Choi Y, Nam J, Yang D, et al. Effect of smartphone application-supported self-rehabilitation for frozen shoulder: a prospective randomized control study. Clin Rehabil. 2018 Dec 10:269215518818866. doi: 10.1177/0269215518818866. (Original study)

OBJECTIVES:: To evaluate the clinical efficacy of smartphone-assisted self-rehabilitation in patients with frozen shoulder.

DESIGN:: A single-center, randomized controlled trial.

SETTING:: Orthopedic department of a university hospital.

SUBJECTS:: A total of 84 patients with frozen shoulder were recruited.

INTERVENTION:: Patients were randomly divided into two groups: a smartphone-assisted exercise group ( n = 42) and a conventional self-exercise group ( n = 42). The study was performed over three months, during which each group performed home-based rehabilitation.

MAIN MEASURES:: Visual analogue scale for pain and passive shoulder range of motion were assessed at baseline and after 4, 8, and 12 weeks of treatment. Technology Acceptance Model-2 and Usefulness, Satisfaction, and Ease of Use scores were evaluated in the smartphone group.

RESULTS:: Initial visual analogue scale for pain of the smartphone group was 6.0 ± 2.2 and ended up with 1.8 ± 2.5 after 12 weeks, whereas the self-exercise group showed 5.8 ± 2.3 for the baseline visual analogue scale for pain and 2.2 ± 1.7 at the end. Significant time-dependent improvements in all measured values were observed in both groups (all Ps < 0.001), but no significant intergroup difference was observed after 4, 8, or 12 weeks of treatment. In the smartphone group, Technology Acceptance Model-2 and Usefulness, Satisfaction, and Ease of Use scores showed high patient satisfaction with smartphone-assisted exercise.

CONCLUSION:: There was no difference between home-based exercise using a smartphone application and a conventional self-exercise program for the treatment of frozen shoulder in terms of visual analogue scale for pain and range of motions.

Discipline Area Score
Rehab Clinician (OT/PT) 5 / 7
Physician 4 / 7
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Comments from MORE raters

Physician rater

The topic is relevant for primary care. The study has some limitations but they are well described. The study show no differences between treatments but this means that doctor could try cell phone to reach people fare from practice/hospital/etc. Time will tell us if the experimental treatment will reach more patients than the residential one. This is the future and it is better to study the efficacy of cell phone co-administered treatment in all fields. No side effects have been found.

Rehab Clinician (OT/PT) rater

Passive ROM and pain are poor indicators to assess if the app worked. They should have measured upper extremity function and QoL.

Rehab Clinician (OT/PT) rater

An important reminder that more technology does not necessarily produce superior results.

Rehab Clinician (OT/PT) rater

Although I have very few patients with frozen shoulder specifically, it is of interest that; although, there was no significant difference in effectiveness, both conventional and smart phone programs did show improvement and the smart phone group did accept this method. It may be helpful in the toolkit, when tailoring programs to meet individual preferences. I would be interested in the evaluation of smart phone delivered programs among other health promotion or treatment populations.
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