AI-Enabled Telerehabilitation for Chronic Nonspecific Neck Pain: Multicenter Randomized Controlled Trial

Exercise therapy is effective in managing chronic nonspecific neck pain (CNP). Nevertheless, the high burden of CNP continues to place pressure on existing rehabilitation services, especially in remote or resource-constrained settings where continuous and standardized physical therapy may be difficult to access. By combining home-based exercise with remote supervision and movement feedback, AI-enabled telerehabilitation may broaden access to rehabilitation and support the continued management of CNP.

This study examined whether an AI-enabled telerehabilitation program was noninferior to standard outpatient rehabilitation for improving neck-related disability in individuals with CNP and compared the effects of the 2 interventions on pain, health-related quality of life, and cervical range of motion.

This multicenter, prospective, parallel-group randomized noninferiority trial was conducted at Peking Union Medical College Hospital and Beijing Jishuitan Hospital. Patients with CNP of at least 3 months' duration were randomized 1:1 to a telerehabilitation group (TG) or outpatient rehabilitation group (OG) using concealed, web-based, variable blocks stratified by center and baseline Neck Disability Index (NDI) severity. Both groups completed identical 24-week strengthening and stretching programs (3 sessions per wk; ≈30 min per session) and were assessed at weeks 0, 4, 8, 12, and 24. TG trained at home using sensor-based movement recognition and threshold rules; OG received face-to-face outpatient rehabilitation. Week-24 NDI was the primary outcome; Numeric Pain Rating Scale (NPRS), EQ-5D, and cervical range of motion were secondary. Noninferiority required the upper 95% CI bound of the TG-OG NDI difference to be <10 percentage points (5/50). Analyses were intention-to-treat; assessors and statisticians were blinded.

Of 312 individuals screened, 116 were randomized (58 per group). At week 24, 55 TG and 53 OG participants completed assessments; all 116 participants were included in the primary intention-to-treat analysis using observed or imputed data. The between-group differences in NDI (TG - OG) were -2.8 (95% CI -6.3 to 0.7; P=.11) at week 12 and -2.5 (95% CI -6.2 to 1.2; P=.15) at week 24. At week 24, the upper 95% CI bound was below the prespecified noninferiority margin of 10 percentage points on the 0 to 100 NDI scale, equivalent to 5 points on the original 0 to 50 scale, demonstrating noninferiority of TG. Both groups showed clinically meaningful reductions in NDI, with comparable improvements in NPRS, EQ-5D, and cervical range of motion. No intervention-related harms occurred.

Over 24 weeks, AI-enabled telerehabilitation was noninferior to exercise-matched outpatient rehabilitation for neck-related disability, with broadly comparable improvements in pain, health-related quality of life, and cervical range of motion. AI-enabled telerehabilitation may be a practical alternative for patients with CNP who are unable to attend outpatient rehabilitation.