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

OBJECTIVE: To compare the effectiveness of different types of telerehabilitation in managing chronic musculoskeletal pain. DESIGN: A systematic review with network meta-analysis of randomized controlled trials (RCTs). LITERATURE SEARCH: Relevant records were retrieved from the Cochrane Library, Web of Science, EMBASE, MEDLINE, PubMed, Scopus, and CINAHL databases from their inception to August 2024. STUDY SELECTION CRITERIA: Trials that evaluated the effectiveness of telerehabilitation interventions for patients with chronic musculoskeletal pain, focusing on pain and functional disability outcomes. DATA SYNTHESIS: 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. RESULTS: 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. CONCLUSION: Self-managed rehabilitation applications and videoconferencing rehabilitation appeared to be the most effective telerehabilitation delivery modes for managing chronic musculoskeletal pain. J Orthop Sports Phys Ther 2025;55(11):695-704. Epub 12 September 2025. doi:10.2519/jospt.2025.13366