Digitally Assisted Versus Conventional Home-Based Rehabilitation After Arthroscopic Rotator Cuff Repair

Correia, Fernando Dias; Molinos, Maria; Luis, Sara Fenandez; Carvalho, Diana M.; Carvalho, Carlos Roberto Ribeiro; Costa, Pedro F.; Seabra, Rosmaninho; Francisco, Gerard E.; Bento, Virgílio; Laíns, Jorge

doi:10.1097/phm.0000000000001780

Cited by 38 publications

(52 citation statements)

References 56 publications

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“…These results may be useful for postoperative pain control. In a digitally assisted versus conventional home-based rehabilitation study for rehabilitation following ARCR, pain was maintained or increased for up to 12 weeks [ 51 ]. In addition, when comparing our results with those of a study that used steroid injections for pain control, our results were much higher at 6 weeks [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Pain Neuroscience Education on Active Rehabilitation Following Arthroscopic Rotator Cuff Repair: A CONSORT-Compliant Prospective Randomized Single-Blind Controlled Trial

Kim

Lee

2022

Brain Sciences

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Pain neuroscience education (PNE), a modern educational therapy, has been reported to be effective in pain control by reducing fear of movement. This study investigated the effects of additional PNE on a physical therapy rehabilitation protocol (PTRP) following arthroscopic rotator cuff repair (ARCR). In this single-blind, randomized controlled trial, 34 patients who had undergone ARCR were randomly allocated (1:1) into two groups: PNE (PTRP plus PNE) and PTRP. PTRP was performed five times a week, for four weeks, 115 min per session (physical agents, manual therapy, and exercises), and PNE was performed twice at the beginning (face-to-face PNE) and end (non-face-to-face) of the PTRP. The outcome measures were measured four times for pain intensity, pain cognition, and shoulder function; two times for a range of motion; and once for satisfaction. No significant difference in pain intensity was observed between the groups. However, in pain cognition, the Tampa Scale for Kinesiophobia avoidance showed a significant interaction between time and group, and PNE showed a higher effect size than PTRP in the post-test and follow-up in several variables. In conclusion, the significant improvement in avoidance in postoperative rehabilitation suggests that there is a partially positive benefit in terms of pain, range of motion, and shoulder function in ARCR patients.

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Section: Discussionmentioning

confidence: 99%

The Efficacy of Pain Neuroscience Education on Active Rehabilitation Following Arthroscopic Rotator Cuff Repair: A CONSORT-Compliant Prospective Randomized Single-Blind Controlled Trial

Kim

Lee

2022

Brain Sciences

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“…This DCP was previously validated (feasibility and effectiveness) 39 , 40 in the rehabilitation of MSK conditions, including after shoulder tendon repair surgery, where it demonstrated comparable results to conventional therapy in the short term, and the ability to maximize clinical outcomes in the long term. 42 …”

Section: Introductionmentioning

confidence: 99%

Asynchronous and Tailored Digital Rehabilitation of Chronic Shoulder Pain: A Prospective Longitudinal Cohort Study

Janela¹,

Costa²,

Molinos³

et al. 2022

JPR

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Background Chronic shoulder pain (SP) is responsible for significant morbidity, decreased quality of life and impaired work ability, resulting in high socioeconomic burden. Successful SP management is dependent on adherence and compliance with effective evidence-based interventions. Digital solutions may improve accessibility to such treatments, increasing convenience, while reducing healthcare-related costs. Purpose Present the results of a fully remote digital care program (DCP) for chronic SP. Patients and Methods Interventional, single-arm, cohort study of individuals with chronic SP applying for a digital care program. Primary outcome was the mean change between baseline and 12 weeks on the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Secondary outcomes were change in pain (NPRS), analgesic consumption, intention to undergo surgery, anxiety (GAD-7), depression (PHQ-9), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI) and engagement. Results From 296 patients at program start, 234 (79.1%) completed the intervention. Changes in QuickDASH between baseline and end-of-program were both statistically (p < 0.001) and clinically significant, with a mean reduction of 51.6% (mean −13.45 points, 95% CI: 11.99; 14.92). Marked reductions were also observed in all secondary outcomes: 54.8% in NPRS, 44.1% ceased analgesics consumption, 55.5% in surgery intent, 37.7% in FABQ-PA, 50.3% in anxiety, 63.6% in depression and 66.5% in WPAI overall. Higher engagement was associated with higher improvements in disability. Mean patient satisfaction score was 8.7/10.0 (SD 1.6). Conclusion This is the first real-world cohort study reporting the results of a multimodal remote digital approach for chronic SP rehabilitation. High completion and engagement rates were observed, which were associated with clinically significant improvement in all health-related outcomes, as well as marked productivity recovery. These promising results support the potential of digital modalities to address the global burden of chronic musculoskeletal pain.

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“…Previously, we reported a multimodal digital care program (DCP) that integrates physical therapy exercise-based management with a psychoeducational component, including CBT, that aims to encourage patients to develop self-management skills and strategies for their pain. This DCP has been validated in different MSK conditions in chronic [37], acute [38,39], and postsurgical contexts [40][41][42][43]. Herein, we aimed to assess mental health and work-related outcomes after a completely remote multimodal DCP for patients with MSK pain stratified by baseline depression levels.…”

Section: Introductionmentioning

confidence: 99%

Impacts of Digital Care Programs for Musculoskeletal Conditions on Depression and Work Productivity: Longitudinal Cohort Study

Costa¹,

Janela²,

Molinos³

et al. 2022

J Med Internet Res

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Background Comorbidity between musculoskeletal (MSK) pain and depression is highly common, and is associated with a greater symptom burden and greater loss of work productivity than either condition alone. Multimodal care programs tackling both physical and mental health components may maximize productivity recovery and return to work. Digital delivery of such programs can facilitate access, ensure continuity of care, and enhance patient engagement. Objective The aim of this study was to assess the impact of a completely remote multimodal digital care program (DCP) for MSK pain on mental health and work-related outcomes stratified by baseline depression levels. Methods Ad hoc analysis of an interventional, single-arm, cohort study of individuals with MSK pain undergoing a DCP was performed. Three subgroups with different baseline depression severity levels were established based on responses to the Patient Health Questionnaire (PHQ-9): cluster 1 (score<5: minimal depression), cluster 2 (scores 5-10: mild depression), and cluster 3 (score≥10: moderate depression). The mean changes in depression, anxiety, fear-avoidance beliefs, work productivity, and activity impairment and adherence between baseline and end of program (8-12 weeks) were assessed across subgroups by latent growth curve analysis. Results From a total of 7785 eligible participants, 6137 (78.83%) were included in cluster 1, 1158 (14.87%) in cluster 2, and 490 (6.29%) in cluster 3. Significant improvements in depression and anxiety scores were observed in clusters 2 and 3 but not in cluster 1, with average end-of-the program scores in clusters 2 and 3 below the initially defined cluster thresholds (score of 5 and 10, respectively). All clusters reported significant improvements in productivity impairment scores (mean changes from –16.82, 95% CI –20.32 to –13.42 in cluster 1 to –20.10, 95% CI –32.64 to –7.57 in cluster 3). Higher adherence was associated with higher improvements in depression in clusters 2 and 3, and with greater recovery in activities of daily living in cluster 3. Overall patient satisfaction was 8.59/10.0 (SD 1.74). Conclusions A multimodal DCP was able to promote improvements in productivity impairment scores comparable to those previously reported in the literature, even in participants with comorbid depression and anxiety. These results reinforce the need to follow a biopsychosocial framework to optimize outcomes in patients with MSK pain. Trial Registration ClinicalTrials.gov NCT04092946; https://clinicaltrials.gov/ct2/show/NCT04092946

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Digitally Assisted Versus Conventional Home-Based Rehabilitation After Arthroscopic Rotator Cuff Repair

Cited by 38 publications

References 56 publications

The Efficacy of Pain Neuroscience Education on Active Rehabilitation Following Arthroscopic Rotator Cuff Repair: A CONSORT-Compliant Prospective Randomized Single-Blind Controlled Trial

The Efficacy of Pain Neuroscience Education on Active Rehabilitation Following Arthroscopic Rotator Cuff Repair: A CONSORT-Compliant Prospective Randomized Single-Blind Controlled Trial

Asynchronous and Tailored Digital Rehabilitation of Chronic Shoulder Pain: A Prospective Longitudinal Cohort Study

Impacts of Digital Care Programs for Musculoskeletal Conditions on Depression and Work Productivity: Longitudinal Cohort Study

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