shoulder stabilization and RTSP was conducted to identify specific psychological barriers, aspects of recovery, assessment tools, and intervention methods. Key Content and Findings: Athletes who desire to RTSP after shoulder stabilization face many challenges and barriers during the recovery process. In addition to physical challenges throughout rehabilitation, the athlete experiences psychological challenges and states that, while common, they may hinder RTSP if left unaddressed. Recognition of an athlete's unique psychological characteristics and challenges and subsequently addressing them with appropriate interventions may support successful RTSP after shoulder stabilization. Conclusions: The prevalence of psychological factors that affect athletes' ability to RTSP after shoulder stabilization has become well known. General and disease-specific assessment tools are available to identify those who may benefit from psychological interventions alongside physical rehabilitation to support RTSP. Combining these interventions is often reported to have positive effects on known emotional and behavioral impairments displayed by athletes after shoulder stabilization and other injuries/surgeries, though more research is needed to describe specific interventions and their effects directly on RTSP outcomes in appropriately matched athletes. It is important for the clinician to recognize these psychological barriers and work with their patients to address them to maximize outcomes.