Effectiveness of telerehabilitation in patients with post-COVID-19: an updated systematic review and meta-analysis of randomized controlled trials.

INTRODUCTION

Post-COVID-19 syndrome affects 10-15% of survivors, causing multisystem complications and significant economic burden. Telerehabilitation (TR) has emerged as a scalable solution to deliver care remotely. This study aims to re-evaluate the effectiveness of TR in improving physical and psychological outcomes in post-COVID-19 patients.

METHODS

Registered on PROSPERO (CRD420251082578) under PRISMA guidelines, we searched PubMed, Cochrane, and Scopus from April 2024 till July 2025 for randomized trials. Primary outcomes included clinical symptoms (Borg score, dyspnea) and physical function (30-s sit-to-stand test, 6-min walking distance). A random-effects model assessed pooled outcomes with heterogeneity (I2) and sensitivity analyses along with subgroup analysis. Additionally, publication bias and certainty of evidence using Gradepro was performed. Risk of bias was evaluated using the Cochrane ROB2 tool.

RESULTS

Twenty-eight randomized controlled trials (RCT's) comprising approximately 1,400 participants were included. TR significantly improved physical function, including the 30 s-STS (MD = 2.07; 95% CI: 1.24 to 2.90; p < 0.00001) and 6MWD (MD = 85.83 m; 95% CI: 67.14 to 104.52; p < 0.00001). Significant reductions were observed in dyspnea (Borg overall MD = -3.74, p = 0.003) and fatigue (VASF MD = -1.83, p < 0.0001). However, no significant differences were found for HADS-Anxiety (p = 0.27) or HADS-Depression (p = 0.11). Pulmonary function showed significant gains only in FEV1 change scores (p = 0.008). Preliminary data suggests a favorable safety profile; while no serious adverse events were reported across the trials, safety was infrequently listed as a primary outcome.

CONCLUSION

TR appears to be a promising and well-tolerated modality for enhancing physical capacity and alleviating fatigue in post-COVID-19 patients, though further large-scale studies with safety as a primary endpoint are warranted to definitively establish its safety profile. While physical gains are robust, additional targeted interventions may be necessary to address psychological and pulmonary sequelae.