Currently submitted to: JMIR Rehabilitation and Assistive Technologies
Date Submitted: Mar 15, 2026
Open Peer Review Period: Mar 30, 2026 - May 25, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Effects of Telerehabilitation on Quality of Life, Physical Capacity, and Symptom Burden within the Post–COVID-19 Condition: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
ABSTRACT
Background:
Telerehabilitation (TR) is an important option for patients with post-COVID-19 condition (PCC). However, current evidence on its effectiveness remains inconsistent, and the impact of different delivery modes is not fully understood.
Objective:
This study evaluated the effects of telerehabilitation on health-related quality of life (HRQoL), physical capacity, and symptom burden in adults with PCC, and to determine whether delivery mode (synchronous vs. asynchronous) modified these effects.
Methods:
We searched PubMed/MEDLINE, Cochrane Library, Web of Science, Scopus, Embase, EBSCO, and PEDro for randomized controlled trials (RCTs) published from January 2020 to December 2025. The primary outcome was HRQoL; secondary outcomes included functional capacity (6MWT, STS), dyspnea, fatigue, and HADS scores. Risk of bias was assessed using the Cochrane RoB 2 tool. Data were pooled using random-effects models with the Hartung-Knapp-Sidik-Jonkman (HKSJ) adjustment.
Results:
Twenty-three RCTs involving 2,320 participants were included. TR resulted in significant improvements in HRQoL (standardized mean difference [SMD] 1.26, 95% CI 0.07 to 2.45; P=.04), dyspnea (SMD 1.95, 95% CI 0.60 to 3.31; P=.005), and functional aerobic capacity (6MWT: mean difference [MD] 77.79 m, 95% CI 30.44 to 125.14; P=.001). Fatigue was also significantly reduced (SMD 0.89 95% CI: 0.16 to 1.62; P=.02), but no significant effects were observed for lower limb strength (STS: SMD 0.55, 95% CI -0.15 to 1.25; P=.12) or mental health outcomes (HADS: SMD 0.12, 95% CI −0.13 to 0.38; P=.36). No significant differences were observed be-tween delivery modes for most outcomes (P>.05), except for lower limb strength, where a significant subgroup difference was noted (P=.02).
Conclusions:
Telerehabilitation is effective for improving quality of life, aerobic capacity, and alleviating persistent symptoms in PCC patients. Asynchronous delivery appears sufficient for general conditioning, while synchronous supervision may be necessary for strength training. Clinical Trial: PROSPERO CRD42023490863; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023490863
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