Effectiveness of telerehabilitation in non-operatively managed shoulder conditions: a systematic review and meta-analysis.

Background: Non-operatively managed shoulder conditions, including rotator cuff tendinopathy, subacromial pain syndrome, adhesive capsulitis, and non-displaced proximal humerus fractures, frequently cause pain and restricted mobility. While traditional rehabilitation is effective, access to in-person therapy can be hindered by various factors. Telerehabilitation, which leverages telecommunication technologies, is a promising alternative to traditional in-person rehabilitation. However, its overall efficacy remains uncertain due to inconsistent findings in prior studies.

Methods: This systematic review and meta-analysis assessed the effectiveness of telerehabilitation for non-operatively managed shoulder conditions, concentrating on randomized controlled trials (RCTs). The control group received standard in-person rehabilitation or home-based exercise programs. The primary outcomes assessed were pain (using the visual Analog Scale [VAS]), range of motion (ROM) including flexion, abduction, external rotation and internal rotation, as well as functional outcomes evaluated through the Shoulder Pain and Disability Index [SPADI], Disabilities of the Arm, Shoulder, and Hand [DASH], and Quick DASH scores.

Results: Eight randomized controlled trials (RCTs) were included. Data synthesis employed random-effects or fixed-effects models based on heterogeneity, with the risk of bias evaluated via the Cochrane Collaboration tool. Telerehabilitation over 12 weeks significantly reduced pain compared to in-person rehabilitation (MD = -1.06, 95% CI -1.84 to -0.29, P = 0.007; Certainty of evidence: very low) whereas shorter durations showed limited effectiveness. Significant improvements in ROM were observed for flexion (MD = 4.01, 95% CI 2.48 to 5.54, P < 0.001; Certainty of evidence: low), abduction (MD = 4.61, 95% CI 2.63 to 6.60, P < 0.001; Certainty of evidence: low), and external rotation (MD = 3.69, 95% CI 0.77 to 6.62, P = 0.01; Certainty of evidence: low). However, no significant improvement was observed for internal rotation. The functional outcomes, as measured by the SPADI, significantly improved (MD = -13.32, 95% CI -21.40 to -5.23, P = 0.001; Certainty of evidence: low), whereas the DASH scores did not significantly differ (MD = -0.66, 95% CI -3.17 to 1.85, P = 0.60; Certainty of evidence: low).

Conclusion: Telerehabilitation may reduce pain and improve range of motion in patients with non-operatively managed shoulder conditions, particularly when interventions are sustained for 12 weeks or longer. However, the certainty of evidence remains low due to methodological limitations, highlighting the need for further high-quality trials to confirm these findings.