Internet and telerehabilitation management of rotator cuff tendinopathy: a randomised pilot and feasibility trial

Abstract

Introduction: Rotator cuff tendinopathy is a common and disabling musculoskeletal condition. Internet-based and telerehabilitation delivery of recommended care may improve access to care and improve adherence and outcomes. The primary aim of this pilot randomised controlled trial was to assess the feasibility of a 12-week internet delivered intervention for rotator cuff tendinopathy comparing advice only, recommended care and recommended care with group-based telerehabilitation. Methods: Reporting was in accordance with the CONSORT checklist for pilot and feasibility trials and the trial was prospectively registered (ACTRN12620000248965). People with a primary complaint of rotator cuff tendinopathy for ≥3 months were identified via a paid Facebook strategy. Screening involved an online questionnaire followed by a 20-minute telehealth assessment. Participants were randomly allocated to receive: advice only, recommended care delivered via the internet or recommended care delivered via a weekly group teleconference session. Progression criteria for a full-scale trial included (i) recruitment of ≥20% of eligible participants; (ii) acceptable adherence (≥two of the three prescribed weekly sessions) among ≥70% of participants; (iii) ≥80% retention; (iv) absence of intervention-related serious adverse events; and (v) ≥80% response rates to questionnaires. Secondary clinical outcomes were collected at baseline, six and 12 weeks and within group change was reported descriptively. Results: Twelve participants were allocated to each trial arms (36 in total, mean age between 51 and 56, 83% [10/12] to 92% [11/12] female). We enrolled 36 of 38 (95%) eligible participants and all participants were recruited within a three-week period. Retention at the 12-week endpoint was 94% (34/36) and response to email questionnaires at other timepoints was ≥83%. We found acceptable adherence (defined as >70% performing exercise two or three times/week) in the recommended care group with telerehabilitation but not the recommended care group without telerehabilitation. There was a total of 24 adverse events over 108 person-months of observation. All adverse events were mild or moderate (mainly muscle and shoulder symptoms) aside from one instance of elective surgery (unrelated to the person’s shoulder condition). Discussion: Our pre-specified success criteria were met or exceeded but there was a gender imbalance towards women. It is feasible to progress to a fully powered trial but strategies to address the gender imbalance need to be implemented. Conflict of interest statement: The authors have no conflict of interest of relevance to the submission of this abstract.