Digital interventions for chronic musculoskeletal pain show small average gains, with low certainty and no proven superior format

A systematic review and Bayesian network meta-analysis of 92 randomised controlled trials, involving 12,595 adults with chronic musculoskeletal pain, compared digital health interventions with control conditions Meta-analysis (Wang et al., PMID 42842940). App-based, virtual-reality-based and telerehabilitation interventions gave small to moderate favourable average effects on pain and disability. Effects were larger for interventions built around exercise or motor-function training than for those centred on education or cognitive behavioural content.

The certainty is what limits the finding. The prediction intervals crossed the null, which means benefit may not be consistent from one setting to the next, and the certainty of evidence was predominantly low or very low. Several subgroup analyses included few studies. The authors conclude that the clinical importance of the average gains is uncertain, and that exercise-based virtual reality and telerehabilitation appear promising but cannot be considered superior to other formats.

For rehabilitation services the practical reading is cautious. The evidence supports exercise-based telerehabilitation as a plausible way to extend the reach of physiotherapy where distance or access limits attendance, but not as a replacement shown to match in-person care, and not for older people with frailty specifically, who are not the population analysed. The result also bounds the published pattern on remote delivery of exercise, which was written from a sarcopenia network meta-analysis: in chronic musculoskeletal pain, remote and digital delivery gave small, uncertain gains and no demonstrated advantage.