JMIR Publications

ABSTRACT

Background:

Spinal cord injury (SCI) leads to complex physical and psychological impairments that significantly reduce quality of life. Telemedicine has emerged as a promising approach to overcome barriers in rehabilitation access, yet its effectiveness across multiple outcome domains remains uncertain.

Objective:

This systematic review and meta-analysis aimed to evaluate the multidimensional effects of telemedicine interventions on psychological health, sleep quality, health-related quality of life, functional independence, and pain intensity in individuals with SCI.

Methods:

A comprehensive search of PubMed, Web of Science, Embase, Ovid MEDLINE, Cochrane CENTRAL, and ClinicalTrials.gov was conducted up to August 28, 2025. Randomized controlled trials (RCTs) involving telemedicine interventions for individuals with SCI were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane RoB 2 tool. Meta-analyses were performed using fixed- or random-effects models based on heterogeneity (I² statistic), with effect sizes reported as mean differences (MDs) or standardized mean differences (SMDs) and 95% confidence intervals (CIs). Sensitivity analyses and funnel plots were used to assess robustness and publication bias.

Results:

Thirty-three RCTs met inclusion criteria. Telemedicine interventions significantly reduced depressive symptoms at 3–6 months (SMD = −0.31; 95% CI: −0.51 to −0.11; P = .003), with no significant effects at earlier or later time points. Health-related quality of life improved notably in the emotional (MD = 3.52; P = .01) and social domains (MD = 5.37; P = .01), while physical and environmental domains showed limited or borderline effects. Sleep-related functioning improved significantly at longer-term follow-up (MD = −2.24; P = .004), but not at 1 month. No significant improvements were observed in functional independence or pain intensity, although favorable trends were noted in specific subdomains. Overall heterogeneity across analyses was low.

Conclusions:

Telemedicine interventions significantly improved psychological well-being, sleep quality, and health-related quality of life in patients with spinal cord injury, particularly during the early to mid-term post-discharge period. These findings support telemedicine as a viable strategy to expand rehabilitation access and address the multidimensional needs of the SCI population. Clinical Trial: PROSPERO CRD420251149977