Abstract
OBJECTIVE: To assess the effect of tele-rehabilitation interventions on pain and function in middle-aged and older adult patients with knee osteoarthritis (KOA). METHODS: A systematic search of randomized controlled trials (RCTs) was conducted in the EMBASE, PubMed, Cochrane Library, and Web of Science databases, covering the period from 2006 to 31 August 2025. Screening criteria were developed based on the PICOS principle. The Cochrane Risk of Bias Assessment Tool (RoB 2) was used to evaluate the quality of the literature, and meta-analysis was performed using STATA 15.0 software. RESULTS: A total of 12 RCTs involving 1,151 patients were included. The results showed that tele-rehabilitation was effective in VAS Pain (SMD = -0.57, 95% CI: -1.25-0.10), WOMAC pain (SMD = -0.08, 95% CI: -0.98-0.83), WOMAC function (SMD = -0.44, 95% CI: -0.88-0.00), and KOOS total (SMD = 0.52, 95% CI: -0.37-1.40), showing a trend toward improvement, but none reached statistical significance except for WOMAC function score. Sensitivity analyses showed robust results, and Egger's test did not reveal significant publication bias. CONCLUSION: Tele-rehabilitation shows positive trends in pain and functional improvement in middle-aged and older adult patients with KOA; however, current evidence is insufficient to demonstrate significant superiority. Given its good accessibility, tele-rehabilitation can be used as a complementary modality to traditional rehabilitation. More high-quality studies are needed to clarify its optimal intervention protocol and long-term efficacy. SYSTEMATIC REVIEW REGISTRATION: PROSPERO (registration number: CRD420251137582).