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 ( Participants are required to complete their exercises daily, unless their pain symptoms guide them to rest for the day and try again the following day. Participants in group (ii) and group (iii) are expected to enter what exercises they completed (and any modifications) into a daily recording page within the website. This will track adherence to the program and allow the monitoring of progression of exercise and participation throughout the trial. All participants will be required to complete an online survey at baseline, at six weeks and at twelve weeks at the conclusion of the study. Participants will be required to complete an initial baseline Zoom session, and participants in group three will be required to complete a weekly telerehabilitation session. This weekly telerehabilitation session will be completed via Zoom, an online videoconference platform. It will be set up at an agreed upon time between the physiotherapist and the participant. The aim of the session is to assess exercise technique, suggest progressions if indicated and answer any participant questions. It is expected to take between 10-30 minutes per week. Participants will be provided with education at baseline and required to complete a questionnaire regarding this education to measure knowledge improvement. The education intervention has been developed with input from multidisciplinary expert shoulder clinicians.本干预措施将通过为参与者定制的专属在线网站实施。干预组设置如下：*第(ii)组：详细健康教育、指导与训练+“虚拟物理治疗师”（训练动作录入网站后，网站将提供调整优化指导）；*第(iii)组：详细健康教育、指导与训练+“虚拟物理治疗师”+每周通过Zoom（在线视频会议平台）与物理治疗师开展的远程康复会话。 我们假设，为第(iii)组增设每周远程康复会话，可在延续在线平台使用的同时，提升干预方案的个性化程度与人文关怀。我们预期这一设置将提升参与者的方案依从性，且与第(i)组、第(ii)组相比，第(iii)组的主要结局与次要结局将更优异。 本专属在线网站为本试验专门设计，旨在鼓励参与者自主浏览操作。网站由IT专家与肩部物理治疗专家联合开发。网站将涵盖健康教育材料：内容围绕肩袖（rotator cuff）相关疼痛展开，包括解剖学、生理学、致病因素、治疗方案及活动调整、护理建议等，以书面与视频两种形式呈现。 同时包含书面与视频形式展示的训练干预内容，共包含两项训练：站立位肩部上抬训练，以及侧卧位肩部外旋训练。每项训练需完成3组，每组15次重复。训练将根据参与者的疼痛程度（训练过程中疼痛应控制在最低水平，即10分数字评分量表下得分低于5分）与自身耐受能力（每组15次训练结束后，参与者应无法再完成额外2次重复）进行个体化调整。鼓励参与者根据自身感知的疼痛程度调整训练强度（可简化或强化）：若觉得训练过于轻松，可通过每1kg为增量增加外部负荷来提升训练强度。参与者每日需确保训练时疼痛程度处于可接受范围，除非因疼痛症状需当日休息并于次日再进行训练，否则需每日完成训练。 第(ii)组与第(iii)组的参与者需在网站的每日记录页面录入当日完成的训练内容及任何调整情况，以此追踪方案依从性，并监测试验全程的训练进展与参与情况。 所有参与者均需在试验基线期、6周时及研究结束的12周时完成在线问卷。参与者需完成初始基线Zoom会话，其中第(iii)组参与者还需每周完成远程康复会话。该每周远程康复会话将通过在线视频会议平台Zoom开展，时间由物理治疗师与参与者共同商定。会话目标为评估训练动作规范性，视情况给出进阶建议，并解答参与者的所有疑问，单次会话时长预计为10至30分钟。 参与者将在基线期获得健康教育，并需完成针对该教育内容的问卷，以衡量知识掌握程度的提升。本次健康教育干预由多学科肩部临床专家参与开发。