Telerehabilitation and face-to-face rehabilitation for chronic low back pain did not differ significantly, but the evidence is too uncertain to show equivalence

A systematic review and meta-analysis of randomised controlled trials in adults with chronic low back pain compared telerehabilitation with face-to-face rehabilitation, using strict criteria to isolate the delivery mode Meta-analysis (Liu et al., PMID 42877061). Paper-based home exercise programmes, continuous hybrid delivery and remote-assessment-only designs were excluded. Ten trials involving 562 participants were included, and risk of bias and certainty were assessed with RoB 2 and GRADE.

In the primary, content-matched analyses there was no significant difference in pain intensity (7 trials; standardised mean difference −0.05, 95% confidence interval −0.34 to 0.24; very low certainty) or functional disability (8 trials; 0.22, −0.07 to 0.52; low certainty). A secondary analysis added two trials in which only the face-to-face group received manual therapy. Pain still did not differ (9 trials; −0.01, −0.26 to 0.24), but functional disability favoured face-to-face rehabilitation (10 trials; 0.26, 0.01 to 0.52). Subgroup interaction tests were non-significant for intervention duration, weekly treatment frequency and supervision status.

The authors state that these findings should not be interpreted as evidence of equivalent effectiveness, because certainty was low or very low and the disability estimate was sensitive to the exclusion of one study. The population is adults with chronic low back pain, not older people or people living with frailty, and the abstract reports no patient-experience outcomes.

The value for benchmarking is as a caution. It adds a second meta-analysis to the week-ending 9 October signal on digital interventions in chronic musculoskeletal pain in which remote delivery was not shown to be better, and it corroborates, weakly because the population differs, the qualification on the published pattern on remote exercise delivery: remote delivery has not been shown to match face-to-face delivery on patient-centred outcomes.