研究目的
中小尺度旋轉肌破裂後以關節鏡手術修補是目前已被廣泛接受的治療方式，但術後常見併發症包括肩關節沾粘與修補處再破裂，問題關鍵在於患者如何配合施行術後復健治療，過去要求患者必須至醫院接受復健治療，但長時間的復健造成患者經濟與時間上的負擔，因此本研究目的為評估使用手機APP輔助中小尺度旋轉肌破裂者接受關節鏡修補術後施行居家自主復健的效益。

研究方法
徵求42位中小尺度旋轉肌破裂經關節鏡修補術後的患者為本研究受試者，受試者自行選擇居家自主復健(居家組22人)或醫院治療師復健(醫院組20人)。居家復健組以手機APP輔助執行復健運動，醫院復健組安排至醫院接受治療師復健指導，兩組採用相同的復健指引與運動處方，進行24週的復健療程。於術前、術後6週、術後12週與術後24週評估疼痛分數、ASES scores、Constant scores以及肩關節活動角度(前舉、外展、外轉與內轉)；測量兩側肩部不同動作下最大等長收縮肌力並計算比值代表肌力指數，包括肱二頭肌(biceps index)、肩胛下肌(subscapularis index)、脊上肌(supraspinatus index)與脊下肌(infraspinatus index)指數。復健醫囑遵從度於術後6、12與24週由病患主觀問卷與醫師門診評估；復健安全性由術後6個月的MRI評估修補後肌腱是否再斷裂；計算術後復健相關費用，包括門診及復健診療費與來回醫院交通費。

研究結果
完成6個月復健及追蹤評估的受試者共37人(居家組19人與醫院組18人)，再排除“不良”醫囑遵從度者後，居家組與醫院組分別為15人與16人受試者納入結果分析。復健安全性評估：術後6個月MRI，兩組中各有一例部分再破裂；術後復健花費：居家組較醫院組每個月平均減少NT$2986支出。疼痛分數：居家組於術前與術後24週為6.3與0.7，醫院組為7.1與0.7；ASES scores：居家組術前與術後24週分別為40.7與88.4，醫院組為35.5與87.7；Constant scores：居家組術前與術後24週分別為38.8與85.9，醫院組為40.7與83.5，兩組的疼痛與功能性評分於術後24週都較術前有顯著改善，但組間比較術後結果無顯著差異。於術後24週肩關節活動度，居家組vs醫院組：前舉角度165.0度vs 162.8度(p=.85)，外展角度145.0度vs 136.6度(p=.43)，外轉角度44.7度vs 43.1度(p=.49)，內轉分數7.9分 vs 7.6分(p=.62)，術後組間活動度比較無顯著差異，進一步分析其中小尺度破裂手術修補者術後24週關節活動度，兩組間亦無顯著差異。在肌力指數方面，居家組vs醫院組術後24週biceps index為0.91 vs 0.74(p<.05) 以及subscapularis index為0.93 vs 0.79(p<.05)，居家組在biceps與subscapularis等長收縮肌力恢復顯著優於醫院組，supraspinatus index(0.76 vs 0.64, p=.23)與infraspinatus index(0.83 vs 0.80, p=.67)則未達顯著差異，進一步排除受試者中僅肩胛下肌破裂者，脊上肌破裂者術後24週的等長收縮肌力，兩組間亦無顯著差異，惟biceps index居家組仍優於醫院組(0.91 vs 0.70, p<.05)。

結論
本研究設計簡易的四階段復健指引並建置於雲端，利用手機APP輔助居家自主復健，提供患者便利的復健資訊取得與即時醫病雙向溝通，雖然為術後6個月短期追蹤且受試者非隨機分配復健組別，但研究證實可以明顯改善疼痛、肩部功能、關節活動度與肌肉收縮力，可減輕患者經濟負擔且不會增加肌腱再斷裂的風險。因此在術後急性期以手機APP雲端復健平台輔助居家自主復健，可作為中小尺度旋轉肌破裂患者接受修補手術後，除了到醫院由治療師管理復健以外的另一個選擇，這是安全、有效且經濟的復健模式。

The purpose of our study was to assess the treatment effect of using a mobile APP to support the home-based rehabilitation for patients with rotator cuff tear after arthroscopic repair. 42 patients with medium- or small-sized rotator cuff tear after arthroscopic repair were recruited. After excluding patients with poor rehab compliance, 15 patients in the home group and 16 patients in the supervised group were eligible for analysis. At 6 months post-operatively, cuff re-tear rate, pain scores, shoulder functional scores and range of motion were no significant difference between two groups. Isometric muscle strength in forward flexion and internal rotation was superior in the home group. Home-based rehabilitation with mobile APP assistance reduced the associated cost in the mean of NT$2986 monthly comparing to rehabilitation under medical supervision. For post-operative rehabilitation in patients after rotator cuff repair, using a mobile APP to support the home-based rehabilitation is an alternative to the supervised rehabilitation.

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