The effects of telerehabilitation in patients with chronic low back pain: A systematic review and meta-analysis of randomized controlled trials.

ObjectiveLow back pain (LBP) represents a predominant cause of rehabilitation needs worldwide. Telerehabilitation has the potential to improve health systems by decentralizing clinical services and expanding healthcare accessibility. This systematic review and meta-analysis aims to evaluate the effectiveness of telerehabilitation compared to face-to-face (FtF) rehabilitation or minimal interventions (e.g. usual care, educational booklets, advice to stay active) in treating chronic LBP based on existing worldwide data.MethodsPubMed, Web of Science, and EMBASE were searched from inception to February 2026 for randomized controlled trials (RCTs) comparing telerehabilitation to face-to-face therapy or minimal interventions in adults with chronic LBP (ID: CRD420251083396).Results21 RCTs (2148 participants) were included. Telerehabilitation showed a statistically significant reduction in pain intensity (Hedges' g = -0.37, 95% CI: -0.68 to -0.06). No statistically significant effects were observed for disability level or kinesiophobia. Quality-of-life outcomes showed favorable descriptive trends in specific domains, although no consistent significant effects were observed across instruments. Subgroup analyses for pain intensity showed that a statistically significant reduction was exclusively captured in the 8-week duration (Hedges' g = -0.50, 95% CI: -0.93 to -0.07). 2 of 3 economic evaluations suggested potential cost savings in specific contexts. The certainty of evidence was rated as "low" for pain intensity and "very low" for all other outcomes, with wide prediction intervals.ConclusionsTelerehabilitation may reduce pain intensity compared to FtF rehabilitation or minimal interventions in adults with chronic LBP, with the greatest effect observed in the 8-week subgroup. No significant improvements were observed in disability level or kinesiophobia, while quality-of-life outcomes showed inconsistent effects across instruments. Given the low to very low certainty of evidence, these findings should be interpreted cautiously. Telerehabilitation may represent a clinically viable alternative for selected patients with chronic LBP.