Virtual reality-assisted rehabilitation after arthroscopic rotator cuff repair for small-to-medium supraspinatus tears: a prospective assessor-blinded randomized controlled trial

Abstract

Rehabilitation after arthroscopic rotator cuff repair (ARCR) must protect the repair while restoring active shoulder use. Immersive virtual reality (VR) can standardize rehabilitation tasks and provide immediate feedback, but whether VR delivery offers benefit over conventional delivery when exercise dose and therapist supervision are matched remains uncertain. This assessor-blinded randomized trial assigned 86 adults undergoing ARCR for small-to-medium full-thickness supraspinatus tears 1:1 to VR-assisted or conventional rehabilitation. During postoperative weeks 4–8, both groups received matched exercise content, dose, progression criteria, safety limits, and face-to-face therapist supervision; only the delivery format differed. Assessments were conducted at baseline, weeks 4 and 6, and months 2, 3, and 6. The primary outcome was activity-related pain measured using a 10-cm visual analogue scale (VAS). Secondary outcomes included rest pain, the 17-item Tampa Scale for Kinesiophobia (TSK-17), Constant-Murley Score (CMS), global shoulder active range of motion, the 12-item Short Form Health Survey (SF-12), isometric strength, and supraspinatus cross-sectional area; surface electromyography (sEMG) was exploratory. Complete-case longitudinal outcomes were analysed using repeated-measures analysis of variance. Seventy participants completed all assessments (VR, n = 36; conventional rehabilitation, n = 34); mean age was 58.1 years, 47 (67.1%) were women, and 35 (50.0%) had small tears. Baseline activity-related VAS scores were 7.3 and 7.2 cm, and mean CMS values were 49.2 and 48.7 in the VR and conventional rehabilitation groups, respectively. Mean activity-related pain was 0.7 cm lower with VR at 6 weeks (4.0 vs. 4.7) and 0.8 cm lower at 2 months (3.1 vs. 3.9); both differences were smaller than the published 1.4-cm clinical-importance threshold. The TSK-17 group × time interaction was significant ( P = 0.001); at 3 months, the mean difference was − 3.1 points (95% CI − 4.5 to − 1.8; Hedges g = − 1.11). Rest pain was similar between groups, and group × time interactions for CMS, global shoulder active range of motion, SF-12, isometric strength, supraspinatus cross-sectional area, and exploratory sEMG outcomes were nonsignificant. No clear between-group difference in activity-related pain or TSK-17 was apparent at 6 months. In the complete-case analysis, VR delivery was associated with lower activity-related pain at 6 weeks and 2 months and lower TSK-17 scores at 3 months compared with conventional rehabilitation. The pain differences were below a published clinical-importance threshold, and the clinical importance of the TSK-17 difference remains uncertain. No between-group difference in activity-related pain or TSK-17 was apparent at 6 months, and the trial did not demonstrate broader functional, structural, or neuromuscular benefits. Chinese Clinical Trial Registry ( https://www.chictr.org.cn ), ChiCTR2400088194. Registered 13 August 2024. Recruitment began on 14 August 2024, after registration.