Comparing Digital to Conventional Physical Therapy for Chronic Shoulder Pain: Randomized Controlled Trial

Area of Science:

• Orthopedics and Sports Medicine
• Digital Health and Telemedicine
• Physical Therapy and Rehabilitation

Background:

• Chronic shoulder pain (CSP) significantly impacts quality of life and productivity, with physical therapy as a primary treatment.
• Barriers to accessing in-person physical therapy are common, leading to exploration of alternative delivery models like telerehabilitation.
• Digital physical therapy offers potential benefits including improved access, convenience, adherence, and cost reduction for CSP management.

Purpose of the Study:

• To compare the clinical outcomes of digital physical therapy versus conventional in-person physical therapy for patients with nonoperative chronic shoulder pain.
• To evaluate the effectiveness and viability of fully remote digital rehabilitation programs as a care delivery model for CSP.

Main Methods:

• A single-center, parallel-group randomized controlled trial involving 82 patients with CSP.
• Participants were randomized to an 8-week digital intervention (home exercise, education, CBT with biofeedback) or conventional in-person physical therapy.
• Primary outcome: change in function and symptoms (short-form Disabilities of the Arm, Shoulder, and Hand questionnaire); secondary outcomes included pain, surgery intent, and mental health.

Main Results:

• Both digital and conventional physical therapy groups showed significant improvements in function, with no statistically significant difference between groups.
• No significant differences were observed in surgery intent, analgesic intake, mental health, or worst pain between the digital and conventional therapy groups.
• High adherence and satisfaction were reported in both groups, with no adverse events, indicating the safety and acceptability of digital CSP management.

Conclusions:

• Fully remote digital physical therapy programs are a scalable and effective care delivery model for chronic shoulder pain.
• Digital interventions provide comparable clinical outcomes to high-dosage in-person rehabilitation, addressing access barriers and improving patient experience.
• The study supports the integration of digital health solutions into standard care pathways for nonoperative chronic shoulder pain.