A Scoping Review of Biopsychosocial Outcome Measures Used for Patients with Shoulder Instability.

BACKGROUND: Shoulder instability is a multifactorial condition characterized by recurrent subluxations, dislocations, and functional limitations. While biological impairments, such as capsulolabral injury and neuromuscular deficits, are central, recovery is also influenced by psychological factors (kinesiophobia, catastrophizing) and social factors (return-to-sport demands, participation). This biopsychosocial interplay underscores the need for comprehensive outcome measurement, yet current literature remains fragmented, predominantly emphasizing pain and function with limited integration of psychological and social domains. OBJECTIVE: This scoping review aimed to identify biopsychosocial outcome measures used in shoulder instability, map them to biological, psychological, and social domains, and summarize available evidence regarding their psychometric properties. METHODS: Following Arksey and O'Malley's framework, a systematic search across PubMed, PEDro, and the Cochrane Library (2015-2025) was conducted. Studies involving any form of shoulder instability and reporting at least one biopsychosocial outcome measure were included. Two reviewers independently screened studies, extracted data, classified outcomes into biopsychosocial domains, and evaluated psychometric properties using the COSMIN checklist. RESULTS: Of 3092 records, 43 studies were included, reporting 22 outcome measures (12 PROMs and 10 clinician-reported). Common PROMs included VAS, Western Ontario Shoulder Instability Index (WOSI), Shoulder Subjective Value, and QuickDASH, while clinician measures frequently included range of motion, re-dislocation rate, Constant score, and Rowe score. Shoulder-specific measures accounted for 58% of outcomes. Only WOSI, EQ-5D, and GROC addressed all biopsychosocial domains. WOSI demonstrated the strongest psychometric evidence. CONCLUSION: WOSI is the most robust and suitable outcome measure for shoulder instability. Other measures may complement assessment but require cautious interpretation. Further validation of existing tools is needed in this population. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s43465-026-01727-z.