Effectiveness of biofeedback-assisted asynchronous telerehabilitation in musculoskeletal care: A systematic review

Dora Janela; Fabíola Costa; Brandon Weiss; Anabela C Areias; Maria Molinos; Justin K Scheer; Jorge Lains; Virgílio Bento; Steven P Cohen; Fernando Dias Correia; Vijay Yanamadala

doi:10.1177/20552076231176696

Effectiveness of biofeedback-assisted asynchronous telerehabilitation in musculoskeletal care: A systematic review

Digit Health. 2023 Jun 9:9:20552076231176696. doi: 10.1177/20552076231176696. eCollection 2023 Jan-Dec.

Authors

Dora Janela¹, Fabíola Costa¹, Brandon Weiss², Anabela C Areias¹, Maria Molinos¹, Justin K Scheer³, Jorge Lains^{4

5}, Virgílio Bento¹, Steven P Cohen^{6

7}, Fernando Dias Correia^{1

8}, Vijay Yanamadala^{1

9

10}

Affiliations

¹ Sword Health, Inc, Draper, UT, USA.
² Lake Erie College of Osteopathic Medicine, Erie, PA, USA.
³ Department of Neurological Surgery, University of California, San Francisco, CA, USA.
⁴ Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal.
⁵ Faculty of Medicine, Coimbra University, Coimbra, Portugal.
⁶ Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.
⁷ Departments of Anesthesiology and Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
⁸ Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal.
⁹ Department of Surgery, Quinnipiac University Frank H. Netter School of Medicine, Hamden, CT, USA.
¹⁰ Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, USA.

Abstract

Background: Musculoskeletal conditions are the leading cause of disability worldwide. Telerehabilitation may be a viable option in the management of these conditions, facilitating access and patient adherence. Nevertheless, the impact of biofeedback-assisted asynchronous telerehabilitation remains unknown.

Objective: To systematically review and assess the effectiveness of exercise-based asynchronous biofeedback-assisted telerehabilitation on pain and function in individuals with musculoskeletal conditions.

Methods: This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The search was conducted using three databases: PubMed, Scopus, and PEDro. Study criteria included articles written in English and published from January 2017 to August 2022, reporting interventional trials evaluating exercise-based asynchronous telerehabilitation using biofeedback in adults with musculoskeletal disorders. The risks of bias and certainty of evidence were appraised using the Cochrane tool and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE), respectively. The results are narratively summarized, and the effect sizes of the main outcomes were calculated.

Results: Fourteen trials were included: 10 using motion tracker technology (N = 1284) and four with camera-based biofeedback (N = 467). Telerehabilitation with motion trackers yields at least similar improvements in pain and function in people with musculoskeletal conditions (effect sizes: 0.19-1.45; low certainty of evidence). Uncertain evidence exists for the effectiveness of camera-based telerehabilitation (effect sizes: 0.11-0.13; very low evidence). No study found superior results in a control group.

Conclusions: Asynchronous telerehabilitation may be an option in the management of musculoskeletal conditions. Considering its potential for scalability and access democratization, additional high-quality research is needed to address long-term outcomes, comparativeness, and cost-effectiveness and identify treatment responders.

Keywords: Pain; motion sensors; nonsynchronous care; physical therapy; remote care.

Publication types

Review