EFFECTIVENESS OF TELE-REHABILITATION IN IMPROVING FUNCTIONAL OUTCOMES IN PATIENTS WITH MUSCULOSKELETAL DISORDERS

Abstract

Background: Musculoskeletal disorders (MSDs) are a leading global cause of disability. Conventional rehabilitation faces access barriers; tele-rehabilitation (TR) offers a scalable alternative, though evidence on functional outcomes remains heterogeneous. Objective: To evaluate the effectiveness of TR on functional outcomes in adults with MSDs and examine moderation by disorder type, delivery modality, and intervention duration. Methods: Following PRISMA 2020 guidelines, we systematically reviewed randomized controlled trials (2018–2025) comparing TR to conventional care or waitlist controls across PubMed, Embase, CINAHL, and Cochrane Central. Risk of bias was assessed using Cochrane RoB 2. Pooled standardized mean differences (SMDs) with 95% confidence intervals were calculated for functional outcomes, with subgroup analyses and meta-regression to explore heterogeneity. Results: Twenty-four RCTs (N = 3,842) met inclusion criteria. TR demonstrated statistically significant improvements in functional capacity (SMD = 0.52, 95% CI [0.38, 0.66], p < 0.001) and pain reduction (SMD = −0.48, 95% CI [−0.61, −0.35], p < 0.001) compared to control conditions, with non-inferiority established against in-person rehabilitation. Adherence rates averaged 78.4%, and economic evaluations favored TR for rural and mobility-limited populations. Heterogeneity was moderate (I² = 48.2%), largely explained by intervention modality and follow-up duration. Conclusion: TR is an effective, clinically comparable alternative to conventional rehabilitation for improving functional outcomes in MSD populations. Standardized dosing, long-term follow-up, and equity-focused implementation frameworks are required to optimize real-world translation.