(How) Can an App Support Physiotherapy for Frozen Shoulder Patients?

Abstract

People affected by the frozen shoulder syndrome show limited shoulder mobility which is often accompanied by pain. The frozen shoulder syndrome often lasts from months to years, and mostly affects people in the age group of 40 to 70 years. The frozen shoulder syndrome severely reduces the quality of life and the ability to work. A common treatment method is physiotherapy. Patients are referred to a physiotherapist, who selects specific exercises adapted for the specific patient. Physiotherapy requires patient compliance, time, and effort. Correct exercise performance and compliance are the main issues in physiotherapy. A smartphone app could support patients by providing detailed exercise instructions and motivation through exercise logging, as is common for fitness and sport. In this work, such an app for frozen shoulder syndrome, the ShoulderApp, is evaluated in two user studies. The main contribution is that the user studies were conducted in an ambulatory assessment setting, which allows to draw conclusions about real-world usage, usability and user acceptance. The app was regularly used and study participants were satisfied. Additionally, we researched the usability and usage of interactive 3D and multi-modal exercise instructions, motivational aspects, exercise correctness and the interplay of physiotherapy and app usage. Measurements of shoulder mobility are the key assessment tool for the state and progress of the frozen shoulder syndrome. A smartphone sensor-based measurement tool, which only required a simple band in addition to the smartphone, was developed and evaluated. Interventions with the ShoulderApp were evaluated in a three-week short-term intervention and an 18-week midterm evaluation with 5 patients each. For the evaluation of the results, we used standardized questionnaires, SUS, TAM-2, and USE. In addition, semi-structured interviews and automatic logging of user-interactions in the app were included as the outcome measurements. Overall, the results for both the short-term and mid-term user studies showed that the ShoulderApp could support physiotherapy for frozen shoulder patients. The positive results of the studies show the potential of a generalization of the ShoulderApp concept to the large group of musculoskeletal disorders such as lower back pain and knee injuries.

Barriers and facilitators related to self-management of shoulder pain: a systematic review and qualitative synthesis

“… 41 Overall, 20 studies were included in this review. 18 – 37 Characteristics of the included studies are described in Table 1 . Quality assessment of the included studies, using the Joanna Briggs Institute critical appraisal checklist for qualitative research, is presented in Table 2 .…”

“…Support from the clinician 20 , 23 , 26 , 28 , 31 , 34 , 35 and from family members, 23 , 36 and social support 18 , 35 , 36 were mentioned as facilitating participant adherence to self-management strategies. Early support from clinicians was valued and as participants progressed through treatment and their condition improved, this high level of support was reduced, and participants were encouraged to self-manage their shoulder pain.…”

“… 18 Follow-up appointments with the clinician were also reported to facilitate self-management. 23 , 27 , 29 , 36 Participants also mentioned that group classes increased adherence to their home exercise programmes. 18 , 35…”

“…Two reviewers (AOS and JMcV) independently categorized the findings from the 20 included studies. 18 – 37 These reviewers then met to reach a consensus on the name and content of each category. Two reviewers (JD and CL) who were not involved in the categorization process validated these categories following discussion and refinement.…”

“…When participants experienced a favourable therapeutic response with a selfmanaged approach, they reported being more likely to adhere. 18,23,29,36 When previous clinician-led interventions yielded a poor therapeutic response, participants were amenable to engaging with a self-managed approach. 23 External factors People with shoulder pain described external factors as being important; specifically, categories related to the (1) influence of the clinician and (2) therapeutic approach (Supplemental Appendix 8).…”