Effectiveness of Different Telerehabilitation Strategies on Pain and Physical Function in Patients With Knee Osteoarthritis: Systematic Review and Meta-Analysis

Abstract

Background: Knee osteoarthritis (OA) is a chronic, degenerative bone and joint disease. It can lead to major pressure to the quality of life and mental health of patients, and also brings a serious economic burden to society. However, it is difficult for patients with knee OA to access rehabilitation when discharging from the hospital. Internet-based rehabilitation is one of the promising telemedicine strategies for the improvement of knee OA, but the effect of different telerehabilitation strategies on knee OA is not clear.

Objective: The aim of this systematic review and meta-analysis was to identify telerehabilitation strategies attributing to the improvement of pain and physical function outcomes in patients with knee OA.

Methods: We reviewed and analyzed telerehabilitation strategies from randomized controlled trials (RCTs) comparing telerehabilitation with conventional treatment or usual care. For each strategy, we examined whether RCTs that applied the telerehabilitation strategy resulted in a significant improvement in pain or physical function compared with conventional treatment or usual care.

Results: We included 6 RCTs (n=734) incorporating 8 different telerehabilitation strategies. The duration of the interventions ranged from 1 to 48 weeks, and sample sizes ranged from 20 to 350 patients. The results showed that RCTs that provided telerehabilitation were found to be more effective than conventional treatments for improving pain (P=.003; standardized mean difference [SMD] -0.21, 95% CI -0.35 to -0.07), but not physical function (P=.24; SMD -0.09, 95% CI -0.25 to 0.06). Furthermore, this systematic review and meta-analysis indicated that there is no significant correlation between different telerehabilitation strategies and the pain and physical function of patients with knee OA.

Conclusions: This systematic review and meta-analysis showed that telerehabilitation programs could relieve pain but not improve physical function for patients with knee OA. These results indicated that telerehabilitation is beneficial for the implementation of home rehabilitation exercises for patients with knee OA, thereby reducing the economic burden of health. However, there were limitations in terms of the number of search results and the number of studies that were eligible for this review and meta-analysis. Therefore, the results need to be interpreted with caution, and more high-quality studies with large samples are needed to focus on the long-term outcomes of telerehabilitation for patients with knee OA to address this limitation.

Keywords: knee osteoarthritis; meta-analysis; pain; physical function; systematic review; telemedicine; telerehabilitation.

Figure 1

Flow diagram of the review. RTC: randomized controlled trial.

Figure 2

Risk of bias assessment. Judgments about each methodological quality item are presented as percentages.

Figure 3

Risk of bias summary. Judgements about each risk of bias item were summarized for each included randomized controlled trial.

Figure 4

Forest plot of the included studies comparing the effect of telerehabilitation and conventional treatment on pain according to the Western Ontario and McMaster Universities Osteoarthritis index pain subscale.

Figure 5

Forest plot of the included studies comparing the effect of telerehabilitation and conventional treatment on physical function based on the Western Ontario and McMaster Universities Osteoarthritis index function subscale.