ADHERENCE TO TELEHEALTH-DELIVERED EXERCISE INTERVENTIONS IN KNEE AND HIP OSTEOARTHRITIS: A SYSTEMATIC REVIEW
DOI:
https://doi.org/10.71000/6ysw6j46Keywords:
Adherence, Exercise Therapy, Digital Health, Osteoarthritis, Patient Compliance, Telerehabilitation, Telemedicine, RehabilitationAbstract
Background: Osteoarthritis (OA) of the knee and hip is a leading cause of disability worldwide, commonly associated with pain, reduced physical function, and decreased quality of life. Exercise therapy is a cornerstone of OA management; however, adherence to exercise programs remains a major challenge. Telehealth-delivered interventions have emerged as a potential solution to improve accessibility and engagement, yet their effectiveness in promoting adherence is not well established.
Objective: To evaluate adherence to telehealth-delivered exercise interventions compared to conventional physiotherapy in individuals with knee and/or hip osteoarthritis.
Methods: A systematic review was conducted in accordance with PRISMA guidelines. PubMed was searched for randomized controlled trials (RCTs) published between January 2015 and February 2026. Studies including adults with knee and/or hip OA, comparing telehealth-based exercise interventions with conventional physiotherapy or usual care, and reporting adherence outcomes were included. Methodological quality was assessed using the PEDro scale. Data were extracted and synthesized narratively, with a primary focus on adherence rates, session completion, and retention.
Results: Nine RCTs involving sample sizes ranging from 29 to 208 participants were included. Overall, telehealth interventions demonstrated moderate to high adherence levels. High adherence (>80–95%) was reported in several studies, particularly those incorporating supervision, feedback, or behavioral support. Some studies showed comparable adherence between telehealth and conventional physiotherapy, while others reported either slightly higher or lower adherence in telehealth groups. Self-directed or minimally supervised interventions were associated with lower adherence. Factors such as real-time supervision, personalized feedback, and patient engagement strategies positively influenced adherence outcomes.
Conclusion: Telehealth-delivered exercise interventions can achieve adherence levels comparable to conventional physiotherapy in individuals with knee and hip osteoarthritis. However, adherence is influenced more by intervention design than delivery mode alone. Incorporating supervision, behavioral support, and interactive components appears essential for optimizing adherence. Further research is needed to standardize adherence measures and evaluate long-term outcomes in telehealth-based rehabilitation.
Key words: Adherence, Exercise Therapy, Digital Health, Osteoarthritis, Patient Compliance, Telerehabilitation, Telemedicine, Rehabilitation
References
Organization WH. Osteoarthritis 2023 [updated 14 July 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/osteoarthritis?utm.
Peng X, Chen X, Zhang Y, Tian Z, Wang M, Chen Z. Advances in the pathology and treatment of osteoarthritis. Journal of Advanced Research. 2025;78:257-83.
Nguyen A, Lee P, Rodriguez EK, Chahal K, Freedman BR, Nazarian A. Addressing the growing burden of musculoskeletal diseases in the ageing US population: challenges and innovations. The Lancet Healthy Longevity. 2025;6(5).
Organization WH. Osteoarthritis 2023 [Available from: https://www.who.int/news-room/fact-sheets/detail/osteoarthritis#:~:text=Overview,with%20the%20ageing%20of%20populations.
Young JJ, Pedersen JR, Bricca A. Exercise Therapy for Knee and Hip Osteoarthritis: Is There An Ideal Prescription? Curr Treatm Opt Rheumatol. 2023:1-17.
Withers HG, Glinsky JV, Chu J, Jennings MD, Hayes AJ, Starkey IJ, et al. Face-to-face physiotherapy compared with a supported home exercise programme for the management of musculoskeletal conditions: protocol of a multicentre, randomised controlled trial-the REFORM trial. BMJ Open. 2021;11(5):e041242.
Jack K, McLean SM, Moffett JK, Gardiner E. Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review. Man Ther. 2010;15(3):220-8.
Martinsen L, Østerås N, Moseng T, Tveter AT. Adherence to in-person and app-based exercise for patients with hip or knee osteoarthritis; secondary analyses from a randomized controlled trial. Rheumatol Int. 2025;45(9):208.
Collado-Mateo D, Lavín-Pérez AM, Peñacoba C, Del Coso J, Leyton-Román M, Luque-Casado A, et al. Key Factors Associated with Adherence to Physical Exercise in Patients with Chronic Diseases and Older Adults: An Umbrella Review. Int J Environ Res Public Health. 2021;18(4).
Fernandes JB, Ferreira N, Domingos J, Ferreira R, Amador C, Pardal N, et al. Health Professionals' Motivational Strategies to Enhance Adherence in the Rehabilitation of People with Lower Limb Fractures: Scoping Review. Int J Environ Res Public Health. 2023;20(22).
Perez-Maletzki J, Dominguez-Navarro F, Hernandez-Guillen D, Roig-Casasus S, Blasco J-M. Effectiveness of strategies to improve adherence to physical therapy in patients with knee and hip osteoarthritis: a systematic review and meta-analysis. Disability and Rehabilitation. 2024;46(21):4915-30.
Ezeamii VC, Okobi OE, Wambai-Sani H, Perera GS, Zaynieva S, Okonkwo CC, et al. Revolutionizing Healthcare: How Telemedicine Is Improving Patient Outcomes and Expanding Access to Care. Cureus. 2024;16(7):e63881.
Stoltzfus M, Kaur A, Chawla A, Gupta V, Anamika FNU, Jain R. The role of telemedicine in healthcare: an overview and update. The Egyptian Journal of Internal Medicine. 2023;35(1):49.
Gajarawala SN, Pelkowski JN. Telehealth Benefits and Barriers. J Nurse Pract. 2021;17(2):218-21.
Nicolas B, Leblong E, Fraudet B, Gallien P, Piette P. Telerehabilitation solutions in patient pathways: An overview of systematic reviews. Digit Health. 2024;10:20552076241294110.
Özden F, Uysal İ, Özkeskin M. Specialized Telerehabilitation Approaches for People with Disabilities. In: Bennett G, Goodall E, editors. The Palgrave Encyclopedia of Disability. Cham: Springer Nature Switzerland; 2024. p. 1-13.
Baigi SFM, Kimiafar K, Ghaddaripouri K, Mehneh MR, Mousavi AS, Sarbaz M. The effect of telerehabilitation on improving the physical activity of patients with osteoarthritis: A systematic review. J Educ Health Promot. 2023;12:408.
Zhu J, Jiang YS, Wang H. Effectiveness of telemedicine-delivered exercise interventions in older adult patients with osteoarthritis: a systematic review and meta-analysis. Front Public Health. 2025;13:1719841.
Wang HN, Luo P, Liu S, Liu Y, Zhang X, Li J. Effectiveness of Internet-Based Telehealth Programs in Patients With Hip or Knee Osteoarthritis: Systematic Review and Meta-Analysis. J Med Internet Res. 2024;26:e55576.
Baigi SFM, Kimiafar K, Ghaddaripouri K, Mehneh MR, Mousavi AS, Sarbaz M. The effect of telerehabilitation on improving the physical activity of patients with osteoarthritis: A systematic review. Journal of Education and Health Promotion. 2023;12(1):408.
Naeemabadi M, Fazlali H, Najafi S, Dinesen B, Hansen J. Telerehabilitation for patients with knee osteoarthritis: a focused review of technologies and teleservices. JMIR Biomedical Engineering. 2020;5(1):e16991.
Wang H-N, Luo P, Liu S, Liu Y, Zhang X, Li J. Effectiveness of internet-based telehealth programs in patients with hip or knee osteoarthritis: systematic review and meta-analysis. Journal of Medical Internet Research. 2024;26:e55576.
Ouendi N, Avril E, Dervaux B, Pudlo P, Wallard L. Effectiveness of telerehabilitation programs in elderly with hip or knee arthroplasty: a systematic review. Telemedicine and e-Health. 2024;30(6):1507-21.
Zhang H, Wang J, Jiang Z, Deng T, Li K, Nie Y. Home-based tele-rehabilitation versus hospital-based outpatient rehabilitation for pain and function after initial total knee arthroplasty: a systematic review and meta-analysis. Medicine. 2023;102(51):e36764.
Aily JB, Barton CJ, Mattiello SM, Silva DDO, De Noronha M. Telerehabilitation for knee osteoarthritis in Brazil: a feasibility study. International journal of telerehabilitation. 2020;12(2):137.
Bearman SK, Schneiderman RL, Zoloth E. Building an Evidence Base for Effective Supervision Practices: An Analogue Experiment of Supervision to Increase EBT Fidelity. Adm Policy Ment Health. 2017;44(2):293-307.
Wilson TE, Hennessy EA, Falzon L, Boyd R, Kronish IM, Birk JL. Effectiveness of interventions targeting self-regulation to improve adherence to chronic disease medications: a meta-review of meta-analyses. Health Psychol Rev. 2020;14(1):66-85.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Bmj. 2009;339.
Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. Bmj. 2021;372:n160.
Eriksen MB, Frandsen TF. The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: a systematic review. J Med Libr Assoc. 2018;106(4):420-31.
Eybye MN, Madsen SD, Schultz A, Nim CG. Database coverage and their use in systematic reviews regarding spinal manipulative therapy: an exploratory study. Chiropr Man Therap. 2022;30(1):57.
Chapman D. Advanced search features of PubMed. J Can Acad Child Adolesc Psychiatry. 2009;18(1):58-9.
Michaleff ZA, Costa LO, Moseley AM, Maher CG, Elkins MR, Herbert RD, et al. CENTRAL, PEDro, PubMed, and EMBASE are the most comprehensive databases indexing randomized controlled trials of physical therapy interventions. Phys Ther. 2011;91(2):190-7.
Moseley AM, Elkins MR, Van der Wees PJ, Pinheiro MB. Using research to guide practice: The Physiotherapy Evidence Database (PEDro). Braz J Phys Ther. 2020;24(5):384-91.
Roos R. Current state of evidence-based practice in clinical physiotherapy. S Afr J Physiother. 2025;81(1):2139.
Veginadu P, Calache H, Gussy M, Pandian A, Masood M. An overview of methodological approaches in systematic reviews. J Evid Based Med. 2022;15(1):39-54.
MacFarlane A, Russell-Rose T, Shokraneh F. Search strategy formulation for systematic reviews: Issues, challenges and opportunities. Intelligent Systems with Applications. 2022;15:200091.
Bramer WM, de Jonge GB, Rethlefsen ML, Mast F, Kleijnen J. A systematic approach to searching: an efficient and complete method to develop literature searches. J Med Libr Assoc. 2018;106(4):531-41.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. bmj. 2021;372.
Jeyaraman M, Muthu S, Nischith DS, Jeyaraman N, Nallakumarasamy A, Khanna M. PRISMA-Compliant Meta-Analysis of Randomized Controlled Trials on Osteoarthritis of Knee Managed with Allogeneic vs Autologous MSCs: Efficacy and Safety Analysis. Indian J Orthop. 2022;56(12):2042-59.
Booth A, Martyn-St James M, Clowes M, Sutton A. Systematic approaches to a successful literature review. 2021.
Aslam S, Georgiev H, Mehta K, Kumar A. Matching research design to clinical research questions. Indian Journal of Sexually Transmitted Diseases and AIDS. 2012;33(1):49-53.
Minozzi S, Cinquini M, Gianola S, Castellini G, Gerardi C, Banzi R. Risk of bias in nonrandomized studies of interventions showed low inter-rater reliability and challenges in its application. Journal of clinical epidemiology. 2019;112:28-35.
Dawson R, Oliveira JS, Kwok WS, Bratland M, Rajendran IM, Srinivasan A, et al. Exercise Interventions Delivered Through Telehealth to Improve Physical Functioning for Older Adults with Frailty, Cognitive, or Mobility Disability: A Systematic Review and Meta-Analysis. Telemed J E Health. 2024;30(4):940-50.
De Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Australian Journal of Physiotherapy. 2009;55(2):129-33.
Cashin AG, McAuley JH. Clinimetrics: physiotherapy evidence database (PEDro) scale. Journal of physiotherapy. 2020;66(1):59.
Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Physical therapy. 2003;83(8):713-21.
Tore NG, Oskay D, Haznedaroglu S. The quality of physiotherapy and rehabilitation program and the effect of telerehabilitation on patients with knee osteoarthritis. Clin Rheumatol. 2023;42(3):903-15.
Aily JB, de Noronha M, Approbato Selistre LF, Ferrari RJ, White DK, Mattiello SM. Face-to-face and telerehabilitation delivery of circuit training have similar benefits and acceptability in patients with knee osteoarthritis: a randomised trial. J Physiother. 2023;69(4):232-9.
Akgül H, Birtane M, Tonga E. Effects of a Digitally Supported Physical Activity Intervention in Knee Osteoarthritis: A Pilot Randomized Controlled Trial. Musculoskeletal Care. 2025;23(2):e70085.
Baker K, LaValley MP, Brown C, Felson DT, Ledingham A, Keysor JJ. Efficacy of Computer-Based Telephone Counseling on Long-Term Adherence to Strength Training in Elderly Patients With Knee Osteoarthritis: A Randomized Trial. Arthritis Care Res (Hoboken). 2020;72(7):982-90.
Dieter V, Martus P, Seißler D, Serna-Higuita LM, Janssen P, Krauss I. Effectiveness of the Self-Directed mHealth Exercise Intervention re.flex in Patients With Knee Osteoarthritis: Randomized Controlled Trial. J Med Internet Res. 2025;27:e71558.
Im YJ, Choi J, Choi SA, Kwon JY, Do JG. Feasibility and Preliminary Effectiveness of a Mobile App-Based Personalized Exercise Program in Older Patients With Chronic Knee Osteoarthritis: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth. 2025;13:e71073.
Kloek CJJ, Bossen D, Spreeuwenberg PM, Dekker J, de Bakker DH, Veenhof C. Effectiveness of a Blended Physical Therapist Intervention in People With Hip Osteoarthritis, Knee Osteoarthritis, or Both: A Cluster-Randomized Controlled Trial. Phys Ther. 2018;98(7):560-70.
Rini C, Porter LS, Somers TJ, McKee DC, DeVellis RF, Smith M, et al. Automated Internet-based pain coping skills training to manage osteoarthritis pain: a randomized controlled trial. Pain. 2015;156(5):837-48.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Iqra Dilbar, Tayyaba Zaman (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
