Partial Supraspinatus Tear, Shoulder Pain
Conditions
Keywords
Virtual Reality, Kinesiophobia, Exercise Therapy, Rehabilitation, Rotator cuff
Brief summary
This randomized controlled trial investigated the effects of virtual reality-assisted rehabilitation in patients with partial supraspinatus tendon tears. Partial supraspinatus tears are a common cause of shoulder pain, functional limitation, restricted range of motion, and fear of movement. Conservative rehabilitation is commonly used as first-line treatment, while evidence regarding immersive virtual reality rehabilitation in this patient population remains limited. Participants were randomly allocated to either a virtual reality-assisted rehabilitation group or a conventional rehabilitation group. Both groups received the same physical therapy modalities, including hot pack, therapeutic ultrasound, and transcutaneous electrical nerve stimulation. The control group subsequently performed conventional therapeutic shoulder exercises, whereas the virtual reality group performed approximately equal-duration immersive VR-based exercises instead of the conventional exercise component. Outcomes included pain, shoulder range of motion, disability, kinesiophobia, health-related quality of life, and supraspinatus tendon thickness.
Detailed description
This randomized controlled trial investigated the effects of immersive virtual reality-assisted rehabilitation in patients with partial supraspinatus tendon tears. Partial supraspinatus tendon tears are a common cause of shoulder pain and functional impairment and may be associated with restricted shoulder range of motion, reduced quality of life, and increased fear of movement. Conservative rehabilitation is commonly used as first-line treatment and typically includes physical therapy modalities together with exercises aimed at restoring shoulder mobility, rotator cuff function, and scapular control. Virtual reality allows patients to perform repetitive, task-oriented upper-extremity movements within an interactive environment. Such systems may support active participation and provide visual feedback during movement; however, evidence regarding immersive virtual reality rehabilitation specifically in patients with partial supraspinatus tendon tears remains limited. Participants with MRI-confirmed partial supraspinatus tendon tears were randomly allocated to either a virtual reality-assisted rehabilitation group or a conventional rehabilitation group. Both groups received a standardized physical therapy program consisting of hot pack, therapeutic ultrasound, and transcutaneous electrical nerve stimulation. Following these physical therapy modalities, participants in the control group performed approximately 30 minutes of supervised conventional therapeutic exercises targeting shoulder mobility, stretching, strengthening, and scapular stabilization. Participants in the virtual reality group instead performed approximately 30 minutes of immersive virtual reality-based upper-extremity exercise. Thus, the virtual reality intervention replaced the conventional therapeutic exercise component rather than being added as an additional treatment, and the scheduled exercise duration was approximately equivalent between groups. The intervention was delivered over 15 sessions during three weeks, with five sessions per week. Evaluations were performed at baseline and after completion of treatment. The study evaluated pain intensity, passive shoulder range of motion, shoulder pain and disability, kinesiophobia, health-related quality of life, and supraspinatus tendon thickness measured by ultrasonography. The aim was to compare immersive virtual reality-based exercise with conventional therapeutic exercise when delivered within an otherwise similar rehabilitation program.
Interventions
BEHAVIORALVR-assisted rehabilitation program
Participants received physical therapy modalities consisting of hot pack, therapeutic ultrasound, and transcutaneous electrical nerve stimulation. They subsequently performed approximately 30 minutes of immersive virtual reality-based upper-extremity exercise using a Meta Quest Pro headset instead of the conventional therapeutic shoulder exercise component. The virtual reality activities involved repetitive, task-oriented shoulder and upper-extremity movements within an interactive three-dimensional environment. The intervention was delivered five days per week for three weeks, for a total of 15 sessions.
BEHAVIORALConventional shoulder exercise program
After receiving physical therapy modalities consisting of hot pack, therapeutic ultrasound, and transcutaneous electrical nerve stimulation, participants performed approximately 30 minutes of supervised conventional therapeutic shoulder exercise. The program included scapular mobilization; stretching exercises for shoulder flexion, abduction, internal rotation, and external rotation; and strengthening exercises for the shoulder and scapular stabilizer muscles. Exercises were performed in three sets of 10 repetitions. The intervention was delivered five days per week for three weeks, for a total of 15 sessions.
Sponsors
Hitit University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Intervention model description
Participants were randomly allocated in a 1:1 ratio to two parallel groups. Both groups received the same standard physical therapy modalities. The control group subsequently performed approximately 30 minutes of conventional therapeutic shoulder exercise, whereas the experimental group performed approximately 30 minutes of immersive virtual reality-based exercise instead of the conventional exercise component.
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Aged 18 to 65 years * Shoulder pain persisting for more than four weeks * Partial supraspinatus tendon tear confirmed by shoulder magnetic resonance imaging
Exclusion criteria
* Physiotherapy treatment within the previous six months * Shoulder injection within the previous six months * History of tendon repair surgery * Communication or cognitive impairment * Vertigo, vestibular disorder, or another condition causing balance instability * History of epilepsy or seizures * Photosensitivity * Diagnosed psychiatric condition, including an anxiety disorder or claustrophobia * Additional orthopedic condition affecting the same shoulder * Neurological, vascular, or cardiac disorder restricting functional capacity * Pregnancy or breastfeeding
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain intensity measured by the Numeric Rating Scale (NRS) | Baseline and after 3 weeks of treatment | Pain intensity at rest and during shoulder movement was assessed separately using an 11-point Numeric Rating Scale, ranging from 0 (no pain) to 10 (the worst pain imaginable). Higher scores indicated greater pain intensity. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Passive range of motion (ROM) of the affected shoulder | Baseline and after 3 weeks of treatment | Passive range of motion of the affected shoulder, including flexion, extension, abduction, internal rotation, and external rotation, was measured in degrees using a Saehan goniometer. Higher values indicated greater range of motion. |
| Shoulder pain and disability measured using the Shoulder Pain and Disability Index (SPADI) | Baseline and after 3 weeks of treatment | The Shoulder Pain and Disability Index is a 13-item questionnaire comprising a five-item pain subscale and an eight-item disability subscale. Pain, disability, and total scores are expressed on a scale from 0 to 100, with higher scores indicating greater pain and disability. |
| Health-related quality of life measured using the Short Form-36 (SF-36) | Baseline and after 3 weeks of treatment | The Short Form-36 is a 36-item questionnaire comprising eight domains: physical functioning, role limitations due to physical health, bodily pain, general health, vitality, social functioning, role limitations due to emotional problems, and mental health. Each domain is scored from 0 to 100, with higher scores indicating better health status. |
| Kinesiophobia measured using the Tampa Scale of Kinesiophobia | Baseline and after 3 weeks of treatment | The Tampa Scale of Kinesiophobia is a 17-item questionnaire scored using a four-point Likert scale. Total scores range from 17 to 68, with higher scores indicating greater fear of movement or reinjury. |
| Supraspinatus tendon thickness measured using ultrasonography (USG) | Baseline and after 3 weeks of treatment | Supraspinatus tendon thickness was measured with the participant seated and the affected arm placed in the modified Crass position. Using a Logiq V2 portable ultrasound device, the transducer was positioned longitudinally over the supraspinatus tendon, and tendon thickness was measured at the point of maximal thickness and recorded in centimeters. The measurement procedure was based on the EURO-MUSCULUS shoulder scanning protocol. |
Countries
Turkey (Türkiye)
Outcome results
None listed