JMIR Publications

ABSTRACT

Background:

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.

Objective:

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

Methods:

PubMed, Embase, Web of Science, PEDro, CENTRAL, CNKI, Wanfang, VIP, and CBM were searched from inception to May 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 certainty of evidence was evaluated using the GRADE approach. Random-effects meta-analyses were conducted with Hartung-Knapp-Sidik-Jonkman adjustment. Prediction intervals were calculated where appropriate.

Results:

Fourteen randomized controlled trials involving 794 participants were included. Overall, telerehabilitation was associated with statistically significant reductions in pain intensity (mean difference [MD] −1.02, 95% CI −1.78 to −0.26; P=.013; I²=89.9%) and functional disability (MD −7.04, 95% CI −13.43 to −0.65; P=.03; I²=82.6%) 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%). The 95% prediction intervals for all three outcomes crossed the null, indicating substantial uncertainty in the distribution of effects across clinical settings. Subgroup analyses suggested that benefits were mainly observed when telerehabilitation was compared with minimal/non-active 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 be interpreted cautiously because several subgroups included few studies and these factors were not mutually independent.

Conclusions:

This review extends previous evidence by focusing specifically on adults with CNSLBP and by highlighting the importance of comparator intensity, delivery mode, and supervision level in interpreting the effects of telerehabilitation. Telerehabilitation may provide context-dependent benefits, particularly when compared with minimal/non-active management, but current evidence does not support its clinical superiority over structured active rehabilitation. Given the substantial heterogeneity, wide prediction intervals, risk of bias, and low certainty of evidence, telerehabilitation may be better positioned as a flexible or adjunctive approach to improve access and continuity of care rather than as a replacement for active rehabilitation. Future trials should use standardized comparator conditions, include longer follow-up, provide clearer intervention reporting, and incorporate economic evaluations. Clinical Trial: PROSPERO CRD420251151727; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251151727