Rotator cuff lesions are among the most common causes of shoulder pain and functional limitation, often affecting daily living activities and quality of life. Conventional physiotherapy interventions such as therapeutic exercises and electrophysical agents are widely used; however, persistent pain, kinesiophobia, and functional disability may limit treatment outcomes. Virtual reality-supported task-oriented training has emerged as a promising rehabilitation approach by providing immersive, functional, and goal-directed activities that may enhance motor performance and psychosocial outcomes.

The aim of this randomized controlled trial is to investigate the effects of virtual reality-supported task-oriented training added to conventional physiotherapy in individuals with rotator cuff lesions. Participants will be randomly allocated into two groups: a control group receiving conventional physiotherapy (therapeutic exercises and electrophysical agents) and an intervention group receiving virtual reality-supported task-oriented training in addition to conventional physiotherapy. Both groups will undergo treatment three times per week for six weeks, totaling 18 sessions.

Outcome measures will include pain intensity at rest, during activity, and at night assessed by the Visual Analog Scale (VAS); grip strength measured by dynamometry; pinch strength measured by pinchmeter; upper extremity function assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire; shoulder pain and disability assessed by the Shoulder Pain and Disability Index (SPADI); kinesiophobia assessed by the Tampa Scale of Kinesiophobia; pain catastrophizing assessed by the Pain Catastrophizing Scale; and anxiety and depression assessed using the Hospital Anxiety and Depression Scale (HADS). The findings of this study are expected to contribute to evidence-based rehabilitation strategies for individuals with rotator cuff lesions.

Rotator cuff lesions are a leading cause of shoulder pain, reduced range of motion, muscle weakness, and functional limitations, significantly affecting activities of daily living. In addition to physical impairments, individuals with rotator cuff lesions often experience psychosocial factors such as kinesiophobia, pain catastrophizing, anxiety, and depression, which may negatively influence rehabilitation outcomes. Conventional physiotherapy interventions, including therapeutic exercises and electrophysical agents, are commonly prescribed; however, these approaches may not adequately address functional task performance and psychosocial components of recovery.

Task-oriented training focuses on practicing meaningful, goal-directed activities that closely resemble real-life tasks, thereby facilitating motor learning and functional improvement. Recently, virtual reality-supported rehabilitation has gained increasing attention as it enables the simulation of functional environments, provides multisensory feedback, and enhances patient engagement and motivation. Virtual reality-supported task-oriented training may offer additional benefits by integrating physical and cognitive demands while reducing fear of movement through graded exposure to functional tasks.

This randomized controlled trial aims to investigate the effectiveness of virtual reality-supported task-oriented training when added to conventional physiotherapy in individuals with rotator cuff lesions. Eligible participants will be randomly assigned to either a control group or an intervention group using a random allocation method. The control group will receive conventional physiotherapy consisting of therapeutic exercises and electrophysical agents. The intervention group will receive the same conventional physiotherapy program plus virtual reality-supported task-oriented training. Both interventions will be administered three times per week for six weeks, resulting in a total of 18 treatment sessions.

The virtual reality-supported task-oriented training program will include functional tasks designed to simulate activities of daily living, such as kitchen-related activities, cleaning tasks, and pushing and pulling movements. These tasks will be performed using a virtual reality device and will be progressively adapted according to the participant's functional level and tolerance. The training is intended to promote upper extremity use, improve shoulder function, and address psychosocial factors associated with pain and movement avoidance.

The results of this study will provide evidence regarding the effectiveness of virtual reality-supported task-oriented training as an adjunct to conventional physiotherapy in improving pain, strength, functional outcomes, and psychosocial factors in individuals with rotator cuff lesions. The findings may help guide clinical decision-making and the development of innovative, functionally oriented rehabilitation programs.

Inclusion Criteria:

• Aged between 18 and 65 years
• Diagnosed with a rotator cuff lesion confirmed by clinical examination and/or imaging methods (MRI or ultrasound)
• Presence of shoulder pain and functional limitation for at least 3 months
• Ability to actively use the affected upper extremity
• Ability to understand and follow verbal instructions
• Willingness to participate in the study and provide written informed consent

Exclusion Criteria:

• History of shoulder surgery on the affected side
• Full-thickness rotator cuff tear requiring surgical intervention
• Presence of shoulder fracture, dislocation, or acute traumatic injury within the last 6 months
• Neurological disorders affecting the upper extremity (e.g., stroke, multiple sclerosis, peripheral neuropathy)
• Systemic inflammatory or rheumatologic diseases affecting the shoulder (e.g., rheumatoid arthritis)
• Severe cervical spine pathology with referred shoulder pain
• Severe visual, vestibular, or cognitive impairments that may limit participation in virtual reality training
• Current participation in another structured shoulder rehabilitation program
• Contraindications to physical therapy or virtual reality-based interventions