Effectiveness of Telerehabilitation for Upper-Limb Pain After Breast Cancer: Systematic Review.

CONTEXT: Upper-limb pain is a frequent and disabling sequela following breast cancer treatment, often persisting beyond the acute postoperative period and substantially impairing function, self-management, and quality of life. Telerehabilitation has emerged as a strategy to expand access to physiotherapy-based care; however, its effectiveness for pain management in this population remains unclear.

OBJECTIVES

To systematically evaluate the effectiveness of telerehabilitation interventions in reducing upper-limb pain in women after breast cancer treatment.

METHODS

This systematic review was conducted in accordance with the PRISMA 2020 guidelines and prospectively registered in PROSPERO (CRD420261332939). PubMed, CINAHL, Web of Science, and EMBASE were searched through December 2025. Randomized controlled trials evaluating telerehabilitation-based physiotherapy interventions and reporting outcomes related to upper-limb pain were included. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and the certainty of evidence was evaluated using the GRADE framework.

RESULTS

Six randomized controlled trials involving 517 women were included. Telerehabilitation interventions varied in delivery format (synchronous, asynchronous, app-based, or telephone-based), intensity, and duration. One trial demonstrated a significant reduction in the proportion of women reporting chronic arm pain, and another reported greater improvement in pain interference, but not pain intensity. The remaining studies showed pain outcomes comparable to usual care or no significant benefit. Methodological limitations included heterogeneity in pain assessment tools, limited individualization of interventions, attrition, lack of blinding, and inconsistent reporting of analgesic use. Overall certainty of evidence was rated as low.

CONCLUSIONS

Telerehabilitation appears feasible and comparable to usual care for upper-limb pain management after breast cancer treatment; however, consistent superiority has not been demonstrated. Evidence of benefit is primarily associated with structured, high-frequency, and multimodal programs. Further well-designed trials with standardized pain-specific outcomes are needed.

IMPLICATIONS FOR MULTIDISCIPLINARY PRACTICE: Management of upper-limb pain after breast cancer treatment through telerehabilitation requires coordinated input from multidisciplinary healthcare teams, including nurses and physical therapists. Telerehabilitation may facilitate remote pain monitoring, patient education, and self-management across survivorship care, provided that interventions are structured, clearly protocolized, and focused on pain-specific outcomes.