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Massive rotator cuff tears are associated with significant pain, functional limitations, and prolonged rehabilitation following surgical repair. In the early postoperative phase, rehabilitation protocols are often limited due to surgical protection requirements, which may delay the restoration of motor control and shoulder function. Graded motor imagery (GMI), a movement representation technique that includes laterality recognition, motor imagery, and mirror therapy, has been shown to modulate cortical processing and improve pain and motor function in various musculoskeletal and neurological conditions. However, its potential role in early postoperative shoulder rehabilitation has not been adequately investigated.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Conventional Rehabilitation Program | Active Comparator | Participants will receive a conventional postoperative rehabilitation program following massive rotator cuff repair. The program will include standard physiotherapy interventions such as protected passive range-of-motion exercises, gradual progression to active-assisted and active exercises, scapular stabilization exercises, and pain management strategies according to the early postoperative rehabilitation protocol. |
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| Graded motor imagery | Experimental | Participants in the experimental group will receive the conventional rehabilitation program in addition to a graded motor imagery intervention. The graded motor imagery program will include laterality recognition training, motor imagery exercises, and mirror therapy tasks aimed at activating cortical motor networks without physical shoulder movement during the early postoperative phase. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Graded Motor İmagery | Other | The graded motor imagery program will include laterality recognition training, motor imagery exercises, and mirror therapy tasks aimed at activating cortical motor networks without physical shoulder movement during the early postoperative phase. |
| Measure | Description | Time Frame |
|---|---|---|
| Pain Intensity (Numeric Rating Scale, NRS) | Pain intensity will be assessed using the Numeric Rating Scale (NRS), where participants rate their average shoulder pain over the past 24 hours on a scale from 0 (no pain) to 10 (worst imaginable pain). Pain will be evaluated at rest, during activity, and at night. | Baseline (postoperative day 0), 2 weeks, 4 weeks, 6 weeks, and 12 weeks after surgery. |
| Subjective Shoulder Value (SSV) | Participants will rate the overall function of their shoulder on a 10-cm scale ranging from "as bad as it could be" to "as good as it could be." | Baseline (postoperative day 0), 2 weeks, 4 weeks, 6 weeks, and 12 weeks. |
| Passive Shoulder Range of Motion | Passive shoulder range of motion will be measured using a goniometer. | 4 weeks, 6 weeks, and 12 weeks after surgery. |
| Measure | Description | Time Frame |
|---|---|---|
| Shoulder Pain and Disability Index (SPADI) | The Shoulder Pain and Disability Index (SPADI) is a self-reported questionnaire consisting of pain (5 items) and disability (8 items) subscales. Scores range from 0 to 100, with higher scores indicating greater pain and functional limitation. | 6 weeks and 12 weeks after surgery. |
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Inclusion Criteria:
Exclusion Criteria:
Age younger than 30 years or older than 65 years
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Nuray ALACA | Contact | 05324251290 | nuray.alaca@acibadem.edu.tr |
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| ID | Term |
|---|---|
| D020069 | Shoulder Pain |
| ID | Term |
|---|---|
| D018771 | Arthralgia |
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
| D010146 | Pain |
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| Motor Imagery Ability (VMIQ-2) |
Motor imagery ability will be evaluated using the Vividness of Movement Imagery Questionnaire-2 (VMIQ-2), which assesses internal visual imagery, external visual imagery, and kinesthetic imagery across 36 items. Lower scores indicate more vivid imagery ability. |
| Baseline (postoperative day 0), 6 weeks, and 12 weeks. |
| Tampa Scale of Kinesiophobia (TSK) | The Tampa Scale of Kinesiophobia evaluates fear of movement related to pain. Scores range from 17 to 68, with higher scores indicating greater fear of movement. | Baseline (postoperative day 0), 6 weeks, and 12 weeks. |
| Pain Catastrophizing Scale (PCS) | The PCS assesses catastrophic thinking related to pain across 13 items. Total scores range from 0 to 52, with higher scores indicating greater catastrophizing. | Baseline (postoperative day 0), 6 weeks, and 12 weeks. |
| Pain Self-Efficacy Questionnaire (PSEQ) | The PSEQ measures confidence in performing activities despite pain. Scores range from 0 to 60, with higher scores indicating greater self-efficacy. | Baseline (postoperative day 0), 6 weeks, and 12 weeks. |
| D009461 |
| Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |