Effect of Smartphone-Based Visual Biofeedback During Scapular Stabilization Exercises in Individuals with Subacromial Pain Syndrome
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Background: Scapular stabilization exercises are commonly used to manage subacromial pain syndrome, but inaccurate exercise performance may limit their effectiveness. Smartphone-based real-time visual feedback may improve movement awareness and exercise execution without requiring specialized equipment. Objective: To determine whether smartphone-based visual feedback added to scapular stabilization exercises improves clinical, psychological, adherence, and implementation outcomes in individuals with subacromial pain syndrome. Methods: This assessor-blinded, parallel-group randomized controlled trial included 54 participants allocated equally to an experimental group receiving smartphone-based visual feedback with conventional rehabilitation and a control group receiving the same programme without visual feedback. Treatment was delivered three times weekly for eight weeks. Outcomes were assessed at baseline, Week 4, Week 8, three months, and six months. The primary outcome was the Shoulder Pain and Disability Index. Continuous outcomes were evaluated using longitudinal mixed-effects models. Results: Forty-seven participants completed post-intervention and follow-up assessments. At Week 8, SPADI scores were 22.8 ± 8.7 in the experimental group and 31.6 ± 10.3 in the control group, with an unadjusted mean difference of −8.8 points (95% CI, −14.4 to −3.2; (p=0.003)). Significant group-by-time interactions favoured the experimental group for SPADI, pain intensity, shoulder range of motion, strength, kinesiophobia, and pain catastrophizing. The experimental group also demonstrated higher exercise adherence and satisfaction. No serious intervention-related adverse events occurred. Conclusion: Smartphone-based real-time visual feedback may enhance the effects of scapular stabilization rehabilitation on pain, disability, shoulder function, and patient engagement, although larger multicentre trials are required
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