Discussion
shoulder impairments, pain
The present study aimed to determine the effectiveness of a digital therapy performed with the Playball® device during a shoulder rehabilitation protocol. Both the therapeutic and engagement responses to the digital therapy were investigated and compared to a non-digital equivalent rehabilitation protocol. The main finding was that the rehabilitation carried out with the Playball® was as effective as the equivalent non-digital rehabilitation. Namely, both proposed rehabilitation programs effectively improved shoulder recovery, improved strength, reduced pain, and globally increased the subjects’ self-perceived satisfaction and functionality.Our findings align with previous research [Concerning the engagement variables, the scores from Self-efficacy and Attitude to train at home dimensions significantly improved following the shoulder rehabilitation, regardless of therapy. Therefore, the repetition of therapeutic exercises and the shoulder functional improvements could have influenced the higher subjects’ self-efficacy and attitude to train at home. Thus, the longer the rehabilitation time, the more the subjects feel self-confident, and consequently, their will to exercise at home increases. It is well accepted that repeated practice, such as during an exercise training period, increases the subject’s confidence and motor learning [The usability of the Playball®, evaluated through the SUS, showed an increment score of almost 10% at the end of the rehabilitation program. Although this result was not statistically significant, it underlined that the employment of the Playball® became progressively easier and more familiar over time. In addition, the SUS mean score at the end of the rehabilitation program exceeded the cut-off value of 68 reported in the scientific literature to define “good” the usability of a device [Given the importance of therapeutic effectiveness, the purpose of digital therapies is also to be more attractive and entertaining than conventional treatments, allowing patients to be less focused on their health status (e.g., pain and discomfort) because of the more positive engagement during therapy. Indeed, two significant positive correlations were detected only in the PG. The Δ score from PACES significantly correlated with the Δ scores from the Self-efficacy dimension and the Intention to train at home dimension. Thus, our data suggested that the greater the enjoyment in rehabilitation with Playball®, the greater the self-efficacy and the stronger the intention to continue exercising at home once the rehabilitation is ended. This result highlighted that the digital therapy was positive and favored a greater patient engagement.The present study has some potential limitations to acknowledge. First, though the short-term application of digital therapy could represent a novelty in this field, long-term compliance was not addressed in this study. Second, although researchers supervised the rehabilitation sessions, treatment fidelity was not objectively measured. Finally, results should be confirmed in a more significant number of patients since the sample size of the present study was not fully representative of the whole population suffering from shoulder impairments.