Telerehabilitation and internet-based management of rotator cuff related pain: a pilot and feasibility randomised controlled trial

The intervention will be delivered via a tailored online website for participants.
The intervention groups include:
*Group (ii): Detailed education, advice and exercises + “virtual physiotherapist” (performance of exercises is entered into a website and it provides guidance for modification)
*Group (iii): Detailed education, advice and exercises + “virtual physiotherapist” + weekly telerehabilitation session via Zoom with physiotherapist.

We hypothesize the addition of a weekly telerehabilitation session for Group (iii) will improve the personalization and personability of the program while still using an online platform. We anticipate this will improve adherence to the program and result in superior results of primary and secondary outcomes in group (iii) compared to group (i) and group (ii).

The online website has been specifically designed for this trial. It is built to encourage self-navigation throughout the website. The online website was built by an IT expert in conjunction with a physiotherapy shoulder expert.
It will include the education material, which is a document around rotator cuff related pain including anatomy, physiology, contributing factors, treatment and advice including activity modification and recommended care. This is provided in both written and video format.
It also includes the exercise intervention, which is provided in both written and video exercises. There will be two exercises: shoulder elevation in standing; and shoulder external rotation in side-lying. Three sets of 15 repetitions of each exercise will be performed. The exercise will be individualised based on pain (pain should be minimal during the exercise, i.e. less than 5/10 on a 10-point numerical rating scale), and capacity (they should feel they are not able to perform more than 2 additional repetitions at the end of each set of 15). Participants are encouraged to modify the exercises (either make easier or more difficult) as per their self-perceived levels of pain. If they find the exercise too easy, they are prompted to increase the exercise intensity by adding external load in increments of 1kg. Each day they should ensure that they can perform the exercise with acceptable pain (

此次干预将通过为参与者量身定制的在线网站进行交付。干预组包括：
* 组 (ii)：详细的教育、建议和练习 + “虚拟物理治疗师”（将练习动作输入网站，并提供修改指导）
* 组 (iii)：详细的教育、建议和练习 + “虚拟物理治疗师” + 通过 Zoom 与物理治疗师进行的每周远程康复会议。

我们假设，对于组 (iii)，每周远程康复会议的加入将提升程序的个人化和人性化，同时仍使用在线平台。我们预期这将提高对程序的依从性，并导致相较于组 (i) 和组 (ii)，组 (iii) 在主要和次要结果方面取得更卓越的成绩。

该在线网站专为此次试验设计，旨在鼓励用户在网站中进行自我导航。该在线网站由一位 IT 专家与一位物理治疗肩部专家合作构建。
它将包括教育材料，这是一份关于肩袖相关疼痛的文档，涵盖解剖学、生理学、影响因素、治疗和咨询，包括活动调整和推荐的护理措施。这些材料以书面和视频两种格式提供。
它还包括锻炼干预措施，这些措施以书面和视频形式提供。将有两种锻炼：站立时的肩部抬高；和侧卧时的肩部外旋。每种锻炼将进行三组，每组15次。锻炼将根据疼痛程度（锻炼期间疼痛应最小，即10分制评分量表上小于5分）和容量（他们应该感觉在每组15次锻炼结束后，不能再额外完成超过2次）进行个性化调整。鼓励参与者根据自我感知的疼痛程度调整锻炼（或使其更容易或更困难）。如果他们认为锻炼过于简单，他们将收到提示，通过以1kg为单位的增量增加外部负荷来提高锻炼强度。每天他们应确保能够以可接受的疼痛程度完成锻炼（