Effectiveness of a Joint Contracture Prevention Innovation in Improving Range of Motion and Activities of Daily Living among Patients Undergoing Shoulder and Elbow Surgery: A Quasi-Experimental Study

Abstract

Background Joint contracture is a common complication following shoulder and elbow surgery, significantly impacting patients’ activities of daily living (ADLs) and quality of life. Current rehabilitation approaches have several limitations: 1) Institutional physical therapy is mostly limited to one to two sessions daily due to a shortage of physical therapists, 2) Continuous passive motion (CPM) devices are relatively expensive, complex to operate, and require substantial storage space, making them unsuitable for small community hospitals or home-based use, and 3) Although passive exercises help improving the range of motion, they are less effective at preventing muscle atrophy compared to active exercises; furthermore, patients often lack the confidence to perform independent movements. While empirical evidence strongly supports early, continuous, and high-frequency mobilization, there is a critical shortage of low-cost, locally manufactured, innovative devices that patients can safely use independently without constant therapist supervision. Such innovations should feature structured guidance to ensure proper execution across all directions of motion and enable high-frequency utilization of six to eight times per day. Consequently, there is an urgent need to improve the efficacy of postoperative rehabilitation for patients undergoing shoulder and elbow surgery.

Objective The objective of this study was to investigate the effects of an innovative joint contracture prevention device on the range of motion (ROM) and ADLs in patients following shoulder and elbow surgery.

Design This study employed a quasi-experimental design, applying the concepts of Mobility and Rehabilitation Theory, which focuses on consistent and continuous joint mobilization to achieve the following outcomes: (1) maintaining and increasing the ROM, (2) preventing tissue adhesions, (3) promoting localized blood circulation around the joint, and (4) stimulating muscle and tendon function. This framework was integrated with the Enhanced Recovery After Surgery (ERAS) pathway, emphasizing early mobilization and active patient participation. The innovative joint contracture prevention device developed in this study was designed to enable patients to safely perform self-directed active exercises. The device features a structured configuration consisting of five distinct movement patterns that include all anatomical directions for both the shoulder and elbow joints, including flexion–extension, abduction, adduction, and rotation. These five movement configurations are categorized as follows: the Straight Pattern, Low-Level Pattern, High-Level Pattern, Inward Curve Pattern, and Outward Curve Pattern. Patients performed the protocol for six sets per day over three consecutive days. Each set required approxi- mately 15–20 minutes to complete and comprised all five patterns, with five repetitions executed per side for each pattern, interspersed with a 1–2 minute rest period between patterns.

Methodology The sample comprised 60 postoperative shoulder and elbow surgery patients admitted to the orthopedic ward at Uttaradit Hospital. Participants were selected via purposive sampling according to the inclusion and exclusion criteria. The sample size was calculated using the formula for comparing means between two independent groups. The effect size was set at 0.8 based on a previous study demonstrating that structured exercise yields an effect size of 0.75-0.85. With a statistical power of .80 and a significance level of .05, a sample size of 26 participants per group was required. This was increased by 15% to compensate for potential attrition, resulting in a total sample size of 60 participants. Participants were allocated to either the experimental group (n = 30) or the control group (n = 30) in matched pairs. The experimental group received the innovative joint contracture prevention device in conjunction with standard care and performed the exercise protocol 6 times daily for 3 consecutive days, while the control group received standard care alone. Pre- and post-intervention data were collected to evaluate the ROM (measured with a universal goniometer) and ADLs (assessed with a modified Barthel Index). Data were analyzed using the Paired t-test, Independent t-test, and Chi-square test.

Results The experimental and control groups had a mean age of 52.8 years (SD 11.2) and 51.4 years (SD 10.8), respectively, with males accounting for 56.7% and 60.0% of the participants. The mean body mass index (BMI) was 24.6 kg/m2 (SD 3.4) for the experimental group and 24.9 kg/m2 (SD 3.2) for the control group. The mean number of postoperative days was 1.8 days (SD 0.6) and 1.7 days (SD 0.7), respectively. There were no statistically significant differences in baseline demographic and clinical characteristics between the two groups (p > .05). Post-intervention, the experimental group demonstrated a mean increase in ROM of 15.2 degrees (SD = 8.4), which was significantly higher than the mean increase of 4.8 degrees (SD = 6.2) observed in the control group (p < .001). Notably, shoulder flexion improved by greater than 20 degrees. Regarding functional ability in ADLs, the experimental group showed a mean increase of 19.3 points, significantly outperforming the control group’s increase of 6.6 points (p < .001). Furthermore, 73.3% of patients in the experimental group achieved a high level of functional independence, compared to only 26.7% in the control group. Patients in the experimental group reported high satisfaction with the innovative device (mean score of 4.39 out of 5.00), and no serious adverse events were reported.

Recommendation The innovative joint contracture prevention device is effective in improving the ROM and functional ability in ADLs among patients following shoulder and elbow surgery. As a user-friendly, low-cost tool that enables self-directed use, it is highly suitable for application in orthopedic rehabilitation. However, long-term follow-up studies are recommended to evaluate the sustainability of these outcomes.