Asynchronous and Tailored Digital Rehabilitation of Chronic Shoulder Pain: A Prospective Longitudinal Cohort Study
Open accessAbstract
BACKGROUND: Chronic shoulder pain (SP) is responsible for significant morbidity, decreased quality of life and impaired work ability, resulting in high socioeconomic burden. Successful SP management is dependent on adherence and compliance with effective evidence-based interventions. Digital solutions may improve accessibility to such treatments, increasing convenience, while reducing healthcare-related costs. PURPOSE: Present the results of a fully remote digital care program (DCP) for chronic SP. PATIENTS AND METHODS: Interventional, single-arm, cohort study of individuals with chronic SP applying for a digital care program. Primary outcome was the mean change between baseline and 12 weeks on the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Secondary outcomes were change in pain (NPRS), analgesic consumption, intention to undergo surgery, anxiety (GAD-7), depression (PHQ-9), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI) and engagement. RESULTS: From 296 patients at program start, 234 (79.1%) completed the intervention. Changes in QuickDASH between baseline and end-of-program were both statistically (p < 0.001) and clinically significant, with a mean reduction of 51.6% (mean -13.45 points, 95% CI: 11.99; 14.92). Marked reductions were also observed in all secondary outcomes: 54.8% in NPRS, 44.1% ceased analgesics consumption, 55.5% in surgery intent, 37.7% in FABQ-PA, 50.3% in anxiety, 63.6% in depression and 66.5% in WPAI overall. Higher engagement was associated with higher improvements in disability. Mean patient satisfaction score was 8.7/10.0 (SD 1.6). CONCLUSION: This is the first real-world cohort study reporting the results of a multimodal remote digital approach for chronic SP rehabilitation. High completion and engagement rates were observed, which were associated with clinically significant improvement in all health-related outcomes, as well as marked productivity recovery. These promising results support the potential of digital modalities to address the global burden of chronic musculoskeletal pain.
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The authors have previously demonstrated the utility of a completely remote digital care program integrating exercise, education, and cognitive behavioral therapy in several MSK conditions, including for upper limb.
“Previously, we have demonstrated the utility of a completely remote digital care program (DCP) integrating exercise, education, and cognitive behavioral therapy (CBT) in several MSK conditions [42,43,44,45], including for upper limb [46,47,48].”
From Digital Rehabilitation for Elbow Pain Musculoskeletal Conditions: A Prospective Longitudinal Cohort Study (2022) · cites this paper as [48]
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Pak, S. S., Janela, D., Freitas, N., Costa, F. M. T. A., Moulder, R. G., Jr., Molinos, M., Areias, A. C., Bento, V., Cohen, S. P., Yanamadala, V., et al. (2023) · Journal of Medical Internet Research · doi:10.2196/49236 · Cited by 73 · see citing works
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Janela, D., Costa, F., Weiss, B., Areias, A. C., Molinos, M., Scheer, J. K., Lains, J., Bento, V., Cohen, S. P., Correia, F. D., et al. (2023) · DIGITAL HEALTH · doi:10.1177/20552076231176696 · Cited by 18 · see citing works
Scheer, J. K., Areias, A. C., Molinos, M., Janela, D., Moulder, R. G., Jr., Laíns, J., Bento, V., Yanamadala, V., Correia, F. D., & Costa, F. M. T. A. (2023) · JMIR mhealth and uhealth · doi:10.2196/44316 · Cited by 20 · see citing works
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Costa, F. M. T. A., Janela, D., Molinos, M., Moulder, R. G., Jr., Bento, V., Laíns, J., Scheer, J. K., Yanamadala, V., Cohen, S. P., & Correia, F. D. (2022) · Journal of Medical Internet Research · doi:10.2196/38942 · Cited by 12 · see citing works
Trends in Telerehabilitation Utilization in the United States 2020-2021
McLaughlin, K. H., Levy, J. F., Fritz, J. M., & Skolasky, R. L. (2024) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2024.02.728 · Cited by 10 · see citing works
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Digital Rehabilitation for Acute Low Back Pain: A Prospective Longitudinal Cohort Study
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Digital Care Programs for Chronic Hip Pain: A Prospective Longitudinal Cohort Study
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Hague, B., Taylor, L. G., Quarin, C., Grosso, J. C., Chau, D., Kim, R., Verrier, M. C., Bonnyman, A. M., & Gabison, S. (2023) · Physiotherapy Canada · doi:10.3138/ptc-2021-0136 · Cited by 3 · see citing works
Todorović, P., Pavlović, N., Kopilaš, A., Vukojević, K., & Carić, A. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15072694 · Cited by 2 · see citing works
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Marshall, T., Goldman, A., Lyles, R., Grundstein, M. J., Ahmadian, N., Koc, T. A., Jr., & Gruner, M. (2025) · Archives of Rehabilitation Research and Clinical Translation · doi:10.1016/j.arrct.2025.100466 · Cited by 1 · see citing works
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Timurtaş, E., Selçuk, H., Kartal, G., Demırbüken, İ., & Polat, M. G. (2025) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x251326753 · Cited by 1 · see citing works
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ДИСТАНЦІЙНА РЕАБІЛІТАЦІЯ ПОСТРАЖДАЛИХ З УШКОДЖЕННЯМИ ВЕРХНЬОЇ КІНЦІВКИ ЯК КОМПОНЕНТА ПОЛІТРАВМИ
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- Authors
- Janela, D., Costa, F., Molinos, M., Moulder, R. G., Lains, J., Francisco, G. E., Bento, V., Cohen, S. P., & Correia, F. D.
- Affiliations
- University of Colorado Boulder (US)
- Memorial Hermann Institute for Rehabilitation and Research Foundation (US)
- Johns Hopkins University (US)
- Corresponding author
- Correia, Fernando Dias
- Venue
- Journal of Pain Research
- Publisher
- Informa UK Limited
- Published
- 2022-01
- Volume
- Volume 15
- Pages
- 53-66
- ISSN
- 1178-7090 (ISSN-L)
- PMC
- PMC8755939
- OpenAlex
- W4206346329
- Cited by
- 33
- References
- 96
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 3 · 2023: 8 · 2022: 9
- FWCI
- 6.21
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Pain Research (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- CU Scholar (University of Colorado Boulder) (submittedVersion)
- Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
- Estudo Geral (Universidad de Coimbra) (submittedVersion, cc-by-nc)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, cc-by-nc)
- Topics
- Health Sciences › Medicine › Surgery › Shoulder Injury and Treatment
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- chronic shoulder pain, digital rehabilitation, remote care, telemedicine, patient engagement, analgesic use, fear-avoidance beliefs, labor productivity, depression, anxiety, musculoskeletal pain, patient satisfaction
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