Digital Physiotherapeutic Elbow-Specific Training System for Patients After Arthroscopic Release of Elbow Contracture: Noninferiority Randomized Controlled Trial

BACKGROUND: The effectiveness of a digital training (DT) system in which patients receive individually tailored physiotherapeutic elbow-specific training (PEST) delivered via a digital platform remains unclear. OBJECTIVE: This study determines the effectiveness of a DT system in which patients receive individually tailored PEST supervision and guidance via the Joymotion Intelligent Rehabilitation System and educational videos, compared with conventional training (CT) conducted by qualified physiotherapists at outpatient clinics and unsupervised home-based PEST in patients following arthroscopic release for posttraumatic elbow stiffness. METHODS: This single-center, noninferiority randomized controlled trial was conducted at the Rehabilitation Department of Shanghai Sixth People's Hospital between September 2020 and June 2024. Patients aged 16-65 years undergoing arthroscopic release for posttraumatic elbow stiffness were randomized to receive either a 12-week DT program or conventional outpatient clinic-based training. Outcome measures included elbow flexion-extension range of motion (primary outcome); forearm rotation; isometric and dynamic muscle strength; American Shoulder and Elbow Surgeons (ASES) and Disabilities of the Arm, Shoulder, and Hand (DASH) scores; EQ-5D-5L; cost-effectiveness; adherence; and adverse events, assessed at 4, 12, and 24 weeks postoperatively. RESULTS: At 12 weeks, the mean elbow flexion-extension range of motion improved similarly in the DT and CT groups (between-group difference -1.6°, 95% CI -8.2° to 4.9°; P=.53), confirming noninferiority. Forearm rotation gains were slightly greater with DT (difference 14.2°, 95% CI 2.9°-25.6°). Patient-reported outcomes were equivalent between groups: ASES function (difference 0.6, 95% CI -0.3 to 1.5; P=.39) and pain (difference 0, 95% CI -8.3 to 8.5; P=.68) subscores, DASH (difference 0.23, 95% CI -1.54 to 1.99; P=.68), and EQ-5D-5L index (difference 0.001, 95% CI -0.012 to 0.015; P=.56) showed no significant between-group differences. Nearly all patients completed the 12-week program in both arms (104/106, 98.1%, vs 101/102, 99%, adherence; odds ratio 0.52, 95% CI 0.05-5.77). Adverse events occurred in 29 out of 106 (27.4%) participants in the DT group and 32 out of 102 (31.4%) participants in the CT group (odds ratio 0.82, 95% CI 0.45-1.50). Total rehabilitation costs per patient were lower in the DT group by an average of CNY -7418.58, and incremental cost-effectiveness analysis indicated that DT provided comparable outcomes at lower cost. CONCLUSIONS: Individually tailored PEST delivered via a DT system is a viable, cost-effective, and safe alternative to conventional outpatient clinic-based training following arthroscopic release for posttraumatic elbow stiffness. These findings support its integration into routine postsurgical care, particularly for patients facing barriers to traditional therapy. TRIAL REGISTRATION: Chinese Clinical Trial Registry Chictr2400093415; https://www.chictr.org.cn/showprojEN.html?proj=240693.