评估肩关节失稳手术后是否准备好重返运动场的客观方法尚未标准化：系统回顾

Q3 Medicine Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2024-10-01 DOI:10.1016/j.asmr.2024.100978

Heather Myers P.T., D.P.T., A.T.C. , Kristina Wulff P.T., D.P.T., A.T.C. , Christopher Antonelli P.T., D.P.T., A.T.C. , Steven Bokshan M.D., M.B.B.S. , Stephanie Hendren M.L.I.S., A.H.I.P. , Brian C. Lau M.D.

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引用次数: 0

摘要

目的报告用于评估肩关节不稳定术后恢复运动准备情况的客观测量方法。方法我们的系统性综述纳入了对肩关节不稳定术后活跃个体进行评估的研究，这些研究至少包含一项患者报告的结果或身体表现测量方法。我们排除了非创伤性不稳定性研究、仅报告成像的研究或生物力学研究。结果37篇入选文章在 "非随机研究方法学项目 "中的得分中位数为18.5（比较）和10.0（非比较），在 "重返运动价值评估 "中的平均得分为2.5。19 项研究采用了 12 项患者报告结果来评估疼痛、功能和心理准备情况，其中以西安大略省肩关节指数和肩关节不稳定性恢复运动指数的报告最为常见。18 项研究报告了力量，其中最常见的是内旋和外旋，18 项研究报告了活动范围。体能测试（6 项离散测试和 1 项综合评分）的报告频率较低（8 项研究），但有 1 项以上的研究报告了闭合运动链上肢稳定性测试、上肢 Y 平衡测试和单侧坐姿投篮测试。结论大多数接受肩关节稳定手术的患者都恢复了基本力量和活动范围。结论大多数接受肩关节稳定术的患者都恢复了基本力量和活动范围，但一些研究指出，术后6个月内难以达到足够的运动表现指标。由于缺乏标准化的测量方法，因此无法为临床决策提供具体测试内容的建议和基准数据。证据级别IV级，对III级和IV级研究的系统性回顾。

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Objective Measures for Assessing Readiness to Return to Sport After Shoulder Instability Procedures Are Not Standardized: A Systematic Review

Purpose

To report objective measures utilized to assess readiness to return to sport after shoulder instability procedures.

Methods

Our systematic review included studies if they assessed active individuals after a shoulder instability procedure with at least 1 patient-reported outcome or physical performance measure. We excluded studies of atraumatic instability, studies only reporting imaging, or studies of biomechanics. Risk of bias was assessed with the Methodological Items for Non-Randomized Studies tool, and studies were further scored with the Return to Sport Value Assessment.

Results

Thirty-seven articles selected for inclusion scored a median of 18.5 (comparative) and 10.0 (noncomparative) on the Methodological Items for Non-Randomized Studies and a mean of 2.5 on the Return to Sport Value Assessment. Twelve patient-reported outcomes were utilized across 19 studies to assess pain, function, and psychological readiness, with the Western Ontario Shoulder Index and the Shoulder Instability Return to Sport Index reported most frequently. Eighteen studies reported strength, most commonly internal and external rotation, and 18 studies reported range of motion. Physical performance tests, 6 discrete tests and 1 composite score, were less frequently reported (8 studies), with the Closed Kinetic Chain Upper Extremity Stability Test, Y-Balance Test of the Upper Quarter, and Unilateral Seated Shot-Put Test reported in more than 1 study. Deficits in patient-reported outcomes and limb symmetry persisted at the time of return to sport.

Conclusions

Most patients undergoing shoulder stabilization procedures regained fundamental strength and range of motion. However, some studies noted difficulties in achieving sufficient performance metrics for athletic activities 6 months postsurgery. Due to lack of standardized measures, recommendations for specific test components and benchmark data for clinical decision-making are not available.