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Development and Validation of the Elbow Instability-Return to Sport After Injury (EI-RSI) Scale: Assessing
Pavel Kadantsev1, Ahmed Ellafi1,2, Sebastian Siebenlist1
1Department of Sports Orthopaedics, TUM University Hospital, Technical University of Munich, Munich, Germany.
Background:
Psychological readiness is an essential determinant of safe return to sport (RTS) after injury, yet it is often underrepresented in assessments of patients with elbow instability. The Elbow Instability-Return to Sport after Injury (EI-RSI) scale is a questionnaire designed to evaluate psychological readiness in athletes after lateral ulnar collateral ligament (LUCL) reconstruction for posterolateral rotatory instability of the elbow.
Purpose:
To develop and validate the EI-RSI scale.
Study Design:
Cohort study (diagnosis); Level of evidence, 3.
Methods:
The EI-RSI was developed from the anterior cruciate ligament return-to-sport index (ACL-RSI) and the shoulder instability return-to-sport index (SI-RSI) with input from 10 patients with LUCL reconstruction (10 elbow joints), then tested in a retrospective cohort (2015-2021). Validity was assessed by correlating with the Mayo Elbow Performance Score (MEPS) and the Patient-Rated Elbow Evaluation (PREE). Reliability was assessed using test-retest analysis. RTS was measured via a questionnaire assessing participation (yes/no), return to preinjury level, and time to return. Statistical analyses included the Mann-Whitney U test and the Cronbach alpha.
Results:
A total of 47 patients (47 elbow joints; mean age, 40.7 ± 13 years; 22 men) were analyzed, with a median follow-up of 77 months (interquartile range [IQR], 36-110). The EI-RSI demonstrated good construct validity, showing a moderate positive correlation with MEPS (r = 0.472; P < .001) and moderate negative correlations with the PREE total (r = -0.572; P < .001), PREE pain (r = -0.610; P < .001), and PREE function (r = -0.595; P < .001) scores. Test-retest reliability was excellent (Spearman rho = 0.965; P < .001; ICCsingle = 0.965 [95% CI, 0.935-0.981]; ICCaverage = 0.982 [95% CI, 0.966-0.991]). Internal consistency was high (Cronbach α = 0.982). Patients who returned to sport exhibited significantly higher EI-RSI scores (median, 91.3 [IQR, 83.2-94.6]) compared with those who did not (median, 77.5 [IQR, 52.5-91.7]; P = .017). No floor or ceiling effects were observed.
Conclusion:
Our study demonstrated that the EI-RSI is a valid and reliable instrument for evaluating psychological readiness to RTS after LUCL reconstruction for posterolateral rotatory elbow instability. Its clinical implementation may facilitate informed RTS decisions and identify patients who could benefit from psychological support before safely resuming athletic activity.
