Evaluation of the effectiveness of telerehabilitation in cases with rotator cuff tendinopathy

Abstract

Objective: Our study was designed to investigate the effectiveness of adding telerehabilitation (TR) to a home exercise program (HEP) in patients with rotator cuff tendinopathy. Patients and Methods: The study included 45 patients diagnosed with rotator cuff tendinopathy and randomly assigned into two groups. The control group was given a HEP, while the study group received the same program supplemented with TR and following the intervention, patients’ shoulder joint range of motion (ROM) was assessed with a goniometer, and functionality was evaluated using the Western Ontario Rotator Cuff Index (WORC) and the Simple Shoulder Test (SST). Results: In intra-group assessments, there was a significant decrease in the WORC physical symptoms subscale in the TR group at the follow-up assessment (p<0.001), whereas no significant difference was found in the HEP group (p=0.189). Regarding the total SST score, an increase was seen in the TR group post-treatment (p<0.001), while no difference was found in the HEP group (p=0.373). Upon comparing TR and HEP, including increased active abduction of the right shoulder, as well as active flexion, abduction, and external rotation of the left shoulder, the two groups groups showed that TR group patients had significantly better results than HEP group patients in WORC and SST (p=0.007 and p=0.007 respectively). Conclusion: The results of our study indicate that following a HEP with TR enhances shoulder mobility and functionality more effectively than the HEP alone in patients with rotator cuff pathology.

Keywords

• Shoulder
• Rotator cuff
• Tendinopathy
• Telerehabilitation
• Pain

References

1. Hanchard N, Cummins J, Jeffries C. Evidence‐based clinical guidelines for the diagnosis, assessment and physiotherapy management of shoulder impingement syndrome. London, UK: Chartered Society of Physiotherapy, 2004.
2. Burke WS, Vangsness CT, Powers CM. Strengthening the supraspinatus: A clinical and biomechanical review. Clin Orthop Relat Res 2002;(402):292-8.
3. Wong WK, Li MY, Yung PS, Leong HT. The effect of psychological factors on pain, function and quality of life in patients with rotator cuff tendinopathy: A systematic review. Musculoskelet Sci Pract 2020;47:102173. doi: 10.1016/j. msksp.2020.102173.
4. Lewis J, McCreesh K, Roy JS, Ginn K. Rotator cuff tendinopathy: Navigating the diagnosis-management conundrum. J Orthop Sports Phys Ther 2015;45:923-37. doi: 10.2519/jospt.2015.5941.
5. Itoi E. Rotator cuff tear: physical examination and conservative treatment. J Orthop Sci 2013;18:197-204. doi: 10.1007/ s00776.012.0345-2.
6. Akkaya S, Büker N, Kitiş A, Akkaya N, Yörükoğlu AÇ. Rotator manşet lezyonu olan hastalarda ağrı, fonksiyonel durum ve depresyon arasındaki ilişkinin incelenmesi. Pamukkale Tıp Dergisi 2010. 3:84-89.
7. Sachinis NP, Yiannakopoulos CK, Chalidis B, Kitridis D, Givissis P. Biomolecules related to rotator cuff pain: A scoping review. Biomolecules 2022;12:1016. doi: 10.3390/ biom12081016.
8. Kibler WB. Rehabilitation of rotator cuff tendinopathy. Clin Sports Med 2003;22:837-47. doi: 10.1016/s0278- 5919(03)00048-6.

9. Wang JH, Iosifidis MI, Fu FH. Biomechanical basis for tendinopathy. Clin Orthop Relat Res 2006;443:320-32. doi: 10.1097/01.blo.000.019.5927.81845.46.
10. Pastora-Bernal JM, Martín-Valero R, Barón-López FJ, García- Gómez O. Effectiveness of telerehabilitation programme following surgery in shoulder impingement syndrome (SIS): study protocol for a randomized controlled non-inferiority trial. Trials 2017;18:82. doi: 10.1186/s13063.017.1822-x.
11. Fatoye F, Gebrye T, Fatoye C, et al. The clinical and costeffectiveness of telerehabilitation for people with nonspecific chronic low back pain: Randomized controlled trial. JMIR mHealth uHealth 2020;8: e15375. doi:10.2196/15375
12. Laver KE, Adey-Wakeling Z, Crotty M, Lannin NA, George S, Sherrington C. Telerehabilitation services for stroke. Cochrane Database Syst Rev 2020;1:CD010255. doi: 10.1002/14651858. CD010255.pub3.
13. Cottrell MA, Russell TG. Telehealth for musculoskeletal physiotherapy. Musculoskelet Sci Pract 2020; 48:102193 doi: 10.1016/j.msksp.2020.102193
14. Theodoros D, Russell T. Telerehabilitation: current perspectives. Stud Health Technol Infor 2008; 131:191-209.
15. Kulkarni R, Gibson J, Brownson P, et al. Subacromial shoulder pain. Shoulder Elbow 2015;7:135-43. doi: 10.1177/175.857.3215576456.
16. Mazuquin B, Moffatt M, Gill P, et al. Effectiveness of early versus delayed rehabilitation following rotator cuff repair: Systematic review and meta-analyses. PLoS One 2021;16: e0252137. doi: 10.1371/journal.pone.0252137.
17. Christensen BH, Andersen KS, Rasmussen S, Andreasen EL, Nielsen LM, Jensen SL. Enhanced function and quality of life following 5 months of exercise therapy for patients with irreparable rotator cuff tears – an intervention study. BMC Musculoskelet Disord 2016;17:252. doi: 10.1186/ s12891.016.1116-6.
18. Jain NB, Wilcox RB 3rd, Katz JN, Higgins LD. Clinical examination of the rotator cuff. PM R 2013;5:45-56. doi: 10.1016/j.pmrj.2012.08.019.
19. Malliaras P, Cridland K, Hopmans R, et al. Internet and telerehabilitation-delivered management of rotator cuffrelated shoulder pain (INTEL Trial): Randomized controlled pilot and feasibility trial. JMIR mHealth Uhealth 2020;8: e24311. doi: 10.2196/24311.
20. Cunningham G, Charbonnier C, Lädermann A, Chagué S, Sonnabend DH. Shoulder motion analysis during codman pendulum exercises. Arthrosc Sports Med Rehabil 2020 ;2:e333-e339. doi: 10.1016/j.asmr.2020.04.013.
21. Price DD, Staud R, Robinson ME. How should we use the visual analogue scale (VAS) in rehabilitation outcomes? II: Visual analogue scales as ratio scales: an alternative to the view of Kersten et al. J Rehabil Med 2012;44:800-1. doi: 10.2340/16501.977.1031.
22. Kirkley A, Alvarez C, Griffin S. The development and evaluation of a disease-specific quality-of-life questionnaire for disorders of the rotator cuff: The Western Ontario Rotator Cuff Index. Clin J Sport Med 2003; 13:84-92. doi: 10.1097/00042.752.200303000-00004.
23. Lippitt SB, Harryman DT II, Matsen FA III. A practical tool for evaluating function: the Simple Shoulder Test. In: Matsen FA III, Fu FH, Hawkins RJ, eds. The Shoulder: a Balance of Mobility and Stability. Rosemont, Illinois: The American Academy of Orthopaedic Surgeons, 1993: 501-518.
24. Matsen FA 3rd, Smith KL, DeBartolo SE, Von Oesen G. A comparison of patients with late-stage rheumatoid arthritis and osteoarthritis of the shoulder using self-assessed shoulder function and health status. Arthritis Care Res 1997;10:43-7. doi: 10.1002/art.179.010.0107.
25. Agostini M, Moja L, Banzi R, et al. Telerehabilitation and recovery of motor function: a systematic review and meta-analysis. J Telemed Telecare 2015;21:202-13. doi:10.1177/1357633X15572201
26. Russell TG. Physical rehabilitation using telemedicine. J Telemed Telecare 2007; 13:217-20. doi: 10.1258/135.763.307781458886.
27. Eftekhari E, Sheikhhoseini R, Salahzadeh Z, Dadfar M. Effects of telerehabilitation-based respiratory and corrective exercises among the elderly with thoracic hyper-kyphosis: a clinical trial. BMC Geriatrics 2024;24:234. doi: 10.1186/ s12877.024.04779-8.
28. Cramer SC, Dodakian L, Le V, et al. A Feasibility study of expanded home-based telerehabilitation after stroke. Front Neurol 2021;11:611453. doi: 10.3389/fneur.2020.611453.
29. Kenis-Coskun O, Imamoglu S, Karamancioglu B, Kurt K, Ozturk G, Karadag-Saygi E. Comparison of telerehabilitation versus home-based video exercise in patients with Duchenne muscular dystrophy: a single-blind randomized study. Acta Neurol Belg 2022;122:1269-80. doi: 10.1007/ s13760.022.01975-4.
30. Rodríguez Sánchez-Laulhé P, Luque-Romero LG, Barrero- García FJ, et al. An exercise and educational and selfmanagement program delivered with a smartphone app (carehand) in adults with rheumatoid arthritis of the hands: randomized controlled trial. JMIR mHealth uHealth 2022;10:e35462. doi: 10.2196/35462.
31. Cox NS, Dal Corso S, Hansen H, et al. Telerehabilitation for chronic respiratory disease. Cochrane Database Syst Rev 2021 ;1:CD013040. doi: 10.1002/14651858.
32. Tore NG, Oskay D, Haznedaroglu S. The quality of physiotherapy and rehabilitation program and the effect of telerehabilitation on patients with knee osteoarthritis. Clin Rheumatol 2023;42:903-15. doi: 10.1007/s10067.022.06417-3.
33. Pastora-Bernal JM, Martín-Valero R, Barón-López FJ, Moyano NG, Estebanez-Pérez MJ. Telerehabilitation after arthroscopic subacromial decompression is effective and not inferior to standard practice: Preliminary results. J Telemed Telecare 2018 ;24:428-33. doi: 10.1177/1357633X17706583.