Abstract
Interactive postoperative rehabilitation approaches have increasingly been used following arthroscopic rotator cuff (RC) repair; however, evidence comparing their effectiveness with conventional physiotherapist-supervised (PS) rehabilitation remains limited. This study aimed to compare functional recovery outcomes between patients participating in an interactive postoperative rehabilitation program and those receiving PS rehabilitation after arthroscopic RC repair. Patients who underwent arthroscopic RC repair at a tertiary orthopedic center between February 2021 and April 2022 were prospectively included. Patients were allocated to either an interactive online exercise–based rehabilitation program or PS rehabilitation based on internet access availability. Both groups followed the same standardized postoperative exercise protocol. Pain intensity, shoulder range of motion, muscle strength, and functional outcomes were assessed preoperatively and at 2 weeks, 3 months, and 6 months postoperatively. A total of 40 patients were included in the analysis (n = 20 per group). Both rehabilitation approaches resulted in significant improvements in pain, shoulder range of motion, muscle strength, and functional outcomes over time (P < .05). The mean Quick-DASH score decreased from 50.45 ± 33.77 to 1.02 ± 2.14 in the interactive rehabilitation group and from 45.67 ± 20.74 to 0.90 ± 2.89 in the PS group at 6 months, with no statistically significant difference between groups (P > .05). However, patients in the interactive rehabilitation group demonstrated earlier pain reduction during the early postoperative period. An interactive postoperative rehabilitation program provides functional outcomes comparable to those of PS rehabilitation following arthroscopic RC repair. These findings suggest that interactive rehabilitation strategies may represent a feasible alternative for postoperative care, particularly when access to in-person rehabilitation is limited.
Keywords: physiotherapy, postoperative rehabilitation, rotator cuff repair, telerehabilitation
1. Introduction
Rotator cuff injuries represent a leading source of shoulder pain and impaired upper limb function of the upper limb and can significantly negatively impact individuals’ daily living activities, work performance, and quality of life.[1–3] Patients with rotator cuff (RC) tears often present with pain, restricted range of motion (ROM), and muscular weakness, and these functional limitations become more pronounced, especially in middle-aged and older adults.[2,3]
Although surgical repair is often preferred for full-thickness tears, the successful of functional recovery after surgery depends on an appropriately designed rehabilitation program.[4] Postoperative rehabilitation aims to control pain, maintain and increase achieve improvements in joint mobility, recover muscle strength, and support patients in resuming functional activities to their daily activities.[5,6] It has been demonstrated that appropriately planned rehabilitation programs play an important role in preventing complications such as shoulder stiffness, chronic pain, and loss of function.[7]
In clinical practice, rehabilitation following RC repair is generally conducted as physiotherapist-supervised (PS) rehabilitation. However, it may not always be possible for patients to continue their exercise programs regularly after discharge. Difficulties in accessing healthcare centers, individual and environmental factors, and increased patient volume can negatively impact the continuity of the rehabilitation process.[8,9]
For these reasons, interest in telerehabilitation (TR) approaches, which enable rehabilitation services to be provided remotely, has grown significantly in recent years. TR is a method that enables the assessment of patients, the guidance of their exercises, and their monitoring through communication technologies.[10] It has been reported that TR applications in the fields of orthopedic rehabilitation, as well as neurological, cardiac, and pulmonary rehabilitation, can provide functional outcomes comparable to those of in-person rehabilitation[11,12]
Despite a growing body of literature examining TR following RC repair, comparative studies evaluating its effects on pain, joint mobility, muscle strength, and functional results compared to conventional physiotherapist-directed rehabilitation remain limited.[13,14]In particular, the effectiveness of interactive online exercise (IOE) programs, which support regular patient follow-up and active participation in exercises, has not yet been clearly established as a viable option to PS rehabilitation.
The purpose of this study was to evaluate the effectiveness of an IOE program delivered as TR after arthroscopic surgery of RC, in comparison with PS rehabilitation, on the functional status and clinical outcomes of patients with RC injuries. We hypothesized that the IOE–based rehabilitation program would provide clinical and functional outcomes comparable to those achieved with PS rehabilitation.
2. Material method
2.1. Study design and participants
Between February 2021 and April 2022, patients aged between 18 to 65 years who were presenting with complete-thickness RC tears and underwent arthroscopic repair at the Orthopaedics and Traumatology Clinic of Pamukkale University Health Research and Application Center were included in this prospective study. The participant flow through the study is presented in Figure 1.
Figure 1.
Flow diagram of participant enrollment, allocation, follow-up, and analysis according to STROBE guidelines. IOE = interactive online exercise, n = number of patients, PS = physiotherapist-supervised, STROBE = strengthening the reporting of observational studies.
Inclusion criteria for the IOE group included the absence of additional neurological or orthopedic diseases affecting the same extremity, absence of metabolic diseases, voluntary participation, absence of communication problems, inability to regularly access the hospital, and availability of a stable internet connection. Patients who were unable to continue the exercise program, experienced internet access problems, or withdrew consent for any reason were excluded from further evaluation.
Patients were allocated to the IOE or PS group according to the availability of stable internet access required for participation in the online rehabilitation program. Patients with sufficient internet access were assigned to the IOE group, whereas those without adequate access were assigned to the PS group. Both groups followed the same standardized postoperative exercise protocol. Each group consisted of an equal number of participants.
Both groups followed the same standardized exercise protocol. The sample size calculation was performed using a priori power analysis conducted with G*Power software (version 3.1; Heinrich Heine University Düsseldorf, Germany). The significance level (α) was set at 0.05 and the statistical power (1−β) at 80%. The calculation was based on previously reported functional outcome differences in TR studies following arthroscopic RC repair.[14]
2.2. Surgical procedure and postoperative management
All patients arthroscopic RC repair was administered by the same surgeon under interscalene block anesthesia. Surgeries were conducted in the standard beach-chair position using 3 arthroscopic portals. After the procedure, a long shoulder–arm sling was applied to immobilize all patients for 6 weeks.
2.3. Outcome assessment
All assessments were conducted by a single physiotherapist in a quiet environment with patients positioned on an examination table. Demographic and clinical information of the patients, such as age and sex, height, dominant side, affected extremity, duration of preoperative pain, primary complaint, and injury characteristics were recorded preoperatively.
2.4. Pain assessment
Pain severity was measured with the visual analog scale. Consisting on a 10 cm vertical line ranging from 0 (no pain) to 10 (the most severe pain imaginable). Patients rated their pain intensity at rest as well as during activity, and sleep[15] Assessments were assessed before surgery and at 2, 12, and 24 weeks after surgery.
2.5. ROM
An universal goniometer was useed to evaluate joint ROM. Measurements included shoulder flexion, extension, abduction, external and internal rotation; elbow extension and flexion; as well as forearm pronation, supination.[16] Patients were instructed on proper movement execution before measurement, and the mean of 3 repetitions was recorded. ROM assessments were carried out before surgery and repeated at 12 and 24 weeks postoperatively.
2.6. Muscle strength
Upper extremity muscle strength was evaluated manually for each muscle group in positions defined by Kendall et al.[17] The following movements were assessed: shoulder flexion and extension, external, internal rotation; flexion, extension of the elbow; forearm supination and pronation. Each correctly performed movement was awarded a full score of 5, while different scoring was used for movements that could not be performed. Upper extremity muscle strength measurements were assessed preoperatively at the twelfth week postoperatively, and the twenty-fourth week postoperatively.
2.7. Functional assessment
Upper extremity functionality was determined by the Turkish version of the quick-disabilities of the arm, shoulder and hand (Q-DASH) questionnaire.[18]In this study, the Q-DASH score was defined as the primary outcome measure. Pain intensity, ROM, and muscle strength were evaluated as secondary outcome measures.
3. Intervention
3.1. IOE group
In this study, WhatsApp application was used to communicate with patients in the IOE group and conduct individual exercises. Patients and their relatives were informed about the application and trained on how to use the program and camera to follow the exercises explained through the app.[14,19,20] Similar to the PS group, the program was conducted for 40 minutes twice a week. The follow-up period for both groups was 6 months.
3.2. PS group
From the first day post-surgery, the PS began with hand pumping and elbow ROM exercises. Starting from the second week, these exercises were taught to patients and their relatives. Following immobilization, progressive shoulder joint ROM exercises were introduced during weekly sessions to help patients achieve full ROM. Patients were instructed not to exceed 45° passive shoulder abduction and 90° shoulder elevation until the second postoperative week. By the sixth week, passive shoulder abduction was permitted up to 90° and stretching and resistance exercises for full active ROM were initiated. Participants were asked to carry out as home exercises, 4 times a day with 10 repetitions each.[21] The PS group attended the hospital twice a week to advance the program.
3.3. Statistical analysis
The Statistical analyses of the study data were conducted using Statistical Package for the Social Sciences software 26.0. Demographic data were presented as mean ± standard deviation (x ± SD) or percentages. The parametric test assumptions of the obtained data were checked using the Kolmogorov-Smirnov test. The superiority of the demographic data obtained from the patients before the study were analyzed using the independent samples t-test and the chi-square test. To assess the effectiveness of the rehabilitation methods used in our study, the following tests were employed: Repeated measures analysis of variance, paired-samples t-test, friedman variance analysis, Wilcoxon signed-rank test, independent samples t-test, and Mann–Whitney U test. P < .05 significance level was considered statistically significant for all statistical results and and interpreted accordingly. Changes in outcome measures over time were assessed using repeated measures analysis appropriate for the distribution of the data. Intergroup comparisons were performed separately at each time point to evaluate differences in rehabilitation outcomes. In addition, baseline demographic and clinical characteristics were compared between groups to assess potential confounding factors. Comparisons of the primary outcome measure, the Q-DASH score, between groups were performed using either an independent samples t-test or the Mann–Whitney U test, depending on the data distribution. Changes over time within groups were assessed using repeated measures analysis. Secondary outcome measures, including pain scores, ROM, and muscle strength analyses, were performed using parametric or nonparametric tests appropriate for the data distribution.
3.4. Ethics approval:
This investigation was conducted following approval by the Non-Interventional Clinical Research Ethics Committee of Pamukkale University (decision date: February 16,2021; approval number: E-60116787-020-21573).
4. Results
A total of 40 patients were included in the study, with 20 patients in each group. Baseline demographic and clinical characteristics were comparable between the IOE and PS groups. The mean age of the participants was 56.1 ± 5.74 years in both groups, and no statistically significant differences were observed between the groups in terms of age, smoking status, height, weight, body mass index, gender distribution, or education level (P > .05). Baseline demographic characteristics are presented in Table 1.
Table 1.
Descriptive information of the patients.
| Groups | ||||||
|---|---|---|---|---|---|---|
| Variables | IOE Group (n = 20) | PS Group (n = 20) | ||||
| min- max. | x ± SD. | min- max. | x ± SD. | P * | ||
| Age (yr) | 44–65 | 56.1 ± 5.74 | 44–65 | 56.1 ± 5.74 | 0.936 (t = 0.08) | |
| Smoking (no of cigarettes) | 10–20 | 15 ± 4.08 | 20–20 | 20 ± 0 | 0.4 (z = −1.118) | |
| Height (cm) | 152–183 | 164.6 ± 8.58 | 153–185 | 166 ± 7.29 | 0.582 (t = 0.556) | |
| Weight (kg) | 55–94 | 69.95 ± 11.29 | 54–92 | 76.04 ± 10.61 | 0.087 (t = .1.758) | |
| BMI (kg/m2) | 21.41–36.26 | 27.72 ± 3.78 | 21.63–33.53 | 27.47 ± 3.60 | 0.142 (t = .1.500) | |
| n |
% | n | % | p** | ||
| Gender | ||||||
| Female | 15 | 75.0 | 15 | 75.0 | 0.642 | |
| Male | 5 | 25.0 | 5 | 25.0 | ||
| Education Level |
||||||
| Primary School | 13 | 65.0 | 8 | 40.0 | 0.132 | |
| Secondary School | 3 | 15.0 | 4 | 20.0 | ||
| High School | 4 | 20.0 | 5 | 25.0 | ||
| Bachelor’s or higher | 0 | 0.0 | 3 | 15.0 | ||
IOE = interactive online exercise, PS = physiotherapist-supervised, SD = standard deviation.
Independent Samples t-Test.
chi-square test.
Pain scores decreased progressively in both groups during follow-up. For example, sleep pain decreased from 6.94 ± 2.81 before surgery to 0.01 ± 0.02 at 6 months in the PS group and from 6.13 ± 3.09 to 0.28 ± 1.23 in the IOE group. Similar improvements were observed for rest pain and activity pain. However, no statistically significant differences were detected between the groups at any follow-up time point (P > .05) (Table 2).
Table 2.
Comparison of pain values between groups.
| Variables | PS Group | IOE Group | ||
|---|---|---|---|---|
| x ± SD. | x ± SD. | z/t | P | |
| Sleep Pain | ||||
| BS | 6.94 ± 2.81 | 6.13 ± 3.09 | (t = −0.862) | *0.394 |
| 2nd week | 8.08 ± 11.11 | 4.76 ± 2.81 | (t = −1.296) | *0.203 |
| 3rd month | 0.62 ± 1.5 | 1.09 ± 1.93 | (t = 0.871) | *0.389 |
| 6th month | 0.01 ± 0.02 | 0.28 ± 1.23 | (z = −0.036) | **0.989 |
| Rest Pain |
||||
| BS | 4.97 ± 2.96 | 5.78 ± 3.27 | (t = 0.417) | *0.821 |
| 2nd week | 3.78 ± 3.47 | 2.65 ± 2.61 | (t = −1.169) | *0.250 |
| 3rd month | 0.47 ± 1.31 | 0.53 ± 1.69 | (t = 0.115) | *0.909 |
| 6th month | 0.02 ± 0.07 | 0.34 ± 1.5 | (z = −0.036) | **0.989 |
| Activity Pain |
||||
| BS | 5.85 ± 3.67 | 6.73 ± 2.96 | (t = 0.835) | *0.409 |
| 2nd week | 4.4 ± 2.85 | 3.03 ± 2.74 | (t = −1.549) | *0.13 |
| 3rd month | 0.85 ± 1.62 | 0.87 ± 1.51 | (t = 0.04) | *0.968 |
| 6th month | 0.04 ± 0.16 | 0.37 ± 1.63 | (z = −0.036) | **0.989 |
BS = before surgery, IOE = interactive online exercise, PS = physiotherapist-supervised, SD = standard deviation.
Independent samples t-test.
Mann–Whitney U test.
Shoulder ROM improved substantially in both groups during follow-up. For instance, shoulder flexion increased from 115.9 ± 59.97° preoperatively to 176.4 ± 16.1° at 6 months in the PS group and from 133 ± 52.46° to 179.15 ± 2.66° in the IOE group. Improvements were also observed in abduction, internal rotation, and external rotation in both groups. Nevertheless, no statistically significant differences were found between the groups at any time point (P > .05) (Table 3).
Table 3.
Comparison of ROM of shoulder joint between groups.
| Variables | PS Group | IOE Group | ||
|---|---|---|---|---|
| x ± SD. | x ± SD. | z/t | ||
| Flexion | ||||
| BS | 115.9 ± 59.97 | 133 ± 52.46 | (t = −0.960) | *0.343 |
| 2nd week | 2.75 ± 5.25 | 4.75 ± 8.65 | (t = −0.884) | *0.382 |
| 3rd month | 170.95 ± 25.14 | 167.65 ± 20.64 | (t = −0.454) | *0.653 |
| 6th month | 176.4 ± 16.1 | 179.15 ± 2.66 | (t = 0.754) | *0.460 |
| Extension | ||||
| BS | 35.05 ± 9.57 | 37.7 ± 11.38 | (t = 0.797) | *0.430 |
| 2nd week | 1.6 ± 4.67 | 2.2 ± 5.34 | (t = 0.378) | *0.707 |
| 3rd month | 42.05 ± 8.2 | 41.95 ± 6.61 | (t = −0.042) | *0.966 |
| 6th month | 45 ± 0 | 45 ± 0 | (z = 0) | **1 |
| Abduction | ||||
| BS | 98.9 ± 56.66 | 99.1 ± 45.59 | (t = 0.012) | *0.99 |
| 2nd week | 3 ± 5.92 | 3.45 ± 7.83 | (t = 0.205) | *0.939 |
| 3rd month | 161.75 ± 40.67 | 150.7 ± 50.68 | (t = −0.761) | *0.452 |
| 6th month | 180 ± 0 | 173.2 ± 22.69 | (t = −1.340) | *0.188 |
| IR | ||||
| BS | 52.95 ± 32.46 | 52.9 ± 29.16 | (t = −0.005) | *0.996 |
| 2nd week | 0 ± 0 | 0 ± 0 | (z = 0) | **1 |
| 3rd month | 76.25 ± 28 | 75.55 ± 23.75 | (t = −0.085) | *0.932 |
| 6th month | 90 ± 0 | 87.65 ± 9.61 | (t = −1.094) | *0.281 |
| ER | ||||
| BS | 50.2 ± 32.55 | 42.85 ± 31.97 | (t = −0.720) | *0.476 |
| 2nd week | 0 ± 0 | 0 ± 0 | (z = 0) | **1 |
| 3rd month | 77.35 ± 26.57 | 71.3 ± 28.95 | (t = −0.689) | *0.495 |
| 6th month | 90 ± 0 | 86.2 ± 12.14 | (t = −1.40) | *0.170 |
BS = before surgery, ER = external rotation, IOE = interactive online exercise, IR = internal rotation, PS = physiotherapist-supervised, ROM = range of motion, SD = standard deviation.
Independent samples t-test.
Mann–Whitney U test.
Functional outcomes assessed using the Q-DASH questionnaire improved markedly in both groups. The mean Q-DASH score decreased from 50.45 ± 33.77 before surgery to 1.02 ± 2.14 at 6 months in the IOE group and from 45.67 ± 20.74 to 0.90 ± 2.89 in the PS group. Despite these improvements, no statistically significant differences were observed between the groups at any evaluation time point (P > .05) (Table 4).
Table 4.
Comparison of Q-DASH scores between groups.
| IOE Group | PS Group | P * | t | |||
|---|---|---|---|---|---|---|
| min- max. | x ± SD. | min.- max. | x ± SD. | |||
| BS | 0–97.72 | 50.45 ± 33.769 | 11.36–93.18 | 45.676 ± 20.737 | .593 | 0.539 |
| 3rd month | 0–52.27 | 19.087 ± 19.345 | 0–45.45 | 12.61 ± 13.384 | .226 | .1.231 |
| 6th month | 0–6.81 | 1.021 ± 2.144 | 0–11.36 | 0.908 ± .2.892 | .889 | 0.140 |
BS = before surgery. IOE = interactive online exercise, PS = physiotherapist-supervised, Q-DASH = quick disabilities of the arm, shoulder and hand, SD = standard deviation.
Independent samples t-test.
Manual muscle strength values increased during the follow-up period in both groups. Improvements were observed in several shoulder and scapular muscle groups; however, no statistically significant differences were detected between the IOE and PS groups at baseline, 3 months, or 6 months after surgery (P > .05) (Table 5).
Table 5.
Comparison of manual muscle strength values between groups.
| Variables | IOE Group | PS Group | |
|---|---|---|---|
| t/z | P * | ||
| Scapular Elevation | |||
| BS | (t = 2.015) | *0.051 | |
| 3rd month | (t = 0) | *1 | |
| 6th month | (z = −0) | **0 | |
| Scapular Adduction | |||
| BS | (t = 1.470) | *0.150 | |
| 3rd month | (t = −0.636) | *0.529 | |
| 6th month | (z = 0) | **1 | |
| Scapular Depression. | |||
| BS | (t = 1.080) | *0.287 | |
| 3rd month | (t = −0.636) | *0.529 | |
| 6th month | (z = 0) | **1 | |
| Shoulder Flexion | |||
| BS | (t = −0.362) | *0.719 | |
| 3rd month | (t = −0.658) | *0.515 | |
| 6th month | (t = 0) | *1 | |
| Shoulder Hyperextension | |||
| BS | (t = 1.510) | *0.139 | |
| 3rd month | (t = −0.698) | *0.490 | |
| 6th month | (t = 0) | *1 | |
| 90° Shoulder Abduction | |||
| BS | (t = 0.178) | *0.178 | |
| 3rd month | (z = −0.940) | **0.749 | |
| 6th month | (z = 0) | **1 | |
| Shoulder Horizontal Abduction | |||
| BS | (z = −0.32) | **0.762 | |
| 3rd month | (z = −1.363) | **0.173 | |
| 6th month | (z = 0) | **1 | |
| Shoulder Horizontal Adduction | |||
| BS | (z = −0.286) | **0.775 | |
| 3rd month | (z = −1.567) | **0.117 | |
| 6th month | (z = −1) | **0.317 | |
| Shoulder ER | |||
| BS | (z = −0.127) | **0.899 | |
| 3rd month | (z = −0.122) | **0.903 | |
| 6th month | (z = −0.593) | **0.553 | |
| Shoulder IR | |||
| BS | (z = −0.127) | **0.899 | |
| 3rd month | (z = −0.122) | **0.903 | |
| 6th month | (z = −0.593) | **0.553 | |
BS = before surgery, ER = external rotation, IOE = interactive online exercise, IR = internal rotation, PS = physiotherapist-supervised.
Independent samples t-test.
Mann–Whitney U test.
5. Discussion
This study contribute to the literature by providing evidence-based insights on the efficacy of an IOE program for patients who have undergone arthroscopic surgery following a RC injury.[20,22,23] This study demonstrated that the IOE program effectively supports the rehabilitation process after RC surgery, as evidenced by the significant improvements in pain reduction, ROM, and functional recovery observed in the patients.
The IOE program’s real-time, interactive nature fostered curiosity and motivation among patients, leading to an active and enthusiastic attitude towards rehabilitation. Initially, patients had limited knowledge about RC surgery and exercises. However, a rapid recovery process requires active patient participation.[24,25] Throughout the rehabilitation process, the IOE program facilitated patients’ return to their daily lives, enhancing their engagement and motivation.[26–28]
The IOE program requires more skills compared to the PS, such as using a phone, acting quickly, and thinking of practical solutions.[23,29] Consequently, older patients were excluded from the study due to these requirements. Despite these challenges, the IOE group showed significant improvements, suggesting that with the right support, patients can manage their rehabilitation remotely.
Both PS and IOE groups showed improvements in pain, ROM, and functionality over time. However, Q-DASH scores in the PS group decreased earlier than in the IOE group, likely due to higher initial Q-DASH scores in the IOE group from trauma-related RC injuries. Similar findings have been reported in the literature, demonstrating significant functional improvements with PS at discharge and at 6 months.[30]
Unexpectedly, the IOE group experienced early pain reduction, suggesting that patients could achieve pain relief without frequent clinic visits. Despite significant pain reduction, there was no notable difference in activity and rest pain between the groups, possibly due to patients’ fear of incorrect movements when not supervised. There are still few studies in literature that can form a general judgment on this subject.[23,31]
Our study found significant increases in ROM in both groups. The earlier achievement of full ROM in the PS group might be due to the IOE group’s fear of movement. The similarity in 6-month follow-up results is attributed to early exercise initiation and regular follow-up. TR has been reported to be comparable to PS in terms of pain, quality of life, and functionality, supporting our findings[14]
Importantly, both rehabilitation groups demonstrated marked improvements over time in functional outcomes, pain levels, and ROM, as reflected by the numerical reductions in Q-DASH scores and pain measurements, as well as increases in joint mobility. These improvements indicate meaningful functional recovery during the postoperative period. Although no statistically significant differences were observed between groups at the final follow-up, the comparable outcomes suggest that the IOE program may represent a clinically viable alternative to PS rehabilitation in appropriately selected patients.
This study has some limitations. First, patient distribution was not randomized but based on internet access, which may have led to selection bias. Patients with access to digital resources may differ from those without in terms of socioeconomic status, health behaviors, or baseline clinical characteristics. Randomization was not feasible in this study because participation in the IOE program required stable internet access and basic digital literacy. Including patients who did not meet these requirements in the online intervention could have negatively affected both the proper implementation of the intervention and patient safety. Although baseline demographic and clinical characteristics were generally similar between groups, a significant difference was found in body mass index, which may have affected rehabilitation outcomes. Therefore, the results should be interpreted with caution. Larger randomized controlled trials are needed to validate the findings and increase generalizability. Despite these limitations, the study provides valuable preliminary evidence regarding the feasibility and effectiveness of IOE–based rehabilitation following arthroscopic RC repair. Additionally, due to the limited sample size, multivariate analysis was not performed, and this may limit the ability to fully control for potential confounding factors.
6. Conclusion
The IOE program offers a practical and effective rehabilitation method for RC surgery patients, ensuring continuity of care even under pandemic conditions. Despite the longer duration to achieve full ROM in the IOE group, overall improvements in functionality and pain relief were comparable to the PS group. The strengths of this study include consistent follow-up by the same surgeon and physiotherapist, while limitations include technical issues such as power outages and internet connectivity. Nonetheless, the IOE rehabilitation method presents a viable alternative to traditional rehabilitation practices.
Author contributions
Conceptualization: Ali Kitiş, Ali Çağdaş Yörükoğlu.Data curation: Ayşe Çelikel, Ali Kitiş.
Formal analysis: Ayşe Çelikel, Ali Kitiş.
Methodology: Ayşe Çelikel.
Project administration: Ayşe Çelikel.
Resources: Ayşe Çelikel, Ali Çağdaş Yörükoğlu.
Supervision: Ayşe Çelikel, Ali Çağdaş Yörükoğlu.
Software: Ali Kitiş, Ali Çağdaş Yörükoğlu.
Validation: Ali Kitiş, Ali Çağdaş Yörükoğlu.
Visualization: Ali Çağdaş Yörükoğlu.
Writing – original draft: Ali Çağdaş Yörükoğlu.
Writing – review & editing: Ali Kitiş, Ali Çağdaş Yörükoğlu.
Abbreviations:
- IOE
- interactive online exercise
- PS
- physiotherapist-supervised
- Q-DASH
- quick disabilities of the arm, shoulder and hand
- RC
- rotator cuff
- ROM
- range of motion
- TR
- telerehabilitation
Written informed consent was obtained from all participants prior to inclusion in the study.
The authors have no conflicts of interest to disclose.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
How to cite this article: Çelikel A, Kitiş A, Yörükoğlu AÇ. Effectiveness of an interactive online exercise program following arthroscopic rotator cuff repair: A prospective comparative study. Medicine 2026;105:21(e48924).
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