The Effectiveness of Telerehabilitation in Managing Pain, Strength, and Balance in Adult Patients With Knee Osteoarthritis: Systematic Review.

The trials were too different from each other to be added together, so this review describes 6 individual trials one at a time rather than producing a single estimate of benefit. A reader looking for how much telerehabilitation helps will not find a number here. Strength and balance, 2 of the 3 outcomes the review was built around, were measured in very few of the included trials, so the claim about them rests essentially on a single trial. The review contradicts itself on pain. One part of the results says telerehabilitation led to significant pain reduction compared with traditional physiotherapy, while the study table and the discussion both report that the trials making that comparison found significant improvement in both groups and no significant difference between them. Both statements cannot be true, and the table is the more specific one. The paper describes its 581 patients as those who received telerehabilitation, but the sample sizes it lists for each trial are whole-trial totals that include the control groups, so the number actually treated remotely is smaller than 581. Two of the positive results are confined to a subgroup. One is limited to employed participants and comes from what the review itself calls an exploratory analysis of who responds. The other is limited to women, and the review states only that women in the remote group improved more than men in it, never that the remote group as a whole beat its control group. Only English-language papers were included, so trials published in other languages are missing. Most of the included trials followed patients for a short time, so whether any improvement in pain, strength or balance lasts is unknown. Patients and therapists cannot be kept unaware of whether they are getting remote or in-person care, which matters most for pain, because pain is reported by the patient. The reviewers flag specific weaknesses in the trials themselves: randomisation not fully described in one, and a high dropout rate in another. Mean age ranged from 37 to 72 years and the trials came from Australia, the United States, Brazil and Iran, Turkey and Nigeria, so these are not one consistent population, and the review notes that older patients may respond differently. The included trials used telerehabilitation in different ways, some as a full replacement for in-person care and some as an addition to it, so the trials are not all answering the same clinical question.

The authors declared no conflicts of interest. No funder is named anywhere in the text.

Do not read this as evidence that remote physiotherapy beats face-to-face care. In the trials that compared the two directly, both groups improved and neither was better than the other, and the review never combined its trials, so it has no overall figure for the size of any benefit. The title promises strength and balance, but very few of the trials measured either.