Effectiveness of physiotherapist-led tele-rehabilitation for older adults with chronic conditions: a systematic review and meta-analysis

Background: Older adults live with chronic conditions worldwide. The aim of this systematic review was to determine the effectiveness of physiotherapist-led (PT-led) tele-rehabilitation on various health outcomes. Methods: Six databases were searched. Eligible studies were randomized controlled trials that included older adults (>= 65 years) who had >= 1 chronic condition, and evaluated tele-rehabilitation (e.g., video, telephone) that was PT-led or overseen. Screening and data extraction were performed in duplicate. Meta-analyses were performed where appropriate. Cochrane's Risk of Bias 2.0 tool was used. Results: Fifteen studies were included. A meta-analysis of studies of knee osteoarthritis demonstrated that tele-rehabilitation is more effective than usual care for functional mobility (MD= -2.72, 95% CI= -3.56, -1.88, p < 0.001), quadriceps strength (MD= 15.54, 95% CI= 10.14, 20.95, p < 0.001), pain (MD= -1.2, 95% CI= -2.09, -0.39, p = 0.004) and physical function (MD= -5.95, 95% CI= -8.32, -3.58, p < 0.001). No clear differences were found between tele-rehabilitation and usual care or comparator interventions for outcomes related to physical activity level, gait speed, mental health, and quality of life. Conclusions: PT-led tele-rehabilitation appears to be comparable to traditional methods at improving outcomes in older adults with various chronic conditions. However, high-quality trials are needed so future conclusions on the effectiveness of tele-rehabilitation can be made. PROSPERO Registration ID: CRD42023428048