Digitally assisted vs conventional home-based rehabilitation after rotator cuff repair: A meta-analysis

Table 1 Risk of bias assessment of the included studies using risk-of-bias tool

Ref.	Domain 1	Domain 2	Domain 3	Domain 4	Domain 5	Overall
Correia et al[27], 2022	Low	Some concerns	Some concerns	Some concerns	Low	High
Menek et al[28], 2022	Low	Some concerns	Low	Some concerns	Low	High
Shim et al[29], 2023	Low	Low	Low	Low	Low	Low

Table 2 Characteristics of the included studies

Ref.	Country	Study design	Population	Digital rehabilitation intervention	Comparison	Outcome of interest	Longest Follow-up period	Funding and conflict of interest
Correia et al[27], 2022	Portugal	Nonblind parallel randomized controlled trial	All patients over 18 years old and under 70 years old who had primary arthroscopic rotator cuff repair	Mobile app+ inertial motion trackers: Immediate post-surgery phase (weeks 0-2); immobilization period (weeks 3-4); passive mobilization (weeks 5-8); active movement (weeks 9-10); and strengthening (weeks 11-12) performed for both groups. Patients in digital assistance used SWORD mobile app installed on their phone, along with three inertial motion trackers	Conventional therapy	CM score, quick DASH score, shoulder active pain-free range of motion	12 months	The writers of this article were the employee and chief medical officer of SWORD health
Menek et al[28], 2022	Turkey	Single blinded randomized controlled trial	Individuals with partial rupture of the rotator cuff aged between 18-60 without previous shoulder surgery	Video-base game rehabilitation: A video-based game using "Arm rotate" and "Uball" by using Fizuosoft Extremity range of motion. Moreover, "Balance adventure" and "Balance surf" games by using the Fizyosoft Balance System. These games were used twice a week for 6 weeks under the supervision of a physiotherapist	Conventional therapy: Wand and shoulder wheel exercise, finger ladder exercise, holding the endpoint, and stretching exercises. These exercises were performed twice a week for 6 weeks	Pain severity (VAS), pain threshold (Algometer), evaluation of joint ROM (Fizyosoft Extremity ROM), joint position sense, evaluation of shoulder approximation force, evaluation of shoulder approximation force (DASH), evaluation of quality of life for the shoulder (RCQOL)	6 weeks	None
Shim et al[29], 2023	South Korea	Single blinded randomize controlled trial	Patients ≥ 50 years old who underwent rotator cuff repair surgery	AR-based rehabilitation: It consists of three phases including on-brace phase (from immediate to 6 weeks postoperatively), the off-brace phase (6-9 weeks postoperatively), and the active mobilization phase (9-12 weeks post-operatively) by using brochure-based exercises for 6 weeks followed by AR-based exercises for 6 weeks	Conventional treatment: The same as digital rehabilitation except they did not use AR based rehabilitation for them and just used brochure-based exercises for 12 weeks	Simple shoulder test change, DASH score, SPADI index, EQ5D5 L questionnaire, NRS, and shoulder ROM	24 weeks	Funded by the Ministry of Health Welfare, Republic of Korea/No conflict of interest reported

AR: Augmented reality; CM score: Constant-murley score; QuickDASH: Quick Disabilities of the arm, shoulder, and hand; VAS: Visual analogue scale; ROM: Range of motion; RCQOL: Rotator cuff quality of life; SPADI: Shoulder pain and disability index; EQ5D5 L: EuroQol 5-dimension 5-level questionnaire; NRS: Numeric rating scale.