Telerehabilitation improves physical function and reduces dyspnoea in people with COVID-19 and post-COVID-19 conditions: a systematic review.

Only six small RCTs were included, with individual sample sizes ranging from 21 to 119 participants, so all pooled estimates are imprecise. Three of the six trials were judged at high risk of bias (concerns in randomisation, deviations from intended interventions, and selective reporting); the other three had some concerns. Every trial compared telerehabilitation to no treatment or brief educational handouts. None compared it to a face-to-face rehabilitation program, so the results show benefit over inactivity, not equivalence to in-person care. The included programs were heterogeneous in content, duration (1 to 12 weeks), delivery platform, and disease stage (acute vs post-discharge), limiting the ability to generalise to a single patient profile. Satisfaction, a pre-specified primary outcome, was not reported in the results of the included trials. Publication bias could not be assessed because no meta-analysis included more than 10 studies. The small sample sizes and few events mean the true effect could be substantially different from the estimates reported.

Do not read this as proof that telerehabilitation matches in-person physiotherapy. Every trial compared remote exercise to no treatment or brief educational handouts, not to a face-to-face rehabilitation program. The gains may simply reflect the benefit of any structured exercise over inactivity, and the evidence is low certainty across the board.