Effectiveness of biofeedback-assisted asynchronous telerehabilitation in musculoskeletal care: A systematic review
Open accessAbstract
Background: Musculoskeletal conditions are the leading cause of disability worldwide. Telerehabilitation may be a viable option in the management of these conditions, facilitating access and patient adherence. Nevertheless, the impact of biofeedback-assisted asynchronous telerehabilitation remains unknown. Objective: To systematically review and assess the effectiveness of exercise-based asynchronous biofeedback-assisted telerehabilitation on pain and function in individuals with musculoskeletal conditions. Methods: This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The search was conducted using three databases: PubMed, Scopus, and PEDro. Study criteria included articles written in English and published from January 2017 to August 2022, reporting interventional trials evaluating exercise-based asynchronous telerehabilitation using biofeedback in adults with musculoskeletal disorders. The risks of bias and certainty of evidence were appraised using the Cochrane tool and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE), respectively. The results are narratively summarized, and the effect sizes of the main outcomes were calculated. Results: Fourteen trials were included: 10 using motion tracker technology ( N = 1284) and four with camera-based biofeedback ( N = 467). Telerehabilitation with motion trackers yields at least similar improvements in pain and function in people with musculoskeletal conditions (effect sizes: 0.19–1.45; low certainty of evidence). Uncertain evidence exists for the effectiveness of camera-based telerehabilitation (effect sizes: 0.11–0.13; very low evidence). No study found superior results in a control group. Conclusions: Asynchronous telerehabilitation may be an option in the management of musculoskeletal conditions. Considering its potential for scalability and access democratization, additional high-quality research is needed to address long-term outcomes, comparativeness, and cost-effectiveness and identify treatment responders.
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Digital rehabilitation is effective among several musculoskeletal conditions regardless of race/ethnicity and socioeconomic backgrounds.
“Previous research supports its effectiveness among several musculoskeletal (MSK) conditions [16-18] regardless of race/ethnicity [19] and socioeconomic backgrounds [20].”
From Exploring the Importance of Race and Gender Concordance Between Patients and Physical Therapists in Digital Rehabilitation for Musculoskeletal Conditions: Observational, Longitudinal Study (2024) · cites this paper as [18]
The Discussion (Comparison with literature; page unavailable) reports findings across diverse musculoskeletal conditions, including better pain outcomes for chronic knee and low-back pain and comparable outcomes in some post-surgical studies. But it says results varied by condition, and the Conclusions (page unavailable) say asynchronous telerehabilitation *may* be an option and call for more research. This supports the effectiveness portion associated with citations [16–18], though the unqualified wording is stronger than the review’s conclusion; race/ethnicity and socioeconomic background are assigned separate citations [19] and [20]. (LLM, conf=0.82)
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Flagged first, then by citations
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Cited by
Sorted by citations
Areias, A. C., Janela, D., Molinos, M., Bento, V., Moreira, C., Yanamadala, V., Cohen, S. P., Correia, F. D., & Costa, F. (2024) · Journal of Medical Internet Research · doi:10.2196/65354 · Cited by 3 · see citing works
“Previous research supports its effectiveness among several musculoskeletal (MSK) conditions [16-18] regardless of race/ethnicity [19] and socioeconomic backgrounds [20].”
Self-citation
- Authors
- Janela, D., Costa, F., Weiss, B., Areias, A. C., Molinos, M., Scheer, J. K., Lains, J., Bento, V., Cohen, S. P., Correia, F. D., & Yanamadala, V.
- Affiliations
- Sword Health, Inc, Draper, UT, USA
- Lake Erie College of Osteopathic Medicine (US)
- University of California, San Francisco (US)
- Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal
- Johns Hopkins University (US)
- Quinnipiac University (US)
- Corresponding author
- Yanamadala, Vijay
- ORCID
- Venue
- DIGITAL HEALTH
- Publisher
- SAGE Publications
- Published
- 2023-01
- Volume
- 9
- Pages
- 20552076231176696-20552076231176696
- ISSN
- 2055-2076 (ISSN-L)
- PMC
- PMC10262679
- OpenAlex
- W4380077365
- Cited by
- 18
- References
- 68
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 4 · 2023: 1
- FWCI
- 0.65
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Digital Health (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, cc-by-nc)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Medicine › Rehabilitation › Musculoskeletal Disorders and Rehabilitation
- Keywords
- biofeedback, musculoskeletal disorders, exercise rehabilitation, pain, functional outcome, remote patient monitoring, access to rehabilitation services
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