Safety of videoconferencing for physical rehabilitation and exercise: A systematic review and meta-analysis

Objective Investigate the safety of physical rehabilitation and/or exercise interventions conducted via videoconferencing. Design Systematic review/meta-analysis. Data sources PubMed, Web of Science, Embase and CINAHL from inception until 12 June 2025. Review methods Trials including participants with chronic disease or history of restorative or reconstructive surgery implementing a physical rehabilitation or exercise intervention via videoconferencing compared to an in-person exercise comparator and reporting adverse events were included. Meta-analyses were conducted for between-group comparisons of adverse events using incidence rate ratios. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool and the certainty of the evidence with Grading of Recommendations, Assessment, Development and Evaluation. Results Out of 3436 records, 22 trials were included in this review (28 otherwise eligible trials were excluded for not reporting adverse events). No significant differences were observed between groups for minor/moderate [incidence rate ratio (IRR): 1.00, 95% CI: 0.71–1.41, p = 1.00] or major (IRR: 1.77, 95% CI: 0.55–5.70, p = 0.98) adverse events. Incidence was low for both videoconferencing (one every 410 sessions) and in-person (one every 414 sessions). Eighteen trials (82%) were graded ‘some concerns’ or ‘high’ on overall risk of bias score, primarily due to bias arising from measurement and selection of the reported adverse events. Certainty grading was ‘low’ for adverse event outcomes. Conclusion This study suggests that there is no clear evidence of a difference in adverse event incidence between in-person and videoconferencing physical rehabilitation or exercise interventions. Future studies must improve transparency of defining and reporting to improve certainty in these findings.