Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Nov 9, 2025
Open Peer Review Period: Nov 9, 2025 - Jan 4, 2026
Date Accepted: May 13, 2026
(closed for review but you can still tweet)
Digital physiotherapeutic elbow-specific training system for patients after arthroscopic release of elbow contracture: A noninferiority randomized controlled trial.
ABSTRACT
Background:
Digital physiotherapeutic elbow-specific training system for patients after arthroscopic release of elbow contracture: A noninferiority randomized controlled trial.
Objective:
To determine the effectiveness of a digital training system in which patients receive individually tailored PEST supervision and guidance via the Joymotion intelligent Rehabilitation System and educational videos compared with conventional training conducted by qualified physiotherapists at outpatient clinics and unsupervised home-based PEST training in patients following arthroscopic release for post-traumatic elbow stiffness.
Methods:
This single-center, non-inferiority randomized controlled trial was conducted at the Rehabilitation Department of Shanghai Sixth People’s Hospital between September 2020 and June 2024. Patients aged 16–65 undergoing arthroscopic release for post-traumatic elbow stiffness were randomized to receive either a 12-week digital training program, or conventional outpatient clinic-based training. Outcome measures included elbow flexion–extension range of motion (primary outcome), forearm rotation, isometric and dynamic muscle strength, ASES and DASH scores, EQ-5D-5L, cost-effectiveness, adherence, and adverse events, assessed at 4, 12, and 24 weeks postoperatively.
Results:
At 12 weeks, mean elbow flexion–extension ROM improved similarly in the digital training (DT) and conventional training (CT) groups (between-group difference –1.6°, 95% CI –8.2° to 4.9°), confirming noninferiority. Forearm rotation gains were slightly greater with DT (difference 14.2°, 95% CI 2.9° to 25.6°). Patient-reported outcomes were equivalent between groups: ASES function (difference 0.6, 95% CI –0.3 to 1.5) and pain (difference 0, 95% CI –8.3 to 8.5) subscores, DASH (difference 0.23, 95% CI –1.54 to 1.99), and EQ-5D-5L index (difference 0.001, 95% CI –0.012 to 0.015) showed no significant group differences. Nearly all patients completed the 12-week program in both arms (98% vs 99% adherence; OR 0.52, 95% CI 0.05–5.77). Adverse events occurred in 27.4% (DT) vs 31.4% (CT) (OR 0.82, 95% CI 0.45–1.50). Total rehabilitation costs per patient were lower in DT by CNY 7,419 on average, and incremental cost-effectiveness analysis indicated that digital training provided comparable outcomes at lower cost.
Conclusions:
Individually tailored physiotherapeutic elbow-specific training via a digital training system is a viable, cost-effective, and safe alternative to conventional outpatient clinic-based training following arthroscopic release for post-traumatic elbow stiffness. These findings support its integration into routine post-surgical care, particularly for patients facing barriers to traditional therapy. Clinical Trial: This study was registered in Chinese Clinical Trial Registry (https://www.chictr.org.cn/) Trial registration number: Chictr2400093415
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