Effectiveness of Telerehabilitation for Chronic Nonspecific Low Back Pain: Systematic Review and Meta-Analysis of...

Chronic nonspecific low back pain (CNSLBP) is one of the most prevalent pain disorders worldwide. Telerehabilitation is increasingly used in the management of CNSLBP. However, evidence on its effects in CNSLBP remains inconsistent.

This systematic review and meta-analysis aimed to evaluate the potential effects of telerehabilitation on pain intensity, functional disability, and kinesiophobia in adults with CNSLBP and to explore whether these effects differed by comparator intensity, delivery mode, and supervision level.

PubMed, Embase, Web of Science, PEDro, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang, VIP, and China Biology Medicine were searched from inception to May 8, 2026. Randomized controlled trials evaluating telerehabilitation in adults with CNSLBP were included. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool, and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. Random-effects meta-analyses were performed using the Hartung-Knapp-Sidik-Jonkman adjustment, and 95% prediction intervals (PIs) were calculated using the Nagashima confidence distribution approach.

A total of 14 randomized controlled trials involving 794 participants were included. Overall, telerehabilitation was associated with statistically significant average reductions in pain intensity (mean difference [MD] -1.02, 95% CI -1.78 to -0.26; P=.01; I²=89.9%; 95% PI -3.61 to 1.51) and functional disability (MD -7.04, 95% CI -13.43 to -0.65; P=.03; I²=82.6%; 95% PI -27.97 to 13.91) compared with control conditions, whereas the overall effect on kinesiophobia was not statistically significant (MD -3.14, 95% CI -7.88 to 1.59; P=.15; I²=86.5%; 95% PI -15.04 to 8.47). All 95% PIs crossed the null, indicating substantial uncertainty in the expected effects across clinical settings. Subgroup analyses suggested that average benefits were mainly observed when telerehabilitation was compared with minimal or nonactive controls. Compared with active controls, telerehabilitation showed no clear advantage for pain or kinesiophobia, and functional disability slightly favored active rehabilitation. Exploratory subgroup analyses by delivery mode and supervision level suggested possible differences across intervention models, but these findings should not be interpreted causally because several subgroups included few studies and these factors were not mutually independent.

This review highlights the importance of comparator intensity, delivery mode, and supervision level when interpreting telerehabilitation effects. Telerehabilitation may provide context-dependent benefits, particularly when compared with minimal or nonactive management, but current evidence does not show a clear advantage over structured active rehabilitation. Given the substantial heterogeneity, PIs crossing the null, risk of bias, and low or very low certainty of evidence, telerehabilitation may be better positioned as a flexible or adjunctive approach to improve access to and continuity of care rather than as a replacement for active rehabilitation. Future trials should use standardized comparators, improve intervention reporting, include longer follow-up, and evaluate implementation and cost-effectiveness.