{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T00:05:49Z","timestamp":1760918749944,"version":"build-2065373602"},"reference-count":33,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T00:00:00Z","timestamp":1760659200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Proper rehabilitation following rotator cuff repair (RCR) is necessary for successful postoperative outcomes, though the average course of physical therapy (PT) is lengthy and costly. The goals of this study were to (1) develop exercise programs for the CuffLink mHealth system and (2) evaluate early prototype efforts at meeting the needs of RCR clients. A panel of 24 clinicians participated in a Delphi study to identify consensus in rehabilitation, key informatic needs, and appropriate interface modalities for client usage. Utilizing the Delphi findings, the iA CuffLink mHealth system was developed, and a pilot evaluation assessed the feasibility and usability of CuffLink through the mHealth App Usability Questionnaire (MAUQ). During the pilot evaluation, the overall MAUQ score was 6.14. All participants (n = 18) viewed messaging the care team and a real time rep counter as \u201cimportant\u201d or \u201cvery important\u201d. All participants either agreed or strongly agreed that quantifying progress would help motivate them to be compliant, and that the app helped them achieve their recovery outcomes compared to the shoulder device alone. Participants were generally pleased with the ease of use, information arrangement, and usefulness of CuffLink. These findings can advance our understanding of the informatics and usability needs in telerehabilitation systems.<\/jats:p>","DOI":"10.3390\/s25206417","type":"journal-article","created":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T14:29:17Z","timestamp":1760711357000},"page":"6417","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Development of iA CuffLink for Rotator Cuff Repair Telerehabilitation"],"prefix":"10.3390","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7380-8776","authenticated-orcid":false,"given":"Connor","family":"Luck","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15224, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3676-0873","authenticated-orcid":false,"given":"Rachel 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PA 15219, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0933-8150","authenticated-orcid":false,"given":"Andi","family":"Saptono","sequence":"additional","affiliation":[{"name":"Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA 15260, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4907-8402","authenticated-orcid":false,"given":"Bambang","family":"Parmanto","sequence":"additional","affiliation":[{"name":"Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA 15260, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4932-6541","authenticated-orcid":false,"given":"Adam","family":"Popchak","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15219, 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care","volume":"44","author":"Richards","year":"2005","journal-title":"Rheumatology"},{"key":"ref_2","first-page":"57","article-title":"Rotator cuff repair: Challenges and solutions","volume":"7","author":"Amini","year":"2015","journal-title":"Orthop. Res. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1097\/BLO.0b013e31802fc175","article-title":"Indications for rotator cuff repair: A systematic review","volume":"455","author":"Oh","year":"2007","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2392","DOI":"10.1016\/j.arthro.2015.06.018","article-title":"Utilization and Costs of Postoperative Physical Therapy After Rotator Cuff Repair: A Comparison of Privately Insured and Medicare Patients","volume":"31","author":"Arshi","year":"2015","journal-title":"Arthroscopy"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2325967120982293","DOI":"10.1177\/2325967120982293","article-title":"Temporal Utilization of Physical Therapy Visits After Anterior Cruciate Ligament Reconstruction","volume":"9","author":"Burroughs","year":"2021","journal-title":"Orthop. J. Sports Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2325967118763353","DOI":"10.1177\/2325967118763353","article-title":"Medicaid Health Insurance Status Limits Patient Accessibility to Rehabilitation Services Following ACL Reconstruction Surgery","volume":"6","author":"Rogers","year":"2018","journal-title":"Orthop. J. Sports Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"pzae015","DOI":"10.1093\/ptj\/pzae015","article-title":"Variation in Utilization of Physical Therapist and Occupational Therapist Services After Rotator Cuff Repair: A Population-Based Study","volume":"104","author":"Stern","year":"2024","journal-title":"Phys. Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"421","DOI":"10.33546\/bnj.2807","article-title":"Patient compliance: A concept analysis","volume":"9","author":"Thummak","year":"2023","journal-title":"Belitung Nurs. J."},{"key":"ref_9","first-page":"18","article-title":"Understanding Noncompliant Behavior: Definitions and Causes","volume":"7","author":"Kleinsinger","year":"2003","journal-title":"Perm. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.math.2009.12.004","article-title":"Barriers to treatment adherence in physiotherapy outpatient clinics: A systematic review","volume":"15","author":"Jack","year":"2010","journal-title":"Man. Ther."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1046\/j.1365-2710.2001.00363.x","article-title":"Patient adherence to treatment: Three decades of research. A comprehensive review","volume":"26","author":"Vermeire","year":"2001","journal-title":"J. Clin. Pharm. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1942","DOI":"10.2106\/JBJS.L.00964","article-title":"One-to-one therapy is not superior to group or home-based therapy after total knee arthroplasty: A randomized, superiority trial","volume":"95","author":"Ko","year":"2013","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1016\/j.jse.2016.01.004","article-title":"Is the arthroscopic modified tension band suture technique suitable for all full-thickness rotator cuff tears?","volume":"25","author":"Bae","year":"2016","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1016\/j.jse.2005.09.017","article-title":"Cuff integrity after arthroscopic versus open rotator cuff repair: A prospective study","volume":"15","author":"Bishop","year":"2006","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_15","unstructured":"Riffitts, M., Popchak, A., Disantis, A., Bell, K.M., and McClincy, M.P. (2024). Delphi Consensus for Rotator Cuff Repair Precautions and Development of a Remote Rehabilitation System, Orthopaedic Research Society."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.jclinepi.2013.12.002","article-title":"Defining consensus: A systematic review recommends methodologic criteria for reporting of Delphi studies","volume":"67","author":"Diamond","year":"2014","journal-title":"J. Clin. Epidemiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"120484","DOI":"10.1016\/j.techfore.2020.120484","article-title":"Consensus in the delphi method: What makes a decision change?","volume":"163","author":"Barrios","year":"2021","journal-title":"Technol. Forecast. Soc. Change"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e11500","DOI":"10.2196\/11500","article-title":"The mHealth App Usability Questionnaire (MAUQ): Development and Validation Study","volume":"7","author":"Zhou","year":"2019","journal-title":"JMIR Mhealth Uhealth"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3","DOI":"10.5195\/ijt.2016.6196","article-title":"Development of the Telehealth Usability Questionnaire (TUQ)","volume":"8","author":"Parmanto","year":"2016","journal-title":"Int. J. Telerehabilitation"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Roos, R.E., Lambiase, J., Riffitts, M., Scholle, L., Kulkarni, S., Luck, C.L., Parmanto, D., Putraadinatha, V., Yoga, M.D., and Lang, S.N. (2025). The Reliability and Validity of an Instrumented Device for Tracking the Shoulder Range of Motion. Sensors, 25.","DOI":"10.3390\/s25123818"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2094","DOI":"10.2106\/JBJS.9422.EBO365","article-title":"A delayed physical therapy protocol that limited passive range of motion was similar to a protocol with early passive range of motion after rotator cuff repair","volume":"94","author":"Iannotti","year":"2012","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1177\/1941738115576729","article-title":"A Comparison of Rehabilitation Methods After Arthroscopic Rotator Cuff Repair: A Systematic Review","volume":"7","author":"Yi","year":"2015","journal-title":"Sports Health"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1002\/hcs2.70001","article-title":"Does the Timing of the Initiation of Physical Therapy Post-Rotator Cuff Repair Impact Shoulder Function?","volume":"4","author":"Barillas","year":"2025","journal-title":"Health Care Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1177\/0363546514544698","article-title":"Early Versus Delayed Passive Range of Motion Exercise for Arthroscopic Rotator Cuff Repair: A Meta-analysis of Randomized Controlled Trials","volume":"43","author":"Chang","year":"2015","journal-title":"Am. J. Sports Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2057","DOI":"10.1177\/0363546514552802","article-title":"Early Versus Delayed Passive Range of Motion After Rotator Cuff Repair: A Systematic Review and Meta-analysis","volume":"43","author":"Kluczynski","year":"2015","journal-title":"Am. J. Sports Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.arthro.2011.07.012","article-title":"Effect of two rehabilitation protocols on range of motion and healing rates after arthroscopic rotator cuff repair: Aggressive versus limited early passive exercises","volume":"28","author":"Lee","year":"2012","journal-title":"Arthroscopy"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.jse.2024.09.007","article-title":"Association of socioeconomic status and physical therapy compliance after arthroscopic shoulder labrum repair","volume":"34","author":"Suri","year":"2025","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_28","first-page":"e36740","article-title":"Factors Affecting Postoperative Rehabilitation Therapy Utilization After Arthroscopic Rotator Cuff Repair: An Epidemiological Analysis","volume":"15","author":"Baumann","year":"2023","journal-title":"Cureus"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"113","DOI":"10.2106\/JBJS.I.01375","article-title":"Internet-based outpatient telerehabilitation for patients following total knee arthroplasty: A randomized controlled trial","volume":"93","author":"Russell","year":"2011","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.2106\/JBJS.N.01066","article-title":"In-Home Telerehabilitation Compared with Face-to-Face Rehabilitation After Total Knee Arthroplasty: A Noninferiority Randomized Controlled Trial","volume":"97","author":"Moffet","year":"2015","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1007\/s10926-023-10165-9","article-title":"Evaluating Effectiveness of Telerehabilitation Services Among Injured Workers Treated in a Canadian Workers\u2019 Compensation System: A Population-Based Study","volume":"34","author":"Brehon","year":"2024","journal-title":"J. Occup. Rehabil."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e197","DOI":"10.3928\/01477447-20201119-07","article-title":"Postoperative Compliance and Return to Work After Rotator Cuff Repair: Value of an Interactive Online Rehabilitation Program Among Patients Treated Under Workers\u2019 Compensation","volume":"44","author":"Anderson","year":"2021","journal-title":"Orthopedics"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1007\/s11136-023-03505-y","article-title":"Patient adherence to patient-reported outcome measure (PROM) completion in clinical care: Current understanding and future recommendations","volume":"33","author":"Unni","year":"2024","journal-title":"Qual. Life Res."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/25\/20\/6417\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T04:13:50Z","timestamp":1760847230000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/25\/20\/6417"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,17]]},"references-count":33,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["s25206417"],"URL":"https:\/\/doi.org\/10.3390\/s25206417","relation":{},"ISSN":["1424-8220"],"issn-type":[{"type":"electronic","value":"1424-8220"}],"subject":[],"published":{"date-parts":[[2025,10,17]]}}}