"Effectiveness of a Telerehabilitation Program Versus a Conventional Rehabilitation Program in Patients With Subacromial Pain"

Overview

The purpose of this prospective, randomized, parallel-group, single-center, controlled non-inferiority clinical trial is to determine whether a telerehabilitation program is non-inferior to a conventional rehabilitation program in patients with subacromial pain. Subacromial pain is a prevalent musculoskeletal condition, and while therapeutic exercise is the cornerstone of conservative management, adherence to home programs is often low. Conversely, conventional in-person physical therapy presents logistical and economic barriers for patients. This study aims to evaluate if a well-designed telerehabilitation program, utilizing information and communication technologies for remote monitoring, can provide an effective, accessible, and non-inferior alternative to conventional care. The primary outcome measured will be the change in shoulder function utilizing the QuickDASH questionnaire at 12 weeks. Secondary outcomes will assess pain intensity (VAS), range of motion (ROM), treatment adherence, and long-term functional outcomes.

Detailed description

Chronic subacromial pain represents a significant public health challenge and the most common musculoskeletal disorder after back and neck pain. Its etiology is multifactorial, causing substantial functional limitations, work disability, and a decrease in quality of life. The management of subacromial pain is primarily conducted through conservative interventions, with therapeutic exercise constituting the cornerstone of treatment to reduce joint pain, optimize shoulder function, and improve muscle strength.

Despite its efficacy, adherence to home exercise programs is often low due to a lack of supervision and motivation, which compromises long-term outcomes. While supervised, conventional in-person physical therapy improves adherence and functional outcomes, it presents significant logistical and economic barriers, such as travel costs, distance, and difficulty accommodating appointments within work schedules. This creates a gap in care, preventing many patients from receiving the necessary amount of therapy for optimal recovery.

Telerehabilitation, a remote healthcare delivery modality utilizing information and communication technologies, emerges as a promising solution to mitigate these barriers. Assisted digital therapy programs can be utilized to maximize treatment intensity, provide real-time biofeedback, and allow physical therapists to progressively adjust exercise complexity under remote guidance. This approach can potentially improve treatment adherence and reduce indirect costs for patients by eliminating travel needs and decreasing time off work.

Although current evidence provides compelling data regarding the efficacy of telerehabilitation, establishing its superiority over static home exercise programs, there is a lack of standardized protocols. Furthermore, a clear consensus has not been established regarding its non-inferiority to the conventional in-person model within a standard, non-pandemic clinical setting.

To address this gap, this study proposes a prospective, randomized, parallel-group, single-center, controlled non-inferiority clinical trial. The primary objective is to compare the change in shoulder function, as measured by the QuickDASH, at the end of a 12-week program between a telerehabilitation group and a conventional rehabilitation group. Secondary objectives include comparing changes in pain intensity (VAS) and range of motion (flexion, abduction, and external rotation), as well as evaluating treatment adherence, patient satisfaction, and long-term functional outcomes at 6 months. Answering this question will lay the groundwork for establishing a standardized, evidence-based telerehabilitation protocol as a highly accessible and sustainable care modality for patients with subacromial pain.

Interventions

• Other Digital Physical Therapy (Telerehabilitation)
  Multimodal digital intervention delivered via the Moodle platform. It includes a structured therapeutic exercise program (mobility, stretching, and progressive strengthening of rotator cuff and periscapular muscles), asynchronous remote monitoring by a physical therapist, and digital health education. Cognitive-behavioral therapy (CBT) components focused on pain reconceptualization and coping strategies are also integrated. Patients perform 30-minute daily sessions, 3-4 times per week, for a dur
• Other Conventional Physical Therapy
  Standard in-person rehabilitation program conducted at the clinic. The intervention consists of supervised therapeutic exercises (similar to the experimental group), manual therapy techniques (joint mobilization and soft tissue manipulation as clinically indicated), and verbal health education provided by the physical therapist. Patients attend 2-3 in-person sessions per week, each lasting 30 minutes, for 12 to 24 weeks, complemented by printed home exercise instructions.

Primary outcome measures

• Change in Shoulder Function [Time frame: Baseline, 12 and 24 weeks]

Secondary outcome measures (5)

• Change in Pain Intensity [Time frame: Baseline, 12 and 24 weeks]
• Change in Range of Motion (ROM) [Time frame: Baseline, 12 and 24 weeks]
• Treatment Adherence [Time frame: Baseline, 12 and 24 weeks]
• Patient Satisfaction [Time frame: Baseline, 12 and 24 weeks]
• Long-Term Shoulder Function [Time frame: 24 weeks postintervention]

Eligibility criteria

Inclusion criteria

• Men and women aged 18 years or older.
• Diagnosis of Subacromial Impingement Syndrome (SIS) based on clinical criteria (pain with overhead activities, painful arc, positive Neer, Hawkins, or Jobe test). Radiological confirmation (ultrasound and/or magnetic resonance imaging) is accepted.
• Access to the internet and a device (smartphone, tablet, or computer) capable of running the telerehabilitation platform.
• Willingness and ability to provide written informed consent.

Exclusion criteria

• Shoulder pain caused by fractures, tumors, infections, or severe systemic pathologies.
• Previous surgery on the affected shoulder within the last 3 months.
• Prior joint injection (corticosteroid infiltration) in the affected shoulder within the last 3 months.
• Subjects with partial or full-thickness rotator cuff tears.
• Patients currently receiving concurrent physical therapy (PT) or any other external interventions for the shoulder condition.
• Current participation in another rehabilitation or exercise program.
• Pregnancy.
• Cognitive impairment, communication barriers, or any condition that prevents the patient from following the remote instructions.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

Center list to be confirmed — check the primary protocol.

Publications

• Petersson AH, Bjornsson Hallgren HC, Adolfsson LE, Holmgren TM. No need for subacromial decompression in responders to specific exercise treatment: a 10-year follow-up of a randomized controlled trial. J Shoulder Elbow Surg. 2025 Jun;34(6):e477-e487. doi: 10.1016/j.jse.2024.10.027. Epub 2024 Dec 21. PMID 39716615
• Sheth U, Nam D, Richards R, Palinkas V, Wainwright A, Dunn PC, Razmjou H. Agreement on clinical examination and management between virtual videoconferencing and in-person assessment in a tertiary shoulder center. JSES Int. 2025 Jan 28;9(3):859-863. doi: 10.1016/j.jseint.2024.12.021. eCollection 2025 May. PMID 40486802
• Martinez-Rico S, Lizaur-Utrilla A, Sebastia-Forcada E, Vizcaya-Moreno MF, de Juan-Herrero J. The Impact of a Phone Assistance Nursing Program on Adherence to Home Exercises and Final Outcomes in Patients Who Underwent Shoulder Instability Surgery: A Randomized Controlled Study. Orthop Nurs. 2018 Nov/Dec;37(6):372-378. doi: 10.1097/NOR.0000000000000501. PMID 30451774
• Kane LT, Thakar O, Jamgochian G, Lazarus MD, Abboud JA, Namdari S, Horneff JG. The role of telehealth as a platform for postoperative visits following rotator cuff repair: a prospective, randomized controlled trial. J Shoulder Elbow Surg. 2020 Apr;29(4):775-783. doi: 10.1016/j.jse.2019.12.004. PMID 32197766
• Sabbagh R, Shah N, Jenkins S, Macdonald J, Foote A, Matar R, Steffensmeier A, Grawe B. The COVID-19 pandemic and follow-up for shoulder surgery: The impact of a shift toward telemedicine on validated patient-reported outcomes. J Telemed Telecare. 2023 Jul;29(6):484-491. doi: 10.1177/1357633X21990997. Epub 2021 Feb 1. PMID 33525951
• Huang T, Zhang W, Yan B, Liu H, Girard O. Comparing Telerehabilitation and Home-based Exercise for Shoulder Disorders: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil. 2024 Nov;105(11):2214-2223. doi: 10.1016/j.apmr.2024.02.723. Epub 2024 Mar 2. PMID 38432330
• Zhang B, Fang Z, Nian K, Sun B, Ji B. The effects of telemedicine on Rotator cuff-related shoulder function and pain symptoms: a meta-analysis of randomized clinical trials. J Orthop Surg Res. 2024 Aug 14;19(1):478. doi: 10.1186/s13018-024-04986-4. PMID 39143625
• Pak SS, Janela D, Freitas N, Costa F, Moulder R, Molinos M, Areias AC, Bento V, Cohen SP, Yanamadala V, Souza RB, Correia FD. Comparing Digital to Conventional Physical Therapy for Chronic Shoulder Pain: Randomized Controlled Trial. J Med Internet Res. 2023 Aug 18;25:e49236. doi: 10.2196/49236. PMID 37490337

Identifiers

NCT: NCT07536009 · R-2026-3201-029 · FMED-001446

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗