The Relative Efficacy of Different Types of Telerehabilitation for Managing Chronic Musculoskeletal Pain: A Systematic Review With Network Meta-Analysis.

Abstract

<b>OBJECTIVE:</b> To compare the effectiveness of different types of telerehabilitation in managing chronic musculoskeletal pain. <b>DESIGN:</b> A systematic review with network meta-analysis of randomized controlled trials (RCTs). <b>LITERATURE SEARCH:</b> Relevant records were retrieved from the Cochrane Library, Web of Science, EMBASE, MEDLINE, PubMed, Scopus, and CINAHL databases from their inception to August 2024. <b>STUDY SELECTION CRITERIA:</b> Trials that evaluated the effectiveness of telerehabilitation interventions for patients with chronic musculoskeletal pain, focusing on pain and functional disability outcomes. <b>DATA SYNTHESIS:</b> A frequentist random-effects network meta-analysis was conducted to integrate direct and indirect evidence. Sensitivity analyses were performed based on risk-of-bias assessments and study sample sizes to evaluate the robustness of the findings. <b>RESULTS:</b> Thirty-seven RCTs were included. Rehabilitation interventions delivered through self-managed rehabilitation applications (standardized mean difference [SMD] = -0.89; 95% confidence interval [CI]: -1.31, -0.48) and through videoconferencing platforms (SMD = -0.69; 95% CI: -1.19, -0.20) significantly reduced pain intensity compared with usual care or minimal intervention. For functional disability, rehabilitation interventions delivered through videoconferencing rehabilitation (SMD = -0.99; 95% CI: -1.46, -0.53) and self-managed rehabilitation applications (SMD = -0.70; 95% CI: -1.11, -0.29) were most effective. Sensitivity analyses supported these findings, although minor inconsistencies and potential publication bias were noted. <b>CONCLUSION:</b> Self-managed rehabilitation applications and videoconferencing rehabilitation appeared to be the most effective telerehabilitation delivery modes for managing chronic musculoskeletal pain. <i>J Orthop Sports Phys Ther 2025;55(11):1-10. Epub 12 September 2025. doi:10.2519/jospt.2025.13366</i>.