A multicenter randomized controlled trial comparing gamification with remote monitoring against standard rehabilitation for patients after arthroscopic shoulder surgery

Comparing Telerehabilitation and Home-based Exercise for Shoulder Disorders: A Systematic Review and Meta-analysis

OBJECTIVE

This systematic review and meta-analysis aimed to quantitatively compare the effects of telerehabilitation and home-based exercise for shoulder disorders.

DATA SOURCES

We conducted a search for eligible studies in PubMed, EMBASE, Web of Science, Cochrane Library, and MEDLINE databases following Preferred Reporting Items for Systematic Review and Meta-analyses guidelines.

STUDY SELECTION

Independent reviewers selected randomized controlled trials that compared the effects of telerehabilitation and home-based exercise in individuals with shoulder disorders.

DATA EXTRACTION

Two reviewers independently conducted data extraction and assessed the risk of bias using the Cochrane Risk of Bias tool.

DATA SYNTHESIS

A total of 7 studies with 508 participants were included. Compared with home-based exercise, telerehabilitation showed superior improvements in range of motion (flexion: standardized mean difference [SMD] 0.35, 95% confidence interval [CI] 0.14 to 0.56; abduction: SMD 0.37, 95% CI 0.16 to 0.58; external rotation: SMD 0.43, 95% CI 0.22 to 0.64; internal rotation: SMD 0.33, 95% CI 0.08 to 0.58), functional outcomes (Shoulder Pain and Disability Index: SMD -0.37, 95% CI -0.61 to -0.12; shortened Disabilities of the Arm, Shoulder and Hand questionnaire: mean difference [MD] -4.51, 95% CI -8.70 to -0.32), and quality of life (EuroQol Five Dimensions Questionnaire: MD 0.04, 95% CI 0.01 to 0.07). Telerehabilitation was not different from home-based exercise in terms of pain relief (SMD -0.19, 95% CI -0.60 to 0.23). Subgroup analysis demonstrated that telerehabilitation provided significant pain relief when sustained for over 12 weeks (SMD -0.46, 95% CI -0.81 to -0.11).

CONCLUSIONS

Telerehabilitation is more effective than home-based exercise in improving range of motion, functional outcomes, and quality of life for patients with shoulder disorders. Telerehabilitation significantly outperforms home-based exercise in relieving pain when continued for over 12 weeks.

The effects of telemedicine on Rotator cuff-related shoulder function and pain symptoms: a meta-analysis of randomized clinical trials

BACKGROUND

The effectiveness of telemedicine in aiding rehabilitation exercises among patients with rotator cuff (RC) disorders remains unknown. Therefore, this meta-analysis aimed to assess the effectiveness of telemedicine in patients with RC disorders.

METHODS

Randomized clinical trials (RCTs) on the effectiveness of telemedicine in patients with RC disorders were summarized through a meta-analysis. A systematic search for these RCTs was conducted in PubMed, Cochrane, Embase, and Web of Science databases up to July 2024. Statistical analysis was performed using Stata 16. Publication bias was estimated with the funnel plot and Egger's test.

RESULTS

Ten studies involving 497 participants (telemedicine group = 248 and conventional group = 249) were enrolled, with follow-up durations ranging from 8 weeks to 48 weeks. Functional outcomes measured by the Constant-Murley score were markedly improved after treatment in the telemedicine group compared to the conventional group. Moreover, compared to conventional treatment, telemedicine significantly improved shoulder function evaluated by Quick Disabilities of the Arm, Shoulder, and Hand Score, relieved pain assessed by visual analog scale pain score, and improved range of motion after treatment and in the final follow-up period.

CONCLUSION

Telemedicine has demonstrated potential in alleviating pain and enhancing shoulder function and motion in patients with RC injuries. It may be a feasible intervention for rehabilitation exercises. Further research with a large sample size and standardized treatment is warranted to validate these findings.

Advanced Home-Based Shoulder Rehabilitation: A Systematic Review of Remote Monitoring Devices and Their Therapeutic Efficacy

Shoulder pain represents the most frequently reported musculoskeletal disorder, often leading to significant functional impairment and pain, impacting quality of life. Home-based rehabilitation programs offer a more accessible and convenient solution for an effective shoulder disorder treatment, addressing logistical and financial constraints associated with traditional physiotherapy. The aim of this systematic review is to report the monitoring devices currently proposed and tested for shoulder rehabilitation in home settings. The research question was formulated using the PICO approach, and the PRISMA guidelines were applied to ensure a transparent methodology for the systematic review process. A comprehensive search of PubMed and Scopus was conducted, and the results were included from 2014 up to 2023. Three different tools (i.e., the Rob 2 version of the Cochrane risk-of-bias tool, the Joanna Briggs Institute (JBI) Critical Appraisal tool, and the ROBINS-I tool) were used to assess the risk of bias. Fifteen studies were included as they fulfilled the inclusion criteria. The results showed that wearable systems represent a promising solution as remote monitoring technologies, offering quantitative and clinically meaningful insights into the progress of individuals within a rehabilitation pathway. Recent trends indicate a growing use of low-cost, non-intrusive visual tracking devices, such as camera-based monitoring systems, within the domain of tele-rehabilitation. The integration of home-based monitoring devices alongside traditional rehabilitation methods is acquiring significant attention, offering broader access to high-quality care, and potentially reducing healthcare costs associated with in-person therapy.

Network pharmacology, molecular docking, and experimental verification reveal the mechanism of San-Huang decoction in treating acute kidney injury

Background: Cisplatin is an effective anti-tumor drug. However, its usage is constrained by side effects such as nephron toxicity. Cisplatin-induced acute kidney injury (AKI) appears in approximately 20%-30% of cases. Hence, finding an effective protective strategy is necessary. San-Huang decoction (SHD) is a Chinese herbal decoction with good efficacy in treating chronic kidney disease (CKD). Nevertheless, the mechanism of SHD on AKI remains unclear. Consequently, we proposed to explore the potential mechanism of SHD against cisplatin-induced AKI. Methods: Active compounds, core target proteins, and associated signaling pathways of SHD were predicted through network pharmacology. Then confirmed by molecular docking. In vivo experiment, Cisplatin + SHD group was treated with SHD (6.5 g/kg/day) for 6 days before building the model. An AKI model was established with a single intraperitoneal injection of cisplatin at 20 mg/kg. After 72 h of cisplatin injection, all mice were sacrificed to collect blood and kidney tissues for verification of network pharmacology analysis. Results: We found that calycosin, rhein, and ginsenoside Rh2 may be SHD's primary active compounds in treating cisplatin-induced AKI, and AKT, TNF-α, IL-6, IL-1β, caspase-3, and MMP9 are the core target proteins. The relationship between the compound and target protein was further confirmed by molecular docking. The Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses predicted that SHD has an anti-inflammatory role through the TNF and IL-17 signaling pathway. Moreover, Western blot and immunohistochemistry validated the potential molecular mechanisms of SHD, predicted from network pharmacology analysis. The mechanism of cisplatin-induced AKI involves apoptosis and inflammation. In apoptosis, Caspase-3, caspase-8, caspase-9, and Bax proteins were down-regulated, while Bcl-2 was up-regulated by SHD. The differential expression of MMP protein is involved in the pathological process of AKI. MMP9 protects from glomerular tubule damage. MMP9 and PI3K/AKT anti-apoptosis pathway were up-regulated by SHD. In addition, we discovered that SHD alleviated AKI by inhibiting the NF-κB signaling pathway. Conclusion: SHD plays a critical role in anti-inflammation and anti-apoptosis via inhibiting the NF-κB signaling pathway and activating PI3K/AKT anti-apoptosis pathway, indicating that SHD is a candidate herbal drug for further investigation in treating cisplatin-induced AKI.

Remote Patient Monitoring of Postoperative Rehabilitation

Postoperative rehabilitation is a critical part of the treatment algorithm for patients with shoulder issues. When patients could not go to in-person therapy, many therapists pivoted to a remote option, and several application-based rehabilitation programs emerged. This article will discuss the shift to remote patient rehabilitation and will highlight the benefits and potential pitfalls of remote rehabilitation. It will also discuss ways to monitor patients remotely as they are performing their postoperative rehabilitation exercises. Finally, it will discuss how these remote platforms can be used, and what the user experience is like for the patient and the surgeon.

Effectiveness of biofeedback-assisted asynchronous telerehabilitation in musculoskeletal care: A systematic review

Background

Musculoskeletal conditions are the leading cause of disability worldwide. Telerehabilitation may be a viable option in the management of these conditions, facilitating access and patient adherence. Nevertheless, the impact of biofeedback-assisted asynchronous telerehabilitation remains unknown.

Objective

To systematically review and assess the effectiveness of exercise-based asynchronous biofeedback-assisted telerehabilitation on pain and function in individuals with musculoskeletal conditions.

Methods

This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The search was conducted using three databases: PubMed, Scopus, and PEDro. Study criteria included articles written in English and published from January 2017 to August 2022, reporting interventional trials evaluating exercise-based asynchronous telerehabilitation using biofeedback in adults with musculoskeletal disorders. The risks of bias and certainty of evidence were appraised using the Cochrane tool and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE), respectively. The results are narratively summarized, and the effect sizes of the main outcomes were calculated.

Results

Fourteen trials were included: 10 using motion tracker technology (N = 1284) and four with camera-based biofeedback (N = 467). Telerehabilitation with motion trackers yields at least similar improvements in pain and function in people with musculoskeletal conditions (effect sizes: 0.19-1.45; low certainty of evidence). Uncertain evidence exists for the effectiveness of camera-based telerehabilitation (effect sizes: 0.11-0.13; very low evidence). No study found superior results in a control group.

Conclusions

Asynchronous telerehabilitation may be an option in the management of musculoskeletal conditions. Considering its potential for scalability and access democratization, additional high-quality research is needed to address long-term outcomes, comparativeness, and cost-effectiveness and identify treatment responders.

Bibliometric and visualized analysis of scientific publications on rehabilitation of rotator cuff injury based on web of science

Background

Since the discovery of rehabilitation as an intervention for rotator cuff injury, its impact on the recovery of rotator cuff injury has attracted crucial attention, and the number of related studies is increasing worldwide. There were no bibliometric and visualized analysis studies in this field. This study aimed to investigate the research hotpots and trends in the rehabilitation of rotator cuff injury via bibliometric and visualized analysis and to identify the future development of clinical practice.

Method

The publications regarding rehabilitation of rotator cuff injury from inception to December 2021 were obtained from the Web of Science Core Collection database. The trends of publications, co-authorship and co-occurrence analysis and visualized analysis were carried out using Citespace, VOSviewer, Scimago Graphica software, and R Project.

Results

A total of 795 publications were included in this study. The number of publications significantly increased yearly. The United States published the highest number of related papers and the papers published by the United States had the highest citations. The University of Laval, the University of Montreal and Keele University were the top 3 most contributive institutions. Additionally, the Journal of Shoulder and Elbow Surgery was the journal with the highest number of publications. The most common keywords were "rotator cuff", "rehabilitation", "physical therapy", "management", and "telerehabilitation".

Conclusion

The total number of publications has shown a steady upward trend. The cooperation between countries globally was still relatively lacking, and therefore it is necessary to strengthen cooperation between different countries and regions to provide conditions for multi-center, large sample, and high-quality research. In addition to the relatively mature rehabilitation of rotator cuff injury such as passive motion or exercise therapy, telerehabilitation has also attracted much attention with the progress of science.

Evaluation of a Smart Knee Brace for Range of Motion and Velocity Monitoring during Rehabilitation Exercises and an Exergame

Anterior cruciate ligament (ACL) injuries often require a lengthy duration of rehabilitation for patients to return to their prior level of function. Adherence to rehabilitation during this prolonged period can be subpar due to the treatment duration and poor adherence to home exercises. This work evaluates whether a smart instrumented knee brace system is capable of monitoring knee range of motion and velocity during a series of common knee rehabilitation exercises and an exergame. A total of 15 healthy participants completed a series of common knee rehabilitation exercises and played an exergame while wearing a smart instrumented knee brace. The range of motion (ROM) and velocity of the knee recorded by the knee brace was compared to a reference optoelectronic system. The results show good agreement between the knee brace system and the reference system for all exercises performed. Participants were able to quickly learn how to play the exergame and scored well within the game. The system investigated in this study has the potential to allow rehabilitation to occur outside of the clinic with the use of remote monitoring, and improve adherence and outcomes through the use of an exergame.

Gamification in Musculoskeletal Rehabilitation

PURPOSE OF REVIEW

This study is a narrative review aiming at evaluating the current literature of the last 5 years on gamification and musculoskeletal rehabilitation. The article search involved the following MeSH terms at PubMed: "gamification," "exergaming," and "rehabilitation." Original studies in English language were included.

RECENT FINDINGS

After careful analysis of the search results, 17 articles were included in this review. The use of games for rehabilitation was investigated in musculoskeletal rehabilitation conditions such as shoulder surgery, impingement syndrome, rheumatoid arthritis, osteoarthritis, low back pain, fibromyalgia, fracture, and ligament reconstruction. Results were similar or superior to conventional physical therapy or home-based exercises, with the additional benefit of improving motivation to the exercise program. Improvements in quality of life and perceived health status were also observed. The cost-effectiveness of this type of technology was also mentioned as an advantage of exergames in musculoskeletal rehabilitation. Studies involving gamification in musculoskeletal rehabilitation stress the potential of this resource in several aspects of physical fitness, health, and quality of life, also improving motivation and adherence to the exercise treatment.

Effectiveness of physical therapy given by telerehabilitation on pain and disability of individuals with shoulder pain: A systematic review

OBJECTIVE

To systematically review the effects of physical therapy given by telerehabilitation on pain and disability in individuals with shoulder pain.

DATA SOURCES

PubMed, Embase, CINAHL, LILACS, Cochrane, Web of Science, SCOPUS, SciELO and Ibecs were searched in January/2022.

METHODS

This systematic review followed PRISMA guidelines. Randomized controlled trials investigating the effects of physical therapy given by telerehabilitation on pain and disability in patients with shoulder pain were included. The quality and level of the evidence were assessed with the Cochrane Risk of Bias tool and GRADE, respectively. The effect sizes of the main outcomes were also calculated.

RESULTS

Six randomized controlled trials were included with a total sample of 368 patients with shoulder pain. Four and two randomized controlled trials were assessed as low and high risk of bias, respectively. Three randomized controlled trials assessed shoulder post-operative care, two assessed chronic shoulder pain, and one assessed frozen shoulder. Very low to low evidence suggests that there is no difference between telerehabilitation and in-person physical therapy or home-based exercises programs to improve pain and disability in patients with shoulder pain. Low evidence suggests that telerehabilitation is superior to advice only to improve shoulder pain (effect size: 2.42; 95% Confidence Interval: 1.72, 3.06) and disability (effect size: 1.61; 95% Confidence Interval: 1.01, 2.18).

CONCLUSIONS

Although telerehabilitation may be a promising tool to treat patients with shoulder pain and disability, the very low to low quality of evidence does not support a definite recommendation of its use in this population.