Telerehabilitation of chronic low back pain: protocol of a systematic review and network meta-analysis

Background Chronic low back pain (CLBP) is among the most disabling musculoskeletal disorders worldwide. Traditional in-person rehabilitation is often limited by time, geographic, and financial barriers. Telerehabilitation, which delivers personalized interventions through digital technologies (e.g., mobile apps, video coaching, wearable devices, virtual reality, and artificial intelligence feedback systems), is emerging as a complementary and alternative approach to conventional rehabilitation. However, there is currently no consensus on its efficacy and safety. Therefore, this study aims to evaluate the effectiveness of various forms of telerehabilitation in improving pain intensity, physical function, psychological symptoms, and quality of life in patients with CLBP. In addition, the study will assess intervention adherence, patient satisfaction, and safety (as measured by the incidence of adverse events) through systematic review and network meta-analysis. Methods A systematic search will be conducted in the following databases: PubMed/MEDLINE, EMBASE, Cochrane Library, Scopus, and Web of Science, covering all records from database inception to 31 December 2025. Eligible studies will include randomized controlled trials (RCTs) involving adults (≥ 18 years) with CLBP, comparing telerehabilitation interventions to any control intervention. The primary outcome will be pain intensity, while secondary outcomes will include physical function, psychological status, quality of life, and adverse events. The risk of bias for the included studies will be assessed using the revised Cochrane Risk of Bias 2.0 tool. The certainty of evidence will be evaluated using the CINeMA (Confidence in Network Meta-Analysis) web application. All network meta-analyses will be conducted within a frequentist framework using Stata 15 software and will apply random-effects models. Intervention rankings will be estimated using Surface Under the Cumulative Ranking (SUCRA) curves and illustrated with forest plots showing both individual and pooled effect sizes. Additional analyses will include assessments of statistical inconsistency, publication bias, heterogeneity, sensitivity, and subgroup differences. Discussion This study aimed to compare and rank the available evidence on various forms of telerehabilitation for the management of CLBP, as well as to assess its safety. The findings offer valuable insights for healthcare professionals and policymakers, supporting the advancement of patient-centered rehabilitation strategies. Systematic review registration PROSPERO CRD420251015478