THE EFFECTIVENESS OF TELE-REHABILITATION VERSUS IN-PERSON THERAPY FOR CHRONIC MUSCULOSKELETAL PAIN MANAGEMENT
Nội dung chính của bài viết
Tóm tắt
Chronic musculoskeletal (MSK) pain represents a profound and escalating global health burden, traditionally managed almost exclusively through conventional, in-person physiotherapy. However, the rapid digital transformation of healthcare, catalyzed significantly by the COVID-19 pandemic, has positioned tele-rehabilitation as a critical and scalable alternative. This critical review aims to evaluate the clinical efficacy, biomechanical outcomes, and psychosocial dimensions of tele-rehabilitation compared to traditional face-to-face therapy for chronic MSK pain management. Utilizing a systematic synthesis methodology guided by the PICOS framework, this study critically analyzed a finalized cohort of 38 high-level studies, comprising 24 randomized controlled trials and 14 systematic reviews or meta-analyses. The extracted data consistently indicates that for active interventions, such as therapeutic exercise, postural correction, and strength training, tele-rehabilitation is clinically non-inferior to face-to-face care. Significant improvements were observed across complex pathologies, including chronic neck pain, forward head posture, low back pain, and lower extremity osteoarthritis. Furthermore, the results demonstrate that remote diagnostic assessments maintain remarkably high validity and inter-rater reliability, provided that strict, standardized operational protocols are systematically followed. The synthesis also highlights that the long-term success of these digital care models relies heavily on a fundamental restructuring of clinical pedagogy; specifically, the integration of innovative technologies into teaching and learning environments is required to develop robust digital competencies for future clinicians. While acknowledging persistent systemic barriers, including disparities in digital health literacy and the inherent lack of hands-on manual therapy, this review confirms that tele-rehabilitation represents a highly effective, empowering, and essential paradigm for modern MSK pain management.
Chi tiết bài viết
Từ khóa
Tele-rehabilitation; Musculoskeletal Pain; Physical Therapy; Digital Health; Forward Head Posture; Medical Informatics; Therapeutic Exercise.
Tài liệu tham khảo
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[7] Choi, Y. J., Kim, H. J., Han, S. Y., & Choi, B. R. (2018). Effect of interferential current therapy on forward head posture. Journal of Physical Therapy Science, 30(3), 398–399. https://doi.org/10.1589/jpts.30.398
[8] Cieślik, B., Kuligowski, T., Cacciante, L., & Kiper, P. (2023). The impact of personality traits on patient satisfaction after telerehabilitation: A comparative study of remote and face-to-face musculoskeletal rehabilitation during COVID-19 lockdown. International Journal of Environmental Research and Public Health, 20(6), 5019. https://doi.org/10.3390/ijerph20065019
[9] Cottrell, M. A., Galea, O. A., O’Leary, S. P., Hill, A. J., & Russell, T. G. (2017). Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: A systematic review and meta-analysis. Clinical Rehabilitation, 31(5), 625–638. https://doi.org/10.1177/0269215516645148
[10] Cottrell, M. A., & Russell, T. G. (2020). Telehealth for musculoskeletal physiotherapy. Musculoskeletal Science and Practice, 48, 102193. https://doi.org/10.1016/j.msksp.2020.102193
[11] Eitivipart, A. C., Viriyarojanakul, S., & Redhead, L. (2018). Musculoskeletal disorder and pain associated with smartphone use: A systematic review of biomechanical evidence. Hong Kong Physiotherapy Journal, 38(2), 77–90. https://doi.org/10.1142/S1013702518300010
[12] Elgert, L., Steiner, B., Saalfeld, B., Marschollek, M., & Wolf, K. H. (2021). Health-enabling technologies to assist patients with musculoskeletal shoulder disorders when exercising at home: Scoping review. JMIR Rehabilitation and Assistive Technologies, 8(1), e21107. https://doi.org/10.2196/21107
[13] Fathollahnejad, K., Letafatkar, A., & Hadadnezhad, M. (2019). The effect of manual therapy and stabilizing exercises on forward head and rounded shoulder postures: A six-week intervention with a one-month follow-up study. BMC Musculoskeletal Disorders, 20(1), 86. https://doi.org/10.1186/s12891-019-2438-y
[14] Franco, J. B., Maximino, L. P., Luiz, L., Antonelli, B. C., & Blasca, W. Q. (2023). What are the barriers to telerehabilitation in the treatment of musculoskeletal diseases? Portuguese Journal of Public Health, 42(1), 33–42.
[15] Hamilton, C., McCluskey, A., Hassett, L., Killington, M., & Lovarini, M. (2018). Patient and therapist experiences of using affordable feedback-based technology in rehabilitation: A qualitative study nested in a randomized controlled trial. Clinical Rehabilitation, 32(9), 1258–1270. https://doi.org/10.1177/0269215518771820
[16] Havran, M. A., & Bidelspach, D. E. (2021). Virtual physical therapy and telerehabilitation. Physical Medicine and Rehabilitation Clinics of North America, 32(2), 419–428. https://doi.org/10.1016/j.pmr.2020.12.005
[17] Iqbal, Z. A., Alghadir, A. H., & Anwer, S. (2021). Efficacy of deep cervical flexor muscle training on neck pain, functional disability, and muscle endurance in school teachers: A clinical trial. BioMed Research International, 2021, 7190808. https://doi.org/10.1155/2021/7190808
[18] Jirasakulsuk, N., Saengpromma, P., & Khruakhorn, S. (2022). Real-time telerehabilitation in older adults with musculoskeletal conditions: Systematic review and meta-analysis. JMIR Rehabilitation and Assistive Technologies, 9(3), e36028. https://doi.org/10.2196/36028
[19] Kang, J. I., Choi, H. H., Jeong, D. K., Choi, H., Moon, Y. J., & Park, J. S. (2018). Effect of scapular stabilization exercise on neck alignment and muscle activity in patients with forward head posture. Journal of Physical Therapy Science, 30(6), 804–808. https://doi.org/10.1589/jpts.30.804
[20] Kang, N. Y., Im, S. C., & Kim, K. (2021). Effects of a combination of scapular stabilization and thoracic extension exercises for office workers with forward head posture on the craniovertebral angle, respiration, pain, and disability: A randomized-controlled trial. Turkish Journal of Physical Medicine and Rehabilitation, 67(3), 291–299. https://doi.org/10.5606/tftrd.2021.6397
[21] Kim, B. B., Lee, J. H., Jeong, H. J., & Cynn, H. S. (2016). Effects of suboccipital release with craniocervical flexion exercise on craniocervical alignment and extrinsic cervical muscle activity in subjects with forward head posture. Journal of Electromyography and Kinesiology, 30, 31–37. https://doi.org/10.1016/j.jelekin.2016.05.007
[22] Kim, S. Y., & Koo, S. J. (2016). Effect of duration of smartphone use on muscle fatigue and pain caused by forward head posture in adults. Journal of Physical Therapy Science, 28(6), 1669–1672. https://doi.org/10.1589/jpts.28.1669
[23] Lee, A. C. (2020). COVID-19 and the advancement of digital physical therapist practice and telehealth. Physical Therapy, 100(7), 1054–1057. https://doi.org/10.1093/ptj/pzaa073
[24] Lee, J. H., Shin, K. H., Lee, G. B., Son, S., & Jang, K. M. (2023). Comparison of functional outcomes between supervised rehabilitation and telerehabilitation in female patients with patellofemoral pain syndrome during the COVID-19 pandemic. International Journal of Environmental Research and Public Health, 20(3), 2233. https://doi.org/10.3390/ijerph20032233
[25] Lee, S. M., Lee, C. H., O’Sullivan, D., Jung, J. H., & Park, J. J. (2016). Clinical effectiveness of a pilates treatment for forward head posture. Journal of Physical Therapy Science, 28(7), 2009–2013. https://doi.org/10.1589/jpts.28.2009
[26] Letafatkar, A., Rabiei, P., Alamooti, G., Bertozzi, L., Farivar, N., & Afshari, M. (2020). Effect of therapeutic exercise routine on pain, disability, posture, and health status in dentists with chronic neck pain: A randomized controlled trial. International Archives of Occupational and Environmental Health, 93(3), 281–290. https://doi.org/10.1007/s00420-019-01480-x
[27] MacDowall, A., Skeppholm, M., Robinson, Y., & Olerud, C. (2018). Validation of the visual analog scale in the cervical spine. Journal of Neurosurgery: Spine, 28(3), 227–235. https://doi.org/10.3171/2017.5.SPINE1732
[28] Mani, S., Sharma, S., Omar, B., Paungmali, A., & Joseph, L. (2017). Validity and reliability of Internet-based physiotherapy assessment for musculoskeletal disorders: A systematic review. Journal of Telemedicine and Telecare, 23(3), 379–391.
[29] Nilmart, P., Sichuai, A., Chedang, A., Goontharo, C., & Janjamsai, N. (2025). Internet-based telerehabilitation versus in-person therapeutic exercises in young adult females with chronic neck pain and forward head posture: Randomized controlled trial. JMIR Rehabilitation and Assistive Technologies, 12, e74979. https://doi.org/10.2196/74979
[30] Onan, D., Ulger, O., & Martelletti, P. (2023). Effects of spinal stabilization exercises delivered using telerehabilitation on outcomes in patients with chronic neck pain: A randomized controlled trial. Expert Review of Neurotherapeutics, 23(3), 269–280. https://doi.org/10.1080/14737175.2023.2192870
[31] Özel, M., & Kaya Ciddi, P. (2024). The effectiveness of telerehabilitation-based structured exercise therapy for chronic nonspecific neck pain: A randomized controlled trial. Journal of Telemedicine and Telecare, 30(5), 823–833. https://doi.org/10.1177/1357633X221095782
[32] Park, S. H., & Lee, M. M. (2020). Effects of lower trapezius strengthening exercises on pain, dysfunction, posture alignment, muscle thickness and contraction rate in patients with neck pain; randomized controlled trial. Medical Science Monitor, 26, e920208. https://doi.org/10.12659/MSM.920208
[33] Plavoukou, T., Iosifidis, M., Papagiannis, G., Stasinopoulos, D., & Georgoudis, G. (2025). The effectiveness of telerehabilitation in managing pain, strength, and balance in adult patients with knee osteoarthritis: Systematic review. JMIR Rehabilitation and Assistive Technologies, 12, e72466. https://doi.org/10.2196/72466
[34] Rani, B., Paul, A., Chauhan, A., Pradhan, P., & Dhillon, M. S. (2023). Is neck pain related to sagittal head and neck posture?: A systematic review and meta-analysis. Indian Journal of Orthopaedics, 57(3), 371–403. https://doi.org/10.1007/s43465-023-00820-x
[35] Richards, K. V., Beales, D. J., Smith, A. L., O’Sullivan, P. B., & Straker, L. M. (2021). Is neck posture subgroup in late adolescence a risk factor for persistent neck pain in young adults? A prospective study. Physical Therapy, 101(3), pzab007. https://doi.org/10.1093/ptj/pzab007
[36] Ruivo, R. M., Pezarat-Correia, P., & Carita, A. I. (2017). Effects of a resistance and stretching training program on forward head and protracted shoulder posture in adolescents. Journal of Manipulative and Physiological Therapeutics, 40(1), 1–10. https://doi.org/10.1016/j.jmpt.2016.10.005
[37] Shaheen, H. M., Abu Shameh, R., & Abufara, A. (2025). Effectiveness and challenges of tele-physiotherapy compared to in-person care in musculoskeletal rehabilitation. Ahliya Journal of Allied Medico-Technology Science, 2(1), 5–9. https://doi.org/10.59994/ajamts.2025.1.5
[38] Shaheen, H. M., & Belgen Kaygisiz, B. (2025). Comparison of different treatment positions of nerve slider technique for patients with low back pain: A randomized control trial. European Journal of Physical and Rehabilitation Medicine, 61(1), 82–92.
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