The majority of patients presenting with shoulder pain are those with rotator cuff problems. Although telerehabilitation is a promising field in many areas, there is still limited high-quality research with strong evidence of its effectiveness for musculoskeletal problems. In this study, online rehabilitation and face-to-face rehabilitation will be compared in people with partial rotator cuff tears.
The prevalence of shoulder pain increases with age and is mostly associated with inadequate treatment of symptoms. A large part of the patients who apply to the clinic with the complaint of shoulder pain are individuals with rotator cuff problems. Partial rotator cuff (RM) tear is defined as tears that can be seen on the superior, inferior, or both sides of the cuff. It is stated that the most critical risk factors for RM tear are age, dominant arm, and trauma. The degenerative process is generally considered normal in age-related tears and is seen in 20% of individuals over the age of 65. The Coronavirus disease (COVID-19), is still the most important global concern. People with chronic diseases have been known to delay getting healthcare services due to fear of the risk of infection following the COVID-19 pandemic. This could lead to increased morbidity and mortality due to delay and disruption in access to treatment applications needed for patient populations other than COVID-19. At this stage, one of the applications that can be effective for disturbed patient healing processes is the Telerehabilitation application, which has proven its effectiveness in previous epidemics (EBOLA, SARS, etc.), when patients are treated remotely after and after treatment. Especially during the COVID-19 pandemic, there has been an increase in the need for Internet-based remote treatment approaches, as it allows both patients and physiotherapists to advance the treatment process without the risk of infection. In the next decade, telerehabilitation options are expected to diversify and become widespread in assessing and treating many diseases with emerging technologies. Studies have shown that despite the growing number of applications of telerehabilitation worldwide, evidence for clinical effectiveness is still limited. In addition, the effectiveness of telerehabilitation for musculoskeletal problems has not been fully demonstrated due to the lack of a specific standard for telerehabilitation and the variability of the approaches used. In conclusion, although telerehabilitation is a promising field in many areas, there is still a limited amount of good-quality research with strong evidence. Therefore, this study aimed to compare the effects of internet-based telerehabilitation and face-to-face rehabilitation practices on pain, range of motion, functionality, and quality of life in patients with partial rotator cuff injury.
Week 1 * Posterior capsule stretching * Passive range of motion * Wand exercises in supine position * Scapular adduction exercise * Ball rolling on the table (\<90°) * Coldpack (15min) Week 2 * Wand exercises while standing. * Ball roll on wall (\>90°) * Ball roll on the table (90°) * Weightless External Rotation exercises * Functional PNF movements Week 3 * Resistive scapulothoracic strengthening * Ball scrolling on the table (resistive) Week 4 * Single handed ball roll on the table (\>90°) * External rotation exercise with 0.5-1kg weight in side lying * Strengthening exercises, shoulder in 90° scapulation for 10s Week 5 * External rotation with 0.5-1 kg weight in side lying * Strengthening exercises by keeping the shoulder in 90° scapulation for 10s Week 6-8 * Dynamic hugs and push up plus * Ball throwing and catching
Week 1 * Posterior capsule stretching * Passive range of motion * Wand exercises in supine position * Scapular adduction exercise * Ball rolling on the table (\<90°) * Coldpack (15min) Week 2 * Wand exercises while standing. * Ball roll on wall (\>90°) * Ball roll on the table (90°) * Weightless External Rotation exercises * Functional PNF movements Week 3 * Resistive scapulothoracic strengthening * Ball scrolling on the table (resistive) Week 4 * Single handed ball roll on the table (\>90°) * External rotation exercise with 0.5-1kg weight in side lying * Strengthening exercises, shoulder in 90° scapulation for 10s Week 5 * External rotation with 0.5-1 kg weight in side lying * Strengthening exercises by keeping the shoulder in 90° scapulation for 10s Week 6-8 * Dynamic hugs and push up plus * Ball throwing and catching
Istanbul University- Cerrahpasa, Faculty of Medicine, Department of Orthopedics and Traumatology
Istanbul, Turkey (Türkiye)
Visual Analog Scale
Patients' pain levels at rest, during activity, and at night will be assessed using a Visual Analog Scale (VAS). The score is determined by measuring the distance (mm) on a 10 cm line between the "no pain" anchor and the patient's mark, providing a score range of 0 to 100. A higher score indicates greater pain intensity.
Time frame: One year
Range of Motion Assessment
The range of motion values of the participants will be recorded using the universal goniometer, which is an objective tool used in clinical range of motion measurement.The flexion, scapular abduction, internal and external rotation values of the shoulder joint will be measured in the supine position with a universal goniometer in accordance with the procedure in the literature.
Time frame: One year
Muscle Activation Assessment
Delsys Biometrics Datalite WS450, a surface EMG system, will be used to evaluate the function of the shoulder muscles. Previous studies and the website of the SENIAM project of the European Union Biomedical Health and Research Program (http://www.seniam.org/) will be accepted as reference.
Time frame: One year
The Disabilities of the Arm, Shoulder and Hand Questionnaire
Hand, Shoulder and Hand Disability Questionaire will be used to assess the functional state of the participants. The possible score ranges from 0 to 100 points. 0 points represent full unrestricted upper limb function and 100 points represent the maximum possible functional impairment.
Time frame: One year
American Standardized Shoulder and Elbow Surgeon Assessment Form
The ASES section on patient self-reports is a condition-specific scale, i.e. it is for a specific condition that is intended to measure functional limitation and shoulder pain. The total pain score and the functional score are equally weighted (50 points each) and are combined to obtain a total score out of a possible 100 points.
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Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
DOUBLE
Enrollment
44
Time frame: One year
Modified Constant-Murley
The Modified Constant-Murley Scale is widely used to assess disability associated with shoulder injuries, but has been criticized for its use of inaccurate terminology and the lack of a standardized methodology. The Constant-Murley score (CMS) is a 100-points scale composed of a number of individual parameters. The higher the score, the higher the quality of the function.
Time frame: One year
Short Form-12
Short Form-12 will be used to assess quality of life related to physical and mental health. Two summary scores are reported from the SF-12 - a mental component score (MCS-12) and a physical component score (PCS-12). SF-12 PCS mean scores ranged between 48.3 and 49.2, and SF-12 MCS mean scores ranged between 48.0 and 49.6.
Time frame: One year
Global Change Scale
The satisfaction levels of the participants will be assessed using the Global Change Scale. Subjects are asked to rate their post-treatment status on a 5-point scale (-2: I am much worse, -1: I am worse, 0: I am the same, 1: I am better, 2: I am much better). A high score is considered a sign of high satisfaction.
Time frame: One year
Hospital Anxiety and Depression Scale
Participants' levels of anxiety and depression will be assessed using the Hospital Anxiety and Depression Scale. The Hospital Anxiety and Depression Scale is a self-report rating scale of 14 items on a 4-point Likert scale (range 0-3). It is designed to measure anxiety and depression (7 items for each subscale). The total score is the sum of the 14 items, and for each subscale the score is the sum of the respective seven items (ranging from 0-21); 0-7 (Normal) 8-10 (Mild) 11-15 (Moderate) 16-21 (Severe).
Time frame: One year