Dual-Task Training Improves Shoulder Function and is Associated with Changes in Sensorimotor Network Connectivity After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial

BACKGROUND: Recovery after arthroscopic rotator cuff repair (ARCR) is influenced by pain, proprioception, sensorimotor control, and psychological factors in addition to tissue healing. Cognitive-motor dual-task training may improve attentional allocation and motor control, but its role in postoperative ARCR rehabilitation remains unclear. METHODS: In this randomized, parallel-group, controlled trial (Department of Sports Medicine, The First Affiliated Hospital of Fujian Medical University, China; January 2025-January 2026), 72 patients after ARCR were randomly assigned to a control group or a dual-task group (n = 36 each). Both groups received conventional rehabilitation, while the dual-task group additionally performed a serial subtraction-by-3 task during motor training. The intervention started at postoperative week 6 and lasted 12 weeks, with two supervised sessions per week. Assessments were conducted at postoperative weeks 6 and 18. Primary outcomes were the Constant-Murley Score (CMS) and the β-band weighted Phase Lag Index Network-Based Statistic difference (β-ΔwPLINBS). Secondary outcomes included the Visual Analog Scale (VAS), Absolute Angular Error (AAE), Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), and Tampa Scale for Kinesiophobia-11 (TSK-11). RESULTS: All participants completed the intervention, and baseline characteristics were comparable between groups. Compared with the control group, the dual-task group showed significantly greater improvement in CMS and greater reductions in β-ΔwPLINBS, VAS, and TSK-11. Although AAE and DASH improved over time in both groups, no significant time × group interactions were found. CONCLUSIONS: Cognitive-motor dual-task training added to conventional rehabilitation after ARCR may further improve shoulder function and reduce pain and kinesiophobia. It was also associated with changes in sensorimotor network connectivity. Trial registration Chinese Clinical Trial Registry ( https://www.chictr.org.cn ), No. ChiCTR2400087465, 29/07/2024.