Multidimensional Effects of Telemedicine on Patients With Spinal Cord Injury: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract Background Spinal cord injury (SCI) causes persistent physical and psychological impairments and is associated with reduced quality of life. Telemedicine may improve rehabilitation access and follow-up care, but its effectiveness across multiple outcome domains in SCI remains uncertain. Objective This study aimed to evaluate the effects of telemedicine interventions on psychological health, quality of life, sleep, functional independence, and participation, and pain intensity in individuals with SCI. Methods We searched PubMed, Web of Science, Embase, Ovid MEDLINE, and Cochrane CENTRAL until 17 February 2026. We included English-language randomized controlled trials (RCTs) of telemedicine interventions in individuals with SCI. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Risk of Bias 2 (RoB 2; Cochrane) tool. Random-effects meta-analyses used the Hartung-Knapp-Sidik-Jonkman method with restricted maximum likelihood estimation of between-study variance. Effects were summarized as standardized mean differences (SMD) or mean differences (MD) with 95% CIs. For main meta-analyses, 95% prediction intervals were reported when at least 5 studies were available, but not for analyses with fewer than 5 studies or for subgroup meta-analyses. Certainty of evidence was assessed using GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Results We included 33 studies (35 reports). Telemedicine improved the World Health Organization Quality of Life-BREF (WHOQOL-BREF) social domain (MD 3.27, 95% CI 0.64 to 5.89; P =.03) and sleep quality at 3 months (MD −2.24, 95% CI −3.82 to −0.67; P =.04). Depressive symptoms also improved in the >3-≤6 months follow-up subgroup (SMD −0.31, 95% CI −0.57 to −0.04; P =.03). Overall effects for depressive symptoms were not significant (SMD −0.11, 95% CI −0.26 to 0.05; prediction interval −0.37 to 0.15; P =.16; I ²=36.3%), while findings for anxiety, other WHOQOL-BREF domains, sleep quality at 1 month, functional outcomes, and pain intensity generally favored telemedicine but did not reach statistical significance. Approximately half of the studies were rated as low risk overall on RoB 2, with most remaining studies rated as having some concerns and a smaller subset rated as high risk. GRADE certainty was high for the >3-≤6-month depressive-symptoms subgroup, moderate for the WHOQOL-BREF social domain, Pittsburgh Sleep Quality Index (PSQI), and Spinal Cord Independence Measure (SCIM), and low for depressive symptoms overall, anxiety, and pain intensity. Conclusions Telemedicine may improve selected outcomes in SCI, with the most consistent evidence for social aspects of quality of life, sleep after sustained intervention exposure, and a more favorable effect on depressive symptoms in midterm follow-up subgroup analyses. These results suggest telemedicine as a practical adjunct for extending SCI rehabilitation access and continuity. Further trials should focus on optimizing intervention components, intensity, and patient targeting.