Rotator cuff syndrome is one of the most common problems in the shoulder, starting as acute tendinopathy and progressing to partial and full thickness tears. Shoulder pain causes a decrease in shoulder joint movement, joint position sense, upper extremity function and quality of life. Among the most commonly used conservative treatment methods; Joint range of motion exercises, stretching exercises, strengthening exercises, mobilization and electrotherapy method are included.
Nowadays, with the widespread use of technology in rehabilitation, video-based games have begun to be used for rehabilitative purposes in addition to conservative approaches. Although the effectiveness of video-based games has been extensively studied in diseases such as cerebral palsy, stroke and parkinsonism, there are a limited number of studies in the field of orthopedic rehabilitation, especially in shoulder rehabilitation.
Basic body awareness therapy is used to treat chronic musculoskeletal-related painful conditions. In the literature, basic body awareness therapy has been studied in patient groups such as mental health, stroke patient groups, chronic musculoskeletal problems, chronic waist and neck pain, scoliosis and knee osteoarthritis. Studies have shown that the TBFT method provides improvements in individuals' body awareness, mobility in daily living activities, health-related quality of life, body image and pain intensity. However, no studies have been found in which basic body awareness therapy was used in the field of shoulder rehabilitation.
Our study aims to compare the effectiveness of a rehabilitative game exercise program and body awareness training in terms of pain, joint range of motion, shoulder functionality, proprioception, body awareness, shoulder-related quality of life, kinesiophobia and patient satisfaction in individuals with Rotator cuff syndrome.
Diagnosis of partial supraspinatus rupture by an Orthopedics and Traumatology specialist placement.
Unilateral shoulder pain,
Not having been involved in any physiotherapy program before due to shoulder problem,
Body mass index (BMI) ≤ 30 kg/m²
Having had previous shoulder surgery,
Having received local corticosteroid injection/corticosteroid treatment in the last three months,
Presence of a disease that will affect the neurological, cardiac, systemic, cognitive and visual systems,
Parallel
Conventional Exercise Group
Behavioral* Wand Exercises (Shoulder flexion, abduction, extension, external, internal rotation \*10 rep.) * Codmann Exercises (In each direction with front-back, right-left, clockwise and counterclockwise movements \*10 rep.) * Finger Ladder (flexion and abduction directions \* 10 rep.) * Strengthening Exercises (Shoulder flexion, abduction, extension, external, internal rotation \*10 rep). * Posterior, anterior and inferior capsule stretching ,pectoral muscle stretching \* 10 rep.
Body Awareness Training Group
Behavioral* Supine: Body scan, contraction-relaxation exercises, strength recovery exercises combined with sound, stretching exercises, cross and star stretching. * Sitting: Teaching the correct body alignment while sitting, exercise to restore the correct body alignment, * Standing: Weight bearing exercises within stability limits, midline descent and elevation exercises, midline rotation exercises, wave motion, pushing movement combined with oblique weight bearing.
Rehabilitative Game Exercise Group
Behavioral* Cone Knockout: The game requires touching the cones that appear alternately on the right and left within one minute. * Space Pong: It is required to play by hitting the ball with the right or left hand. It requires only upper extremity use and has seven abductions. Scoring is based on the ball hit. * Reaction: It is a game that requires touching the green dots that appear on the screen within a certain period. The points received vary depending on the speed of touching the dots. Points are lost when the red dots are touched. * Whack A Male: The player has 3 rights, and it requires using the upper extremity to hit the moles that come out of 5 holes at different times. A mole with a thorn on its head and a bomb should not be hit. Before the spiny mole emerges, a red light appears in the hole where it will emerge.
Pain Severity rated their feelings of pain on the line by themselves, thereby quantifying the pain.sual Analogue Scale
Participants pain intensities ranged from "0" (no pain) to "10" (unbearable pain) to 10 cm will be evaluated with the Visual Pain Scale. The pain intensity of the participants before and after the treatment was evaluated at rest and during activity.
Pain threshold
Algometer is a device used to evaluate the pain threshold, thanks to the pressure it applies. While increasing the pressure using the algometer, persons are asked to indicate at the first point where they feel pain or discomfort. The first point of discomfort is defined as the pain threshold of the individual.The first point of discomfort is defined as the individual's pain threshold point. When evaluating the pain thresholds of people participating in the study, their most sensitive areas will be taken as reference. Measurements will be repeated 3 times and their average will be taken.
Evaluation of joint range of motion
Baseline digital Absolute + Axis goniometer device will be used. Flexion, extension, abduction, internal and external rotation range of motion of the shoulder joint will be evaluated in degrees. For each joint range of motion value, 3 consecutive measurements will be taken and the average value will be recorded.
Evaluation of Joint Position Sense
Active angle repetition test for shoulder joint position sense will be performed with the smartphone goniometer application. 40° and 100° elevation angles will be used in the scapular plan, which are frequently preferred in the literature. For the evaluation, first of all, the participants will be asked to passively perform a 40° elevation movement on one shoulder in the scapular plane while their eyes are open and they will be asked to learn this angle. Then, the participants will raise their shoulders to 40° elevation 3 more times with their eyes closed, wait 10 seconds to teach this angle, and then return to the starting position.The test will be repeated 6 times and individuals will rest for 5 seconds between each repetition. All applications were repeated for a shoulder elevation angle of 100°. The test was performed at 40° and 100° shoulder elevation on both shoulders.
Rotator Cuff Quality of Life
It is a questionnaire that evaluates the quality of life in rotator cuff injuries. It is a disease-specific questionnaire and is distinctive in assessing quality of life. It is a questionnaire consisting of 34 questions and 5 subparameters that evaluates the physical symptoms of the disease, work activities, daily living activities, social and emotional status. Each question is calculated out of 100 points and the total score is expressed as a percentage.
American Shoulder and Elbow Surgeons (ASES)
American Shoulder and Elbow Surgeons (ASES) created the ASES questionnaire in order to develop a standardized method for evaluating shoulder function. The goal was to design a questionnaire that was easy to use, assessed function, and was entirely based on patient self-evaluation. The ASES score totals 100 points and allocates 50 points for measuring function and 50 points for pain.
Body Awareness Questionnaire
The body awareness questionnaire is a 18 item scale, with the total scale score calculated as a sum of the items. Items are scored on a 1-7 scale, with the total scale score calculated as a sum of the items. The questions with asterisks are reverse scored. This means that for example, if someone scored 1 it would now be a score of 5.
Body Image Survey (BIA)
BIA was used to measure the patients' level of satisfaction with their body image. BIA consists of a person's body parts or functions.It is a scale that determines satisfaction. It was shown in the study by Hovardaoğlu et al. that the scale is valid and reliable in Turkish.
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