Currently submitted to: JMIR Rehabilitation and Assistive Technologies
Date Submitted: Dec 20, 2025
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Experiences and Needs of Patients and Therapists in Exercise-Based Telerehabilitation Delivered via Real-Time Videoconferencing: A Mixed Methods Systematic Review
ABSTRACT
Background:
Real-time videoconferencing is increasingly used to deliver exercise-based telerehabilitation (TR) for musculoskeletal (MSK) conditions. While clinical effectiveness has been demonstrated, a comprehensive synthesis of patient and therapist experiences and needs is lacking, particularly for TR programs that integrate exercise therapy within broader multimodal care models.
Objective:
To synthesize existing literature on the experiences and needs of patients with MSK conditions and physical or occupational therapists in TR programs, including exercise therapy delivered via real-time videoconferencing.
Methods:
We conducted a systematic mixed methods review of studies published between 2000 and 17 November 2025 using MEDLINE, CINAHL, AMED, and the Cochrane Library. A framework-based thematic synthesis combining deductive and inductive analytical approaches was applied to integrate experiential data across quantitative and qualitative study designs.
Results:
Forty-three studies were included, the majority (n= 30) employing quantitative designs, with fewer qualitative and mixed-methods studies. Patients commonly reported high satisfaction, convenience, and perceived effectiveness of TR, particularly valuing flexibility, continuity of care, and reduced travel burden. However, they also emphasized the importance of reliable technology, structured onboarding, and access to hands-on assessment or in-person care when clinically required. Physical therapists described increased reliance on visual and functional assessment strategies, alongside heightened demands on communication skills and clinical reasoning. Key challenges included insufficient training in digital competencies, limited organizational and IT support, increased workload, and unclear reimbursement structures. Across both groups, hybrid care models combining in-person and remote sessions were consistently preferred over fully remote approaches.
Conclusions:
Exercise-based TR delivered via real-time videoconferencing is feasible and acceptable for many MSK conditions when embedded within structured care pathways and supported by adequate training, onboarding, and organizational resources. Hybrid models appear to offer the most pragmatic balance between accessibility, clinical quality, and diagnostic confidence, supporting sustainable integration of TR into routine MSK rehabilitation practice. Clinical Trial: DOI: 10.17605/OSF.IO/FNCSA https://osf.io/fncsa/overview
Citation
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Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.
