Effects of App-assisted Home Exercise Program in Patients With Frozen Shoulder
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ClinicalTrials.gov Identifier: NCT05980572 |
Recruitment Status :
Recruiting
First Posted : August 8, 2023
Last Update Posted : August 30, 2023
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Abstract
Introduction Frozen shoulder is a common musculoskeletal disorder with reported lifetime prevalence to be 2%~5% in the general population. Patients with frozen shoulders present with chronic pain and limited range of motion of affected shoulder and often cause an adverse impact on their daily activities and working ability. Shoulder exercises had been proven to be effective in treatment of frozen shoulders and the effects were even better after intraarticular corticosteroid injection. Strategies to enhance home exercise for patients with frozen shoulders are essential.
Objective To compare the effects of home exercises delivered by a newly developed app named Defrozen app with that by convention home exercise for frozen shoulder patients after intra-articular corticosteroid injection.
Methods and analysis This is a randomized, controlled, assessor-blinded clinical trial. Seventy-eight individuals diagnosed with frozen shoulders will be randomly divided into two groups. The primary outcome will be shoulder pain evaluated by 11-point numeric rating scale. The secondary outcomes will include shoulder passive range of motion (measured with a universal goniometer), , Oxford shoulder score and Disabilities of the arm, shoulder and hand questionnaire. Feasibility of the app includes including Technology Acceptance Model (TAM-2), System Usability Scale (SUS) and Usability, Satisfaction and Ease of Use (USE) questionnaire . The treatment will be conducted for 6 months (Defrozen app home exercise x conventional home exercise by instructions from printed pamphlets).All participants will receive outcome measurements assessment prior to randomization , 4 weeks , 12 weeks after injections interventions. Feasibility will be evaluated 4 weeks after intervention in the Defrozen app group.
Ethics and dissemination The study protocol was approved by the Institutional Review Board. The findings of the trial will be disseminated through peer-reviewed journals and scientific conferences.
Condition or disease | Intervention/treatment | Phase |
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Frozen Shoulder | Drug: Glenohumeral joint and subacromial space triamcinolone injections Device: App-assisted exercise Drug: Nonsteroidal anti-inflammatory drugs (aceclofenac) | Not Applicable |
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Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 76 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Masking: | Single (Outcomes Assessor) |
Masking Description: | Outcome assessor blind to the arm of the subjects |
Primary Purpose: | Treatment |
Official Title: | Mobile Device Based Telerehabilitation for Frozen Shoulder-A Prospective Randomized Controlled Study. |
Actual Study Start Date : | January 1, 2023 |
Estimated Primary Completion Date : | December 31, 2024 |
Estimated Study Completion Date : | December 31, 2024 |
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Arm | Intervention/treatment |
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Experimental: App intervention group
Patients will receive instructions on performing the seven sets of frozen shoulder exercises mentioned earlier. The APP intervention group will be guided through the exercises using the mobile app. Each set of exercises will involve 10 repetitions, and it is recommended to perform four sessions per day.
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Drug: Glenohumeral joint and subacromial space triamcinolone injections
All patients will receive both glenohumeral joint and subacromial space injections. The injections will consist of a solution containing 1 ml of 40 mg/ml triamcinolone acetonide and 1 ml of 1% lidocaine in each site. The glenohumeral joint injection will be performed blindly using an anterior approach. The needle will be inserted medially to the head of the humerus, located approximately 1 cm lateral to the coracoid process, and directed posteriorly at a slight superior and lateral angle. Patients will be educated on how to perform the 7 sets of frozen shoulder exercise. Subjects will be advised to perform all the exercises to a point that they may feel tightness but not painful and hold to the point for 2-3 seconds. Device: App-assisted exercise Patients will be educated on how to perform the 7 sets of frozen shoulder exercise. Subjects will be advised to perform all the exercises to a point that they may feel tightness but not painful and hold to the point for 2-3 seconds. Then the APP group will suggest performing the exercise from APP education The APP intervention group will be guided through the exercises using the mobile app, while the conventional group will be provided with a printed pamphlet illustrating the exercises.. Each set exercise will have 10 repetitions and investigators recommend 4 sessions per day. Drug: Nonsteroidal anti-inflammatory drugs (aceclofenac) All patients will be prescribed two weeks of nonsteroidal anti-inflammatory drugs (aceclofenac) . |
Active Comparator: Conventional group
patients will receive instructions on performing the seven sets of frozen shoulder exercises mentioned earlier. The conventional group will be provided with a printed pamphlet illustrating the exercises. Each set of exercises will involve 10 repetitions, and it is recommended to perform four sessions per day.
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Drug: Glenohumeral joint and subacromial space triamcinolone injections
All patients will receive both glenohumeral joint and subacromial space injections. The injections will consist of a solution containing 1 ml of 40 mg/ml triamcinolone acetonide and 1 ml of 1% lidocaine in each site. The glenohumeral joint injection will be performed blindly using an anterior approach. The needle will be inserted medially to the head of the humerus, located approximately 1 cm lateral to the coracoid process, and directed posteriorly at a slight superior and lateral angle. Patients will be educated on how to perform the 7 sets of frozen shoulder exercise. Subjects will be advised to perform all the exercises to a point that they may feel tightness but not painful and hold to the point for 2-3 seconds. Drug: Nonsteroidal anti-inflammatory drugs (aceclofenac) All patients will be prescribed two weeks of nonsteroidal anti-inflammatory drugs (aceclofenac) . |
- Change of Shoulder pain by Numeric Rating Scale (NRS) [ Time Frame: prior to randomization, 4-weeks after interventions and 12-weeks after intervention ]To assess shoulder pain, investigators will utilize an 11-point NRS. Patients will be informed that a score of 0 represents no pain, while a score of 10 indicates the highest level of pain.
- Change of Oxford shoulder score (OSS). [ Time Frame: prior to randomization, 4-weeks after interventions and 12-weeks after intervention ]A patient-rated outcome measure of shoulder pain and function in patients with shoulder pain. OSS has twelve questions with five possible responses ranging from 0 (worst) to 4 (best).
- Change shoulder active range of motion in degree [ Time Frame: prior to randomization, 4-weeks after interventions and 12-weeks after intervention ]The range of motion of the shoulder will be assessed using a universal goniometer, which measures the angle of movement between specific bone landmarks. The investigator will evaluate the active range of motion of the affected shoulder, including flexion, abduction, internal rotation, and external rotation, using the goniometer to determine the degrees of movement in each direction. Active range of movement of the affected shoulder, including flexion, abduction, internal rotation, and external rotation, will be measured by goniometer in degree.
- Change of Quick Disability of the Arm, Shoulder and Head (QuickDASH) score [ Time Frame: prior to randomization, 4-weeks after interventions and 12-weeks after intervention ]The QuickDASH is a modified version of the original 30-item Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, consisting of 11 items. A minimum of 10 items must be completed by the participant. Each item has five response options.The total QuickDASH score ranges from 0 (indicating no disability) to 100 (representing the most severe disability)
- Selected part of revised Technology Acceptance Model (TAM-2) [ Time Frame: 4 weeks after intervention in App intervention group ]The selected part of revised Technology Acceptance Model(TAM-2) including intention to use, perceived usefulness and perceived ease of use. Participants will be asked to rate their agreement with each statement on a five-point Likert scale, ranging from "Strongly Disagree" to "Strongly Agree."
- System Usability Scale (SUS) [ Time Frame: 4 weeks after intervention in App intervention group ]he SUS is a standardized questionnaire that consists of ten statements related to the usability of the application. Participants will be asked to rate their agreement with each statement on a five-point Likert scale, ranging from "Strongly Disagree" to "Strongly Agree."
- Usability, Satisfaction and Ease of Use (USE) questionnaire [ Time Frame: 4 weeks after intervention in App intervention group ]The questionnaire consists of four statements related to the system or application being evaluated. Participants will be asked to rate their agreement with each statement on a five-point Likert scale, ranging from "Strongly Disagree" to "Strongly Agree."
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Ages Eligible for Study: | 20 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Eligibility Criteria:
Patients with frozen shoulder who are scheduled to receive intra-articular glucocorticosteroid injections, as determined by the physician investigator, will be consecutively enrolled in the study. To be included in the study, patients must meet the following criteria:
- Unilateral frozen shoulder.
- Suitability for treatment with intra-articular and subacromial glucocorticosteroid injection.
- Patients must fulfill the diagnostic criteria for frozen shoulder, as described by Bulgen et al. These criteria include shoulder pain persisting for at least 1 month, sleep disturbance (such as night pain or inability to lie on the affected side), restriction of all active and passive shoulder movements, and a reduction of passive glenohumeral external rotation by at least 50% compared to the unaffected side.
- Plain radiographs of the shoulder will be obtained to exclude other pathologies.
Patients will be excluded from the study if they meet any of the following criteria:
- Age younger than 20 years old.
- Bilateral involvement of the shoulder.
- Secondary frozen shoulder resulting from trauma.
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History of shoulder joint injections or upper limb surgery within the past month.
Presence of rheumatoid arthritis, central nervous system disorders, or cervical radiculopathy.
- Cognitive disorders or inability to understand exercise instructions.
- Contraindications for anesthesia or corticosteroid injection.
- Lack of familiarity with using smartphones.
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To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT05980572
Contact: Chih-Chi Chen, MD | +886975365705 | claudia5477@gmail.com |
Taiwan | |
Chang Gung Memorial Hospital | Recruiting |
Taoyuan, Taiwan | |
Contact: Chih-Chi Chen +8860975365705 |
Principal Investigator: | Chih-Chi Chen | Chang Gung Memorial Hospital |
Responsible Party: | Chih-Chi ,Chen, Principle investigator, Chang Gung Memorial Hospital |
ClinicalTrials.gov Identifier: | NCT05980572 |
Other Study ID Numbers: |
Defrozen_Shoulder_App |
First Posted: | August 8, 2023 Key Record Dates |
Last Update Posted: | August 30, 2023 |
Last Verified: | August 2023 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | No |
Studies a U.S. FDA-regulated Drug Product: | No |
Studies a U.S. FDA-regulated Device Product: | No |
Frozen shoulder App Exercise |
Bursitis Joint Diseases Musculoskeletal Diseases Triamcinolone Anti-Inflammatory Agents Aceclofenac Anti-Inflammatory Agents, Non-Steroidal Glucocorticoids |
Hormones Hormones, Hormone Substitutes, and Hormone Antagonists Physiological Effects of Drugs Analgesics, Non-Narcotic Analgesics Sensory System Agents Peripheral Nervous System Agents Antirheumatic Agents |