The effectiveness of telerehabilitation in upper limb musculoskeletal disorders: a systematic review.
Clinical Snapshot
PICO Framework
| P — Population | Adults with upper limb musculoskeletal disorders in high-income countries |
| I — Intervention | Telerehabilitation interventions |
| C — Comparator | In-person rehabilitation, minimal intervention (brochures), or standard care |
| O — Outcomes | Pain (VAS/NRS), activities of daily living (QuickDASH/DASH), health-related quality of life |
Bottom Line
This systematic review of 20 RCTs (1,285 participants) suggests telerehabilitation may be similarly effective to in-person care for upper limb musculoskeletal disorders, with small improvements over minimal intervention. However, the certainty of evidence remains very low to moderate across all outcomes, with wide confidence intervals that often include no effect. While telerehabilitation shows promise for pain reduction and functional improvement, the current evidence is insufficient to definitively recommend it as equivalent to traditional rehabilitation. The findings support continued development of telerehabilitation services but highlight the need for larger, higher-quality trials to establish non-inferiority compared to in-person care. Clinicians should consider telerehabilitation as a potentially viable option, particularly when access to in-person services is limited, but should monitor outcomes carefully and maintain clinical judgment in treatment selection.
Key Findings
P Value: Not reported in abstract
Effect Size: SMD -0.33 to -0.07 for telerehabilitation vs in-person care; SMD -0.56 to -0.28 vs minimal intervention
Primary Outcome: Pain, activities of daily living, health-related quality of life
Nnt Or Sensitivity: Small to moderate effect sizes, clinical significance uncertain due to wide confidence intervals
Confidence Interval: Most confidence intervals cross null effect (include 0)
Clinical Application
Telerehabilitation appears feasible but evidence insufficient for definitive recommendations Relevant to Australian practice given focus on high-income countries; may support PBS telehealth initiatives and align with RACGP telehealth guidelines for musculoskeletal care Adults with upper limb musculoskeletal disorders in developed healthcare systems
Abstract
BACKGROUND: Telerehabilitative services have been increasingly used in recent years, raising questions about their effectiveness. In musculoskeletal disorders, evidence supports telerehabilitation but methodological quality of evidence is limited and focused on lower limb disorders. Hence, this systematic review aimed to assess the effectiveness of telerehabilitation in upper limb musculoskeletal disorders. METHODS: We conducted electronic searches in MEDLINE, Embase, and AMED (up until 11/27/2024), complemented by hand searches. Randomized (RCTs) and non-randomized studies of interventions (NRSIs) assessing upper limb musculoskeletal disorders reporting on pain, activities of daily living (ADL), or health-related quality of life (HrQol) were included. We focused on studies from high-income countries in English or German. Risk of bias was assessed using RoB 2 and ROBINS-I. Standardized mean differences (SMDs) and 95% confidence intervals were derived from meta-analysis, where negative values favor telerehabilitation. Certainty of evidence was rated using GRADE. We grouped studies comparing telerehabilitation to standard care (subgrouped into in-person or minimal intervention) and separately examined studies with a tele-adjunct. Compared to in-person rehabilitation we assessed whether outcomes were similarly improved with telerehabilitation. For tele-interventions as adjunct or compared to minimal care we assessed whether telerehabilitation improved outcomes. RESULTS: We included twenty RCTs representing 1,285 participants. All NRSIs were excluded due to critically high risk of bias. Compared to in-person rehabilitation, telerehabilitation showed similar improvements with very low certainty of evidence in pain (SMD: -0.33 [-1.16 to 0.5] VAS/NRS), moderate in ADL (SMD: -0.07 [-0.31 to 0.17] QuickDASH/DASH), and low in HrQol (SMD: -0.26 [-0.82 to 0.31]). Compared to brochure-based exercising, certainty of evidence was low for improved pain (SMD: -0.28 [-0.58 to 0.03]), moderate in ADL (SMD: -0.56 [-0.88 to -0.24]), and low in HrQol (SMD: -0.31 [-0.65 to 0.02]). Tele-adjunct yielded low certainty of evidence for improvements in pain (SMD: -0.38 [-0.71 to -0.05]) and moderate in ADL (SMD: -0.51 [-0.88 to -0.14). CONCLUSIONS: Our results tend to support the effectiveness of telerehabilitation across different comparisons although certainty of evidence is inconclusive. Future studies should particularly investigate the non-inferiority of telerehabilitation compared to in-person rehabilitation and the added benefit of tele-adjunct. TRIAL REGISTRATION: Prospero registration ID: CRD42024622465.
References
- 1.Pietzsch, C., Girbig, M., Reissig, D., Titze, S., Freiberg, A., Nienhaus, A., & Seidler, A. (2026). The effectiveness of telerehabilitation in upper limb musculoskeletal disorders: a systematic review. BMC Musculoskeletal Disorders. https://doi.org/10.1016/j.artd.2023.101191
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