JMIR Publications

Background:

Frozen shoulder (adhesive capsulitis) is a painful and functionally limiting condition that can result in prolonged disability and reduced quality of life. While physiotherapy is the mainstay of treatment, accessibility to physiotherapy may be limited. Gamified, home-based exercise and rehabilitation may improve accessibility, though its application in frozen shoulder management remains underexplored.

Objective:

To evaluate the feasibility and preliminary clinical outcomes of a gamified, self-directed laptop-based serious game rehabilitation program for frozen shoulder on pain, function, disability, health-related quality of life, sleep quality, and shoulder range of motion.

Methods:

This pilot, single-group, pretest-posttest quasi-experimental study enrolled 20 patients with newly diagnosed unilateral frozen shoulder. A consecutive convenience sampling approach was used where all patients who met the inclusion and exclusion criteria during the recruitment period were invited to participate. Participants used a customised version of Rehaboo! incorporating physiotherapist and surgeon-guided exercises. The serious game was accessed through laptop web browsers and cameras for body-motion tracking where movements are translated into in-game actions. Participants were instructed to complete 30-minute sessions three times weekly. All participants were assessed at baseline, 6 weeks, 12 weeks, and 24 weeks post-intervention during their follow-up appointments. Baseline data that included sociodemographic information and clinical characteristics such as age, gender, highest education achievement, hand dominance, and affected shoulder side were collected. Significant pairwise differences were identified using Wilcoxon signed rank test with Holm-Bonferroni correction, followed by Hodges-Lehmann median difference.

Results:

A total of 25 participants (mean age 58.2 years, SD 8.9) were assessed sequentially for eligibility. Feasibility outcomes indicated that recruitment (20/25; 80%) and retention (15/20; 75%) were acceptable for a pilot trial and participants were able to use the system safely without major technical issues or protocol deviations. However, user experience and acceptability are uncertain as such data was not collected. In addition to these feasibility indicators, exploratory clinical outcomes suggested encouraging trends in function, symptoms, quality of life, sleep, and shoulder range of motion across all planes. Functional and quality of life improvement exceeded minimal clinically important differences in the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and the Oxford Shoulder Score (OSS) and EQ-5D.

Conclusions:

This pilot study demonstrates that a laptop-based serious game is a feasible and safe approach for delivering home rehabilitation to individuals with frozen shoulders. Recruitment and retention rates were acceptable for a pilot trial, without major technical difficulties or safety concerns. Unlike prior digital rehabilitation studies that rely on specialised hardware, this study contributes early feasibility evidence for a low-touch, home-based intervention. This model may support long-term home exercise and remote guidance in frozen shoulders in real-world settings. However, key pilot-study metrics were not systematically collected, and future studies should incorporate validated usability and engagement measures.

Clinicaltrial: