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

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.

Inclusion Criteria: * Patients who have undergone thoracic surgery (wedge resection, pneumonectomy, lobectomy, or segmentectomy), * Patients who have provided written informed consent to participate in the study, * Patients who are literate, * Patients aged 18 years or older, * Patients who are hemodynamically stable and eligible for mobilization, * Patients who are at least 24-48 hours postoperatively and have been permitted to undergo early mobilization, * Patients with adequate visual and auditory abilities, * Patients without any mental or cognitive disorders, * Patients who can communicate in Turkish and understand instructions, * Patients with no previous experience using virtual reality (VR) headsets. Exclusion Criteria: * Patients who do not wish to participate in the study, * Patients with preoperative shoulder joint movement limitations, contractures, deficits, or similar conditions.