Effect of Extended Reality-Supported Exercise Training on Shoulder Pain, Range of Motion, Pulmonary Function, Quality of Recovery, and Adherence to the Exercise Program in Patients Undergoing Thoracic Surgery

Following thoracic surgery, patients commonly experience several clinical problems during the recovery period, including pain related to improper positioning, the surgical incision and/or thoracic drain, inability to perform effective coughing, decreased lung capacity, development of postoperative pulmonary complications, inadequate airway clearance, restricted shoulder range of motion on the operated side, postural abnormalities, and persistent chest wall tightness. These complications adversely affect patients' quality of recovery. To prevent these complications, exercise training as part of perioperative pulmonary rehabilitation plays a key role. One of the innovative and contemporary approaches that can be incorporated into patient education is extended reality (XR) technology. A systematic and comprehensive review of the international and national literature revealed that although studies have investigated structured and standardized exercise education for patients undergoing thoracic surgery, research evaluating XR-supported exercise education remains limited. The present study aims to determine the effects of an XR-supported exercise education video developed for patients undergoing thoracic surgery on shoulder pain, range of motion (ROM), pulmonary function, quality of recovery, and adherence to the exercise program. This study is designed as a prospective, two-arm (1:1), randomized controlled clinical trial. The study population will consist of patients undergoing thoracic surgery at the Thoracic Surgery Clinic of Mersin University Hospital between October 2026 and October 2027. As shoulder pain is the primary outcome of the study, the sample size calculation was based on the study by Reeve et al. (2010). According to the a priori power analysis performed using G*Power version 3.1, assuming a significance level of ? = 0.05, 95% statistical power (1?ß), and a two-tailed hypothesis, the required total sample size was calculated to be 54 patients. Considering a potential attrition rate of 10%, the target sample size was increased to 60 patients (30 in the XR-supported exercise education group and 30 in the control group). Data will be collected using the Patient Information Form, Visual Analog Scale (VAS), Range of Motion Assessment Form, Pulmonary Function Test Parameters Follow-up Form, Quality of Recovery-40 Questionnaire (QoR-40), and the Exercise Follow-up Form. Upon hospital admission, all participants will complete the Patient Information Form, Visual Analog Scale, Range of Motion Assessment Form, and Pulmonary Function Test Parameters Follow-up Form. Patients assigned to the intervention group will receive XR-supported exercise education before thoracic surgery, whereas those in the control group will receive the routine education provided in the clinic (consisting of verbal instruction and standard face-to-face patient education with demonstration). Participants in both the intervention and control groups will be assessed on postoperative days 7 and 14 using the Visual Analog Scale, Range of Motion Assessment Form, Pulmonary Function Test Parameters Follow-up Form, and the Quality of Recovery40 Questionnaire. During hospitalization, adherence to the prescribed exercise program will be monitored using the Exercise Follow-up Form based on patients' self-reports. Descriptive characteristics of the participants will be presented as mean ± standard deviation, median (minimum maximum), frequency, and percentage. After assessing the normality of data distribution, continuous variables with normal distribution will be compared between the two independent groups using the independent samples t-test. Continuous variables that do not follow a normal distribution will be analyzed using the Mann Whitney U test. Statistical significance will be accepted at p 0.05 with a 95% confidence interval. The study findings are expected to be published in an SCI-Expanded (Q1) journal and presented as an abstract at an international scientific congress. The innovative XR-supported educational approach developed for patients undergoing thoracic surgery is expected to improve patient outcomes and treatment adherence while reducing healthcare costs.