Effectiveness and Therapeutic Compliance of Digital Therapy in Shoulder Rehabilitation

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Introduction:

Shoulder pain is one of the most common complaints in primary care and significantly impacts health, work capability, and quality of life. Shoulder pain (SP) has a lifetime prevalence of nearly 70% and is, therefore, one of the most common musculoskeletal (MSK) complaints in primary care. Notably, after the first episode of shoulder pain, about 50% of cases become chronic, which makes shoulder pain one of the most prevalent causes of chronic MSK pain (Janela et al.,2021).

In the fast-growing healthcare landscape, digital technologies are revolutionizing how we approach rehabilitation and medical treatment. One area that has seen remarkable advancements is shoulder rehabilitation, where digital therapy is proving to be a game-changer. Digital therapies is a term used to define health care services, support, and information provided remotely using digital communication and devices. The purpose of digital physical therapy practice is to facilitate effective delivery of physical therapy services by improving access to care and information and managing health care resources. As technology advances there are many new devices and programs that will assist with the rehabilitation of patients in both home settings and clinics.

In this blog, we will delve into digital therapy’s effectiveness and therapeutic compliance in shoulder rehabilitation, exploring how these cutting-edge approaches are reshaping the path to recovery.

The Evolution of Shoulder Rehabilitation

The remarkable mobility of the shoulder joint is well-known, and it plays a vital role in facilitating necessary everyday actions like reaching, lifting, and throwing. Shoulder injuries are a common challenge, often requiring rigorous rehabilitation to regain strength, flexibility, and range of motion (Cunha et al., 2023).

Traditional rehabilitation methods involve in-person sessions with physical therapists, providing guided exercises and manual techniques. However, these methods can be limited by geographical constraints, scheduling conflicts, and patient adherence. This is where digital therapy steps in, offering a bridge between patients and their rehabilitation journey. A study from 2018 found that digital health was successful in the case of total knee replacement rehabilitation as compared to conventional in-personal rehabilitation and less demanding in terms of human resources (Correia et al., 2018).

Effectiveness of Digital Therapy for Shoulder Rehabilitation

Personalized Treatment Plans

Provide options for personalization and adaptation of the system to meet individual patients’ needs. Exercise intensity allows difficulty levels and duration adjustments based on the patient’s capabilities and progress. By tailoring the rehabilitation journey to each patient’s unique needs, digital therapy optimizes the effectiveness of the treatment (Cunha et al., 2023).

Real-time Monitoring

One of the challenges of traditional rehabilitation is the lack of real-time feedback and monitoring. Digital therapy apps and devices incorporate sensors that track movements and progress. This real-time monitoring allows patients and therapists to assess improvements and identify areas needing more attention. Such insights enable timely adjustments, ultimately enhancing the effectiveness of the rehabilitation process. Wearable sensors are an example of these advancements that present different monitoring functions (Nascimento et al., 2020).

Gamification and Engagement

Digital therapy adds an element of gamification to the rehabilitation process. Through interactive exercises, progress tracking, and achievement rewards, patients are more engaged, distracted from pain and anxiety, and motivated to participate consistently. This engagement can lead to better compliance and ultimately contribute to the success of shoulder rehabilitation (Steiner et al., 2020).

Benefits Of Digital Therapy

Accessibility and Convenience:

One of the key advantages of digital therapy is its accessibility. Digital therapy provides accessibility to individuals who are disabled, housebound or live in rural areas. Patients can engage in rehabilitation exercises from the comfort of their homes, eliminating the need for travel and potential scheduling conflicts. This convenience reduces barriers to compliance, as patients can seamlessly integrate rehabilitation into their daily routines (Cherry, 2021).

Remote Monitoring and Support:

Digital therapy facilitates remote monitoring by therapists or other healthcare providers. This continuous oversight offers a sense of accountability for patients, motivating them to stick to their prescribed exercises. Furthermore, healthcare professionals can provide timely guidance and make an informed decision on that patient’s care to ensure they maintain strong adherence (Argent et al., 2018).

Digital Therapy vs. Traditional Rehabilitation: A Shoulder Recovery Study:

In a randomized controlled trial, twenty-two adults with shoulder pathologies were recruited for a rehabilitation program of ten consecutive sessions for pain, strength, and mobility assessments to determine the effectiveness of a digital therapy performed with the Playball device during a shoulder rehabilitation protocol. The main finding was that the rehabilitation carried out with the Playball was as effective as the equivalent non-digital rehabilitation. Namely, both proposed rehabilitation programs effectively improved shoulder recovery, improved strength, reduced pain, and globally increased the subject’s self-perceived satisfaction and functionality (Rizzato et al., 2023)

This research also revealed that digital therapy effectively reduced pain throughout the range of motion and regained strength levels in short-term shoulder rehabilitation.

Challenges and Considerations Of Digital Therapy

While digital therapy holds immense promise, it is essential to acknowledge potential challenges and considerations. Not all patients have access to the required technology, and some might struggle with the digital learning curve. Therefore, a balanced approach that combines the benefits of digital therapy with occasional in-person sessions could be a way forward.

Squegg, a digital grip strengthener, is a versatile tool that can be used to improve hand grip strength. The app-based Squegg device revitalizes muscle movement in a fun and engaging manner. For patients to use the Squegg device, the user must install the Squegg app on an Apple or Android smartphone/tablet. They need to create an account within the app or log in using a Google or Facebook account (Bateman et al., 2022). The Squegg, featuring an intuitive and user-friendly design, stands as the optimal choice for enhancing grip strength exercises. It not only assists in monitoring your grip strength and the number of grips performed but also provides clear and easily understandable graphical representations to track your progress. With its portability, gamification aspects, and smart activity customization, the Squegg is a motivating tool that encourages users to actively participate in their rehabilitation program, ultimately leading to improved adherence.

References:

Argent, R., Daly, A., & Caulfield, B. (2018). Patient involvement with home-based exercise programs: Can connected health interventions influence adherence? JMIR MHealth and UHealth, 6(3), e47. https://doi.org/10.2196/mhealth.8518.
Bateman, M., Saunders, B., Littlewood, C., Davis, D., Beckhelling, J., Cooper, K., Skeggs, A., Foster, N. E., Vicenzino, B., & Hill, J. C. (2022). Comparing an optimized physiotherapy treatment package with usual physiotherapy care for tennis elbow patients — protocol for the OPTimisE pilot and feasibility randomized controlled trial. Pilot and Feasibility Studies, 8(1). https://doi.org/10.1186/s40814-022-01132-x.
Kendra Cherry, Mse. (2022, May 16). The Pros and cons of online therapy. Verywell Mind. https://www.verywellmind.com/advantages-and-disadvantages-of-online-therapy-2795225
Correia, F. D., Nogueira, A., Magalhães, I., Guimarães, J., Moreira, M., Barradas, I., Teixeira, L., Tulha, J., Seabra, R., Lains, J., & Bento, V. (2018). Home-based rehabilitation with a novel digital biofeedback system versus conventional in-person rehabilitation after total knee replacement: A feasibility study. Scientific Reports, 8(1). https://doi.org/10.1038/s41598-018-29668-0.
Cunha, B., Ferreira, R., & Sousa, A. S. P. (2023). Home-based rehabilitation of the shoulder using auxiliary systems and artificial intelligence: An overview. Sensors, 23(16), 7100. https://doi.org/10.3390/s23167100.
Janela, D., Costa, F., Molinos, M., Moulder, R. G., Lains, J., Francisco, G. E., Bento, V., Cohen, S. P., & Correia, F. D. (2022). Asynchronous and tailored digital rehabilitation of chronic shoulder pain: A prospective longitudinal cohort study. Journal of Pain Research, Volume 15, pp. 53–66. https://doi.org/10.2147/jpr.s343308.
Nascimento, L. M. S. do, Bonfati, L. V., Freitas, M. L. B., Mendes Junior, J. J. A., Siqueira, H. V., & Stevan, S. L. (2020). Sensors and systems for physical rehabilitation and health monitoring—A review. Sensors, 20(15), 4063. https://doi.org/10.3390/s20154063.
Rizzato, A., Pizzichemi, M., Gobbi, E., Gerardi, A., Fortin, C., Ancuta Copcia, Paoli, A., & Marcolin, G. (2023). Effectiveness and therapeutic compliance of digital therapy in shoulder rehabilitation: a randomized controlled trial. Journal of Neuroengineering and Rehabilitation, 20(1). https://doi.org/10.1186/s12984-023-01188-7.
Steiner, B., Elgert, L., Saalfeld, B., & Wolf, K.-H. (2020). Gamification in the rehabilitation of patients with musculoskeletal diseases of the shoulder: Scoping review. JMIR Serious Games, 8(3), e19914. https://doi.org/10.2196/19914.