Previously submitted to: JMIR Serious Games (no longer under consideration since Aug 11, 2026)
Date Submitted: May 8, 2025
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Clinical Evaluation of Remote Home Gamified Rehabilitation for Patients with Frozen Shoulder: A Pilot Study
ABSTRACT
Background:
Frozen shoulder is a painful and disabling condition affecting approximately 5% of the population, often leading to prolonged impairment and incomplete recovery. While physiotherapy is the mainstay of treatment, adherence remains suboptimal. Gamification—integrating game elements into rehabilitation—has shown potential to enhance motivation and accessibility, though its application in frozen shoulder management remains underexplored.
Objective:
To evaluate the efficacy of a fully gamified, self-directed home rehabilitation program (HomeRehab) using a laptop-based platform in improving shoulder function, pain, quality of life, sleep, and range of motion in patients with frozen shoulder.
Methods:
This pilot, single-group, pretest-posttest quasi-experimental study enrolled 20 patients diagnosed with unilateral frozen shoulder. Participants used a customised version of the Rehaboo! platform incorporating physiotherapist- and surgeon-guided exercises. Outcomes measured at baseline, 6, 12, and 24 weeks included the Oxford Shoulder Score (OSS), Disabilities of the Arm, Shoulder, and Hand (DASH), EQ-5D, Pittsburgh Sleep Quality Index (PSQI), and goniometric range of motion (RoM). Statistical analysis was conducted using Friedman tests and Wilcoxon signed-rank tests with Holm-Bonferroni correction.
Results:
17 patients were included in the final analysis. The mean age was 58.2 years (SD = 8.9), with 11 males and 6 females. Over the 24-week period, participants demonstrated statistically and clinically significant improvements in several domains. The mean Oxford Shoulder Score (OSS) improved from 29.2 to 16.5 (p = .010), and the mean Disabilities of the Arm, Shoulder and Hand (DASH) score decreased from 63.4 to 41.1 (p = .010). Health-related quality of life also improved, with the EQ-5D score decreasing from 7.2 to 5.5 (p = .030). Sleep quality improved, as indicated by a reduction in Pittsburgh Sleep Quality Index (PSQI) scores from 5.7 to 3.1 (p = .030). Shoulder range of motion improved across all planes—abduction (95° to 132°), external rotation (23° to 48°), internal rotation (32° to 49°), and forward flexion (114° to 144°)—though these changes were not statistically significant. The gains exceeded minimal clinically important differences for OSS, DASH, and EQ-5D.
Conclusions:
This study supports the potential of a gamified, self-led rehabilitation program to deliver meaningful improvements in function, symptoms, and quality of life for individuals with frozen shoulder. Gamification may enhance accessibility and adherence, offering a promising alternative to traditional physiotherapy. Larger, controlled trials are needed to confirm non-inferiority and long-term efficacy.
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