Impact of Telerehabilitation on Rehabilitation Efficacy and Patient Satisfaction After Knee Surgery: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: Postoperative rehabilitation after knee surgery is crucial for functional recovery, but traditional in-person methods can impose burdens on patients, particularly those with mobility limitations or living remotely. Telerehabilitation, leveraging digital platforms, offers a potential alternative, yet its comparative efficacy and acceptability remain debated, especially across surgery types. Objective: To evaluate if telerehabilitation improves postoperative rehabilitation satisfaction and efficacy compared to traditional methods for knee joint surgery patients. Methods: Six databases (Web of Science, PubMed, MEDLINE, ScienceDirect, EMBASE, Cochrane Library) were searched from inception to September 27, 2025. Eligibility criteria included randomized controlled trials (RCTs) comparing telerehabilitation with traditional rehabilitation in adult postoperative knee surgery patients, reporting patient satisfaction and/or efficacy outcomes. Risk of bias was assessed using the Cochrane Risk of Bias 1 tool. Data were synthesized using random-effects meta-analysis with the Hartung-Knapp-Sidik-Jonkman method for confidence intervals, reporting standardized mean differences or mean differences, τ2, τ, and prediction intervals where applicable. Heterogeneity was assessed with τ2, τ and PIs. Certainty of evidence was evaluated using GRADE. Results: 19 RCTs were included. Overall, on average, patient satisfaction showed no significant difference between telerehabilitation and traditional rehabilitation (SMD = 0.15; 95% CI = -0.48 to 0.78; P = .48; τ2 = 0.30; τ = 0.55; PI = -1.17 to 1.47). Subgroup analysis revealed on average lower satisfaction with synchronous telerehabilitation (k=4; SMD = -0.52; 95% CI = -1.02 to -0.02; P = .04; τ2 = 0.17; τ = 0.41) and higher with asynchronous (k=6; SMD = 0.56; 95% CI = 0.08 to 1.03; P = .02; τ2 = 0.30; τ = 0.55). Telerehabilitation showed significant improvements on total WOMAC (k=4; SMD = -0.76; 95% CI = -1.38 to -0.14; P = .02; τ2 = 0.08; τ = 0.29; PI = -1.85 to 0.33), KOOS (k=5; SMD = 0.58; 95% CI = 0.47 to 0.70; P = .01; τ2 = 0; τ = 0; PI = 0.36 to 0.80), TUG (k=4; MD = -2.73 s; 95% CI = -4.50 to -0.96; P = .04; τ2 = 1.14; τ = 1.07; PI = -7.17 to 1.72) and knee extension range (k=3; MD=9.64°; 95% CI = 6.89 to 12.39; P=.049; τ2 = 2.45; τ = 1.56; PI = 0.60 to 18.68). Risk of bias was low to moderate; heterogeneity moderate. Conclusions: The pooled average effects suggest that telerehabilitation is noninferior to traditional care for patient satisfaction on average and may improve pain and function and some objective measures. However, bootstrapped prediction intervals and between-study variability indicate that effects vary by context; implementation should therefore be individualized with attention to modality, patient digital literacy, and technical support. Targeted trials with standardized measures are recommended to increase certainty and narrow the expected distribution of effects. Clinical Trial: PROSPERO CRD420251025461; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251025461.