Effectiveness of telerehabilitation versus home exercise and in-person therapy for nonoperatively managed tendinopathy: A systematic review and meta-analysis.

ObjectiveTo evaluate the effectiveness of telerehabilitation on pain intensity and functional outcomes in patients with nonoperatively managed tendinopathy compared with home exercise or in-person physical therapy.MethodsA systematic search of major databases was conducted to identify randomized controlled trials comparing telerehabilitation with home exercise or in-person physical therapy. The primary outcomes were pain intensity and functional recovery. Methodological quality was assessed using the Physiotherapy Evidence Database scale and the Cochrane Risk of Bias tool, whereas the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation framework. This review was prospectively registered with International Prospective Register for Systematic Reviews (Registration Number: CRD420251207558).ResultsA total of 10 studies comprising 412 participants were included. Compared with home exercise, telerehabilitation demonstrated a potential advantage in reducing pain (standardized mean difference = 0.99, p < 0.001) and improving functional outcomes (standardized mean difference = 0.52, p < 0.001). Conversely, compared with in-person physical therapy, telerehabilitation showed no statistically significant difference in either pain reduction (standardized mean difference = -0.34, p = 0.49) or functional improvement (standardized mean difference = 0.04, p = 0.76). Sensitivity analyses using the leave-one-out method identified specific outliers contributing to heterogeneity, and the pooled estimates shifted appreciably, indicating limited robustness. The overall certainty of evidence was rated as low to very low because of risk of bias and imprecision.ConclusionsTelerehabilitation shows potential benefit for patients with tendinopathy, providing clinical outcomes that may be superior to home exercise and comparable to conventional in-person therapy. By facilitating consistent progressive loading through remote supervision, telerehabilitation may serve as a promising option for patients facing barriers to traditional care. However, confidence in these findings remains limited, and the results should be interpreted with caution because of the low certainty of evidence, high risk of bias across most studies, and limited robustness of the pooled estimates. These findings highlight the need for future high-quality, adequately powered trials.