JMIR Publications

ABSTRACT

Background:

Chronic musculoskeletal pain (CMP) remains a major global public health challenge. Conventional care models have clear limitations in accessibility, continuity, and long-term management. Although digital health interventions (DHIs) may help address these gaps, comparative evidence on the relative effectiveness of different DHI modalities remains limited.

Objective:

This study aimed to synthesize the available evidence and compare the effects of different digital health intervention modalities on pain outcomes in adults with CMP.

Methods:

PubMed, Cochrane CENTRAL, Embase, Web of Science, CINAHL, MEDLINE, and Scopus were systematically searched from database inception to January 29, 2026. Randomized controlled trials comparing DHIs with control conditions in adults with CMP were included. DHIs were categorized by technological characteristics. Random-effects pairwise meta-analyses and a Bayesian random-effects network meta-analysis were conducted using Hedges’ g. Subgroup analyses were performed according to core therapeutic mechanisms. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and certainty of evidence was evaluated using the GRADE approach for network meta-analysis.

Results:

A total of 92 randomized controlled trials involving 12,595 participants were included. Interventions were categorized as app-based interventions, virtual reality (VR) interventions, wearable device–based interventions, telerehabilitation, and multimodal digital health interventions. Pairwise meta-analyses showed that app-based interventions (Hedges’ g = −0.23, 95% CI −0.34 to −0.11), VR interventions (Hedges’ g = −0.34, 95% CI −0.48 to −0.20), telerehabilitation (Hedges’ g = −0.23, 95% CI −0.38 to −0.09), and multimodal digital health interventions (Hedges’ g = −0.22, 95% CI −0.39 to −0.05) were all associated with significant reductions in pain intensity. Subgroup analyses suggested that, within app-based interventions, exercise-focused apps and exercise-plus-education apps were associated with significant pain reduction, and within the VR category, movement- or functional training–based VR showed the largest effect. In the network meta-analysis, VR had the highest probability of being most effective (SUCRA = 0.854), followed by telerehabilitation (SUCRA = 0.663), multimodal digital health interventions (SUCRA = 0.628), and app-based interventions (SUCRA = 0.531). Network meta-regression suggested that intervention duration and mean participant age improved model fit, whereas other covariates showed limited modifying effects.

Conclusions:

This study provides comparative evidence to inform the selection and optimization of digital intervention strategies for CMP. VR showed the most consistent relative benefit for pain intensity reduction, while multimodal digital health interventions and telerehabilitation were also beneficial. App-based interventions showed moderate effects, whereas wearable device–based interventions require further study. Future research should better define the key active components of DHIs, refine study design, and incorporate longer-term follow-up to support more precise application in CMP management. Clinical Trial: The review was prospectively registered in PROSPERO (CRD420251169866).