{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T13:49:05Z","timestamp":1769608145122,"version":"3.49.0"},"reference-count":40,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2024,7,22]],"date-time":"2024-07-22T00:00:00Z","timestamp":1721606400000},"content-version":"unspecified","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"the Instituto de Salud Carlos III","award":["PI19\/01490"],"award-info":[{"award-number":["PI19\/01490"]}]},{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"crossref","award":["PI19\/01490"],"award-info":[{"award-number":["PI19\/01490"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,7,2]]},"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Rotator cuff-related shoulder pain (RCRSP) is the most common cause of shoulder pain. Currently, exercise is proposed as the first-line treatment for patients suffering from RCRSP. However, adherence to therapeutic exercise programmes can be poor in the long term in a home setting. The aim of this study is to evaluate the effects of adding video animations to a traditional paper-based exercise programme.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>A single-centre, randomised, open-labelled clinical trial will be conducted in a hospital in Spain. Adults aged between 18 and 80 years diagnosed with RCRSP who meet the eligibility criteria will be included. Patients (n=132) will be randomised into two groups, with both receiving paper-based exercises, and the experimental group will also be provided with video animations. The participants will receive seven face-to-face physical therapy sessions and will be asked to perform the exercises at home for 6 months. The primary outcome measure will be the Shoulder Pain and Disability Index, measured at baseline, 3 weeks, 3 months (primary analysis) and 6 months. Secondary outcomes will be the patient\u2019s pain intensity during the last week (rest, during movement and at night); expectations of improvement; satisfaction with treatment; impression of improvement; perceived usability, usefulness and satisfaction of multimedia animations; and adherence to exercises. Generalised least squares regression models with an autoregressive-moving average lag one correlation structure will be implemented, with an intention-to-treat analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study has been approved by the ethics committee of Hospital Universitario Fundaci\u00f3n Alcorc\u00f3n (Madrid, Spain), reference number CI18\/16. All participants will sign an informed consent. The results will be published in a peer-reviewed scientific journal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov,\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" specific-use=\"clinicaltrial results\" xlink:href=\"NCT05770908\">NCT05770908<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-085381","type":"journal-article","created":{"date-parts":[[2024,7,22]],"date-time":"2024-07-22T13:01:10Z","timestamp":1721653270000},"page":"e085381","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Effects of a web application based on multimedia animations to support therapeutic exercise for rotator cuff-related shoulder pain: protocol for an open-label randomised controlled trial"],"prefix":"10.1136","volume":"14","clinical-trial-number":[{"clinical-trial-number":"nct05770908","registry":"10.18810\/clinical-trials-gov","type":"results"},{"clinical-trial-number":"nct05770908","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Irene","family":"P\u00e9rez-Porta","sequence":"first","affiliation":[{"name":"Physical Therapy and Rehabilitation Unit, Hospital Universitario Fundaci\u00f3n Alcorc\u00f3n, Alcorcon, Madrid, Spain"},{"name":"International Doctoral School, Universidad Rey Juan Carlos, Mostoles, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariano Tom\u00e1s","family":"Fl\u00f3rez-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Physical Therapy and Rehabilitation Unit, Hospital Universitario Fundaci\u00f3n Alcorc\u00f3n, Alcorcon, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernando","family":"Garc\u00eda-P\u00e9rez","sequence":"additional","affiliation":[{"name":"Physical Therapy and Rehabilitation Unit, Hospital Universitario Fundaci\u00f3n Alcorc\u00f3n, Alcorcon, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8365-7264","authenticated-orcid":false,"given":"Rub\u00e9n","family":"Fern\u00e1ndez-Mat\u00edas","sequence":"additional","affiliation":[{"name":"Research Unit, Hospital Universitario Fundacion Alcorcon, Alcorcon, Madrid, Spain"},{"name":"Doctoral School, Department of Physical Therapy, Universitat de Valencia, Valencia, Comunitat Valenciana, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M \u00c1ngeles","family":"P\u00e9rez-Manzanero","sequence":"additional","affiliation":[{"name":"Physical Therapy and Rehabilitation Unit, Hospital Universitario Fundaci\u00f3n Alcorc\u00f3n, Alcorcon, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aurora Mar\u00eda","family":"Araujo-Narv\u00e1ez","sequence":"additional","affiliation":[{"name":"Physical Therapy and Rehabilitation Unit, Hospital Universitario Fundaci\u00f3n Alcorc\u00f3n, Alcorcon, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M Alicia","family":"Urraca-Gesto","sequence":"additional","affiliation":[{"name":"Physical Therapy and Rehabilitation Unit, Hospital Universitario Fundaci\u00f3n Alcorc\u00f3n, Alcorcon, Madrid, Spain"},{"name":"Department of Physical Therapy, Occupational Therapy, and Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Mostoles, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C\u00e9sar","family":"Fern\u00e1ndez-Lagarejos","sequence":"additional","affiliation":[{"name":"Physical Therapy and Rehabilitation Unit, Hospital Universitario Fundaci\u00f3n Alcorc\u00f3n, Alcorcon, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gustavo","family":"Plaza-Manzano","sequence":"additional","affiliation":[{"name":"Department of Radiology, Rehabilitation, and Physical Therapy, Universidad Complutense de Madrid, Madrid, Spain"},{"name":"Fisioterapia Contempor\u00e1nea (InPhysio) Research Group, Health Research Institute, Hospital Cl\u00ednico San Carlos, Madrid, Comunidad de Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elia","family":"P\u00e9rez-Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Research Unit, Hospital Universitario Fundacion Alcorcon, Alcorcon, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda","family":"Velasco-Arribas","sequence":"additional","affiliation":[{"name":"Research Unit, Hospital Universitario Fundacion Alcorcon, Alcorcon, Madrid, Spain"},{"name":"Department of Medical Specialties and Public Health, Universidad Rey Juan Carlos, Mostoles, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,7,22]]},"reference":[{"key":"2025121300290090000_14.7.e085381.1","doi-asserted-by":"crossref","DOI":"10.1186\/s12875-023-01976-z","article-title":"Prevalence and characteristics of musculoskeletal complaintsin primary care: an analysis from the population level and analysis reporting (POLAR) database","volume":"24","author":"Haas","year":"2023","journal-title":"BMC Prim Care"},{"key":"2025121300290090000_14.7.e085381.2","doi-asserted-by":"publisher","DOI":"10.1080\/03009740310004667"},{"key":"2025121300290090000_14.7.e085381.3","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1111\/sae.12028","article-title":"Epidemiology of rotator cuff tendinopathy: a systematic review","volume":"5","author":"Littlewood","year":"2013","journal-title":"Shoulder & Elbow"},{"key":"2025121300290090000_14.7.e085381.4","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kei139"},{"key":"2025121300290090000_14.7.e085381.5","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000031118","article-title":"The relationship between shoulder pain and shoulder disability in women: the mediating role of sleep quality and psychological disorders","volume":"101","author":"Hwang","year":"2022","journal-title":"Medicine (Balt)"},{"key":"2025121300290090000_14.7.e085381.6","article-title":"High incidence of lost workdays in patients with subacromial impingement syndrome","volume":"68","author":"Clausen","year":"2021","journal-title":"Dan Med J"},{"key":"2025121300290090000_14.7.e085381.7","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.pmr.2022.12.001","article-title":"Shoulder impingement syndrome","volume":"34","author":"Horowitz","year":"2023","journal-title":"Phys Med Rehabil Clin N Am"},{"key":"2025121300290090000_14.7.e085381.8","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2022-106340"},{"key":"2025121300290090000_14.7.e085381.9","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.l294","article-title":"Subacromial decompression surgery for adults with shoulder pain: a clinical practice guideline","volume":"364","author":"Vandvik","year":"2019","journal-title":"BMJ"},{"key":"2025121300290090000_14.7.e085381.10","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.apmr.2023.09.022","article-title":"A systematic review of clinical practice guidelines on the diagnosis and management of various shoulder disorders","volume":"105","author":"Lowry","year":"2024","journal-title":"Arch Phys Med Rehabil"},{"key":"2025121300290090000_14.7.e085381.11","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2022.11306"},{"key":"2025121300290090000_14.7.e085381.12","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1177\/0269215520934147","article-title":"Effectiveness of progressive and resisted and non-progressive or non-resisted exercise in rotator cuff related shoulder pain: a systematic review and meta-analysis of randomized controlled trials","volume":"34","author":"Naunton","year":"2020","journal-title":"Clin Rehabil"},{"key":"2025121300290090000_14.7.e085381.13","doi-asserted-by":"crossref","DOI":"10.3390\/diagnostics11030529","article-title":"Exercise-based muscle development programmes and their effectiveness in the functional recovery of rotator cuff tendinopathy: a systematic review","volume":"11","author":"Dominguez-Romero","year":"2021","journal-title":"Diagnostics (Basel)"},{"key":"2025121300290090000_14.7.e085381.14","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1177\/17585732221124303","article-title":"The influence of exercise therapy dosing on pain and functional outcomes in patients with subacromial pain syndrome: a systematic review","volume":"16","author":"McConnell","year":"2024","journal-title":"Shoulder & Elbow"},{"key":"2025121300290090000_14.7.e085381.15","doi-asserted-by":"crossref","first-page":"498","DOI":"10.47626\/1679-4435-2022-698","article-title":"Exercise for rotator cuff tendinopathy","volume":"20","author":"de-Queiroz","year":"2022","journal-title":"Rev Bras Med Trab"},{"key":"2025121300290090000_14.7.e085381.16","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.physio.2023.05.002","article-title":"Patient ratings in exercise therapy for the management of tendinopathy: a systematic review with meta-analysis","volume":"120","author":"Shim","year":"2023","journal-title":"Physiotherapy"},{"key":"2025121300290090000_14.7.e085381.17","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1002\/msc.1699","article-title":"Physiotherapists nearly always prescribe exercise for rotator cuff-related shoulder pain; but why? A cross-sectional international survey of physiotherapists","volume":"21","author":"Powell","year":"2023","journal-title":"Musculoskeletal Care"},{"key":"2025121300290090000_14.7.e085381.18","doi-asserted-by":"crossref","first-page":"102646","DOI":"10.1016\/j.msksp.2022.102646","article-title":"\u201cYou have (rotator cuff related) shoulder pain, and to treat it, I recommend exercise.\u201d A scoping review of the possible mechanisms underpinning exercise therapy","volume":"62","author":"Powell","year":"2022","journal-title":"Musculoskelet Sci Pract"},{"key":"2025121300290090000_14.7.e085381.19","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1093\/pm\/pnad134","article-title":"Patient-related barriers and enablers to the implementation of high-value physiotherapy for chronic pain: a systematic review","volume":"25","author":"Dickson","year":"2024","journal-title":"Pain Med"},{"key":"2025121300290090000_14.7.e085381.20","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1177\/02692155221108553","article-title":"Barriers and facilitators related to self-management of shoulder pain: a systematic review and qualitative synthesis","volume":"36","author":"O\u2019Shea","year":"2022","journal-title":"Clin Rehabil"},{"key":"2025121300290090000_14.7.e085381.21","doi-asserted-by":"crossref","DOI":"10.1136\/bmjsem-2019-000656","article-title":"Content reporting of exercise interventions in rotator cuff disease trials: results from application of the Consensus on Exercise Reporting Template (CERT)","volume":"5","author":"Major","year":"2019","journal-title":"BMJ Open Sport Exerc Med"},{"key":"2025121300290090000_14.7.e085381.22","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1016\/j.apmr.2023.09.007","article-title":"Reproducibility of exercise interventions in randomized controlled trials for the treatment of rotator cuff-related shoulder pain: a systematic review","volume":"105","author":"Kucksdorf","year":"2024","journal-title":"Arch Phys Med Rehabil"},{"key":"2025121300290090000_14.7.e085381.23","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2020.8498"},{"key":"2025121300290090000_14.7.e085381.24","doi-asserted-by":"crossref","DOI":"10.2196\/21374","article-title":"Adherence patterns and dose response of physiotherapy for rotator cuff pathology: longitudinal cohort study","volume":"8","author":"Burns","year":"2021","journal-title":"JMIR Rehabil Assist Technol"},{"key":"2025121300290090000_14.7.e085381.25","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1177\/0269215518819706","article-title":"Providing exercise instructions using multimedia may improve adherence but not patient outcomes: a systematic review and meta-analysis","volume":"33","author":"Emmerson","year":"2019","journal-title":"Clin Rehabil"},{"key":"2025121300290090000_14.7.e085381.26","doi-asserted-by":"publisher","DOI":"10.3109\/17483101003671709"},{"key":"2025121300290090000_14.7.e085381.27","doi-asserted-by":"crossref","DOI":"10.2196\/45207","article-title":"The effectiveness of digital apps providing personalized exercise videos: systematic review with meta-analysis","volume":"25","author":"Davergne","year":"2023","journal-title":"J Med Internet Res"},{"key":"2025121300290090000_14.7.e085381.28","first-page":"255","article-title":"Development of a web exercise video for patients with shoulder problems","volume":"35","author":"Park","year":"2017","journal-title":"Comput Inform Nurs"},{"key":"2025121300290090000_14.7.e085381.29","doi-asserted-by":"crossref","DOI":"10.1186\/s12984-023-01188-7","article-title":"Effectiveness and therapeutic compliance of digital therapy in shoulder rehabilitation: a randomized controlled trial","volume":"20","author":"Rizzato","year":"2023","journal-title":"J Neuroeng Rehabil"},{"key":"2025121300290090000_14.7.e085381.30","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-158-3-201302050-00583"},{"key":"2025121300290090000_14.7.e085381.31","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1177\/1758573216663201","article-title":"Shoulder impingement syndrome: a systematic review of clinical trial participant selection criteria","volume":"9","author":"Watts","year":"2017","journal-title":"Shoulder & Elbow"},{"key":"2025121300290090000_14.7.e085381.32","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1111\/j.2044-8317.2011.02029.x","article-title":"Accuracy in parameter estimation for ANCOVA and ANOVA contrasts: sample size planning via narrow confidence intervals","volume":"65","author":"Lai","year":"2012","journal-title":"Br J Math Stat Psychol"},{"key":"2025121300290090000_14.7.e085381.33","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00846-1"},{"key":"2025121300290090000_14.7.e085381.34","doi-asserted-by":"crossref","DOI":"10.1186\/s13063-019-3671-2","article-title":"Sample size estimation for randomised controlled trials with repeated assessment of patient-reported outcomes: what correlation between baseline and follow-up outcomes should we assume?","volume":"20","author":"Walters","year":"2019","journal-title":"Trials"},{"key":"2025121300290090000_14.7.e085381.35","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1097\/PHM.0000000000001169","article-title":"Minimal clinically important difference of shoulder outcome measures and diagnoses: a systematic review","volume":"98","author":"Dabija","year":"2019","journal-title":"Am J Phys Med Rehabil"},{"key":"2025121300290090000_14.7.e085381.36","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2016-096651"},{"key":"2025121300290090000_14.7.e085381.37","doi-asserted-by":"crossref","DOI":"10.1186\/s12955-015-0397-z","article-title":"Shoulder pain and disability index: cross cultural validation and evaluation of psychometric properties of the spanish version","volume":"13","author":"Membrilla-Mesa","year":"2015","journal-title":"Health Qual Life Outcomes"},{"key":"2025121300290090000_14.7.e085381.38","doi-asserted-by":"crossref","first-page":"S240","DOI":"10.1002\/acr.20543","article-title":"Measures of adult pain: Visual Analog Scale for pain (VAS pain), Numeric Rating Scale for pain (NRS pain), Mcgill Pain Questionnaire (MPQ), Short\u2010Form Mcgill Pain Questionnaire (SF\u2010MPQ), Chronic Pain Grade Scale (CPGS), Short Form\u201036 bodily pain scale (SF\u201036 bps), and measure of Intermittent and Constant Osteoarthritis Pain (ICOAP)","volume":"63","author":"Hawker","year":"2011","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2025121300290090000_14.7.e085381.39","doi-asserted-by":"crossref","DOI":"10.2196\/21161","article-title":"Spanish version of the system usability scale for the assessment of electronic tools: development and validation","volume":"7","author":"Sevilla-Gonzalez","year":"2020","journal-title":"JMIR Hum Factors"},{"key":"2025121300290090000_14.7.e085381.40","doi-asserted-by":"crossref","unstructured":"Wilcox RR . Introduction to Robust Estimation and Hypothesis Testing. 3rd Edition. Amsterdam: Elsevier, AP, 2012.","DOI":"10.1016\/B978-0-12-386983-8.00001-9"}],"updated-by":[{"DOI":"10.1136\/bmjopen-2024-085381corr1","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T00:00:00Z","timestamp":1743638400000}}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-085381","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T08:29:12Z","timestamp":1765614552000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-085381"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7]]},"references-count":40,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,7,22]]},"published-print":{"date-parts":[[2024,7]]}},"alternative-id":["10.1136\/bmjopen-2024-085381"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-085381","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7]]}}}