Effectiveness of telerehabilitation in patients with post-COVID-19: an updated systematic review and meta-analysis of randomized controlled trials

INTRODUCTION: Post-COVID-19 syndrome affects 10-15% of survivors, causing multisystem complications and significant economic burden. Telerehabilitation (TR) has emerged as a scalable solution to deliver care remotely. This study aims to re-evaluate the effectiveness of TR in improving physical and psychological outcomes in post-COVID-19 patients. METHODS: ) and sensitivity analyses along with subgroup analysis. Additionally, publication bias and certainty of evidence using Gradepro was performed. Risk of bias was evaluated using the Cochrane ROB2 tool. RESULTS: Twenty-eight randomized controlled trials (RCT's) comprising approximately 1,400 participants were included. TR significantly improved physical function, including the 30 s-STS (MD = 2.07; 95% CI: 1.24 to 2.90; p < 0.00001) and 6MWD (MD = 85.83 m; 95% CI: 67.14 to 104.52; p < 0.00001). Significant reductions were observed in dyspnea (Borg overall MD = -3.74, p = 0.003) and fatigue (VASF MD = -1.83, p < 0.0001). However, no significant differences were found for HADS-Anxiety (p = 0.27) or HADS-Depression (p = 0.11). Pulmonary function showed significant gains only in FEV1 change scores (p = 0.008). Preliminary data suggests a favorable safety profile; while no serious adverse events were reported across the trials, safety was infrequently listed as a primary outcome. CONCLUSION: TR appears to be a promising and well-tolerated modality for enhancing physical capacity and alleviating fatigue in post-COVID-19 patients, though further large-scale studies with safety as a primary endpoint are warranted to definitively establish its safety profile. While physical gains are robust, additional targeted interventions may be necessary to address psychological and pulmonary sequelae.