Effectiveness and cost-effectiveness of telerehabilitation for musculoskeletal disorders: A systematic review and meta-analysis

Background: Internet-based telerehabilitation could be a valuable option for the treatment of musculoskeletal disorders, with the advantage of providing rehabilitation from anywhere. However, there is no solid and updated evidence demonstrating its effectiveness on relevant clinical and cost outcomes.Objective: This systematic review aims to determine the clinical and cost-effectiveness of internet-based tele-rehabilitation during the recovery of musculoskeletal disorders.Methods: Medline, Web of Science, Scopus and Cochrane databases were systematically searched from incep-tion to June 2023. Trials investigating the effects of internet-based telerehabilitation in any musculoskeletal disorder were selected. Nonoriginal articles and grey literature were excluded. Two independent reviewers conducted the study selection and data extraction. Random effect meta-analyses (standardized mean differ-ence) and further sensitivity analyses were performed.Results: We selected 37 clinical trials (33 randomized and 4 non-randomized) and 5 health economics stud-ies, which included a total of 4,288 participants. Telerehabilitation was more favourable than control treat-ments in improving all studied clinical outcomes, although the effectiveness varied depending on the type of musculoskeletal disorder. The standard mean differences (SMD) ranged from 0.24 to 0.91. For physical func-tion, the primary outcome, superior effectiveness was found only in people with hip fractures (SMD, 0.87; 95 % CI, 0.34 to 1.41). The effects for joint replacement, osteoarthritis, and spine pain were similar to those of control treatments. However, the favourable outcomes for telerehabilitation became insignificant when com-pared specifically to face-to-face rehabilitation. Some results displayed publication bias and a lack of robust-ness, necessitating cautious interpretation. In terms of health economics studies, telerehabilitation was 89.55 $ (95 % CI 4.6 to 174.5) cheaper per individual than conventional treatments.Conclusions: Telerehabilitation should be considered in the recovery process of musculoskeletal disorders when optimal face-to-face rehabilitation is not feasible. Moreover, telerehabilitation reduces costs and time. PROSPERO number: CRD42022322425 (c) 2023 Elsevier Masson SAS. All rights reserved.