Effects of telerehabilitation on pain and physical function in patients with patellofemoral pain syndrome: Systematic review and meta-analysis.

TL;DR

Telerehabilitation produces better pain relief and functional improvements than conventional in-person therapy for patellofemoral pain syndrome , though effects on psychological outcomes remain unclear.

What the study found

Patellofemoral pain syndrome (PFPS) is one of the most common knee injuries, particularly affecting active individuals and athletes. It causes pain around the kneecap during daily activities like climbing stairs, squatting, or running, and significantly impairs quality of life. The standard treatment is physiotherapy-based rehabilitation, but poor adherence rates have plagued clinical outcomes. Patients struggle to attend regular appointments due to time constraints, travel burden, or simply lack of access to qualified therapists. This meta-analysis set out to determine whether delivering rehabilitation through digital platforms could address these barriers while maintaining or improving clinical outcomes.

The analysis pooled data from 7 randomized controlled trials covering 531 patients total. The studies compared telerehabilitation programs (delivered via video, apps, or other remote formats) against conventional in-person therapy. The telerehabilitation groups consistently outperformed standard care across the primary outcomes. Patients in telerehabilitation showed greater pain reduction with a standardized mean difference of -0.85 on pain scales, a clinically meaningful improvement. Functional capacity, measured using the KUJALA and AKPS scoring systems (standardized tools for assessing knee-related disability), improved by 13 points on average compared to conventional therapy. Additionally, knee flexion range of motion increased by nearly 6 degrees more in the telerehabilitation group, suggesting better restoration of joint mechanics.

The mechanism behind this finding is worth considering. Telerehabilitation may work better not because the exercises themselves are superior, but because the delivery format addresses real-world barriers to adherence. Remote programs eliminate travel time, increase scheduling flexibility, and allow patients to exercise in familiar home environments. The digital accountability structures (video check-ins, app reminders, progress tracking) may reinforce consistency. Some studies suggest that psychological factors like reduced kinesiophobia (fear of movement) or catastrophizing about pain could mediate these benefits, but this meta-analysis found no significant differences between groups on validated scales measuring these constructs (Tampa Scale for Kinesiophobia and Pain Catastrophizing Scale both showed no significant between-group differences). The lack of psychological improvement doesn't negate the pain and function gains, but it suggests the mechanism operates primarily through behavioral and biomechanical pathways rather than fear reduction.

One important caveat: the evidence base remains modest. Seven trials with 531 total participants represents meaningful data, but most included studies were relatively small and many had variable quality. The authors explicitly call for larger, higher-quality trials with long-term follow-up. Current evidence covers short to medium-term outcomes; we don't yet know whether these advantages persist over years, or whether they apply equally across all patient demographics and PFPS presentations.

What this means for you

If you have patellofemoral pain syndrome and access to telerehabilitation services, the evidence suggests you should expect outcomes at least as good as in-person therapy, with the added convenience of home-based exercise. This is particularly valuable if geographical distance, scheduling conflicts, or mobility limitations make regular clinic visits difficult. The key is selecting programs that include video supervision or regular provider check-ins rather than purely self-directed exercise apps, as the studies finding benefit included real-time feedback components.

The absence of psychological benefit doesn't mean psychology is irrelevant to your recovery. If you experience significant fear of movement, pain catastrophizing, or activity avoidance, discussing these directly with your provider matters. Telerehabilitation alone may not resolve psychological barriers, and some patients benefit from integrating cognitive-behavioral approaches or pain psychology support alongside the exercise component.

For those already accessing in-person therapy, this doesn't suggest you should immediately switch to remote formats if your current arrangement is working. Rather, it indicates that if circumstances change or access becomes an issue, equivalent outcomes are achievable remotely.

Study details

Sources

Lin, Y., et al. (2025). Effects of telerehabilitation on pain and physical function in patients with patellofemoral pain syndrome: Systematic review and meta-analysis. Experimental Gerontology. PubMed: 41936891