JMIR Publications

ABSTRACT

Background:

Physiotherapy is considered essential for the successful operative and non-operative management of rotator cuff pathology. However, the extent to which patients adhere to assigned physiotherapy activities and how this impacts recovery is unknown.

Objective:

The purpose of this study is to measure the rate and patterns of participation in physiotherapy for rotator cuff disorders, assess the dose-response between physiotherapy activity and recovery, and to explore patient factors predictive of physiotherapy participation.

Methods:

We report a prospective longitudinal study of 42 patients undergoing physiotherapy for symptomatic rotator cuff pathology. The patients were issued a smart watch that recorded 9-axis inertial sensor data while they performed physiotherapy exercises both in the clinic and in the home setting. A machine learning approach was used to assess total physiotherapy participation from the smart watch inertial data. Primary outcomes were the Disabilities of the Arm Shoulder and Hand (DASH) and Numeric Pain Rating Scale (NPRS) assessed every 4 weeks until 12 weeks follow-up. The relationship between participation, outcomes, and clinical patient variables were assessed in univariable analyses.

Results:

Mean physiotherapy exercise participation in clinic and at home were 11 and 33 minutes per week respectively, with patients participating in physiotherapy on 41% of days assigned to treatment. Home physiotherapy participation decreased significantly over time (P = 0.03). There was a statistically significant and clinically meaningful relationship between cumulative physiotherapy participation and recovery in pain and disability scores at 8 weeks and 12 weeks follow-up (P < 0.05). Low patient expectations and self-efficacy were associated with low rates of physiotherapy participation.

Conclusions:

There was a low rate of participation in home shoulder physiotherapy exercise, and a statistically and clinically significant dose-response of physiotherapy on treatment outcome in patients with rotator cuff pathology. The findings highlight the opportunity to develop novel methods and strategies to improve the participation in and efficacy of physiotherapy exercises for rotator cuff disorders.