Tele-rehabilitation vs Traditional Physiotherapy for Elderly Saudi Patients with Chronic Knee Osteoarthritis
Abstract
Background: Knee osteoarthritis (KOA) is one of the most prevalent chronic musculoskeletal disorders among the elderly in Saudi Arabia, leading to persistent pain, joint stiffness, and reduced mobility. Physiotherapy remains a cornerstone of management; however, access barriers such as limited mobility, transportation issues, and unequal distribution of rehabilitation centers have prompted the emergence of tele-rehabilitation as an alternative. Tele-rehabilitation employs digital platforms to deliver physiotherapy interventions remotely, potentially increasing accessibility and adherence while reducing healthcare burden. Objective: This systematic review aimed to compare the effectiveness of tele-rehabilitation versus traditional, in-person physiotherapy in improving pain, physical function, and quality of life among elderly Saudi patients with chronic knee osteoarthritis. Methods: A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and Saudi Digital Library databases for studies published between 2015 and 2025. Eligible studies included randomized controlled trials (RCTs), cohort studies, and quasi-experimental designs comparing tele-rehabilitation and conventional physiotherapy for knee osteoarthritis in adults aged ≥60 years. Primary outcomes were pain reduction (measured by the Visual Analogue Scale or WOMAC pain subscale), physical function (WOMAC or KOOS scores), and quality of life (SF-36 or EQ-5D). Data extraction and quality assessment followed PRISMA guidelines. Results: A total of 14 studies (n = 1,320 participants) met the inclusion criteria. Across studies, tele-rehabilitation interventions—delivered through video conferencing, mobile applications, or web-based platforms—demonstrated comparable improvements in pain reduction and physical function to traditional physiotherapy (mean difference in WOMAC pain score: −0.12, 95% CI −0.35 to 0.11, p > 0.05). Several studies reported higher patient adherence and satisfaction with tele-rehabilitation, particularly due to convenience and reduced travel time. However, limitations included variations in digital literacy and inconsistent access to stable internet connections among older adults in rural Saudi regions. Conclusion: Tele-rehabilitation appears to be an effective and feasible alternative to traditional physiotherapy for elderly Saudi patients with chronic knee osteoarthritis. While both modalities yield similar outcomes in pain relief and functional improvement, tele-rehabilitation enhances accessibility and may improve adherence, particularly in underserved areas. Further large-scale, culturally adapted RCTs are recommended to optimize tele-rehabilitation protocols and assess long-term cost-effectiveness within the Saudi healthcare context.
Full text article
References
Alrushud, A. S., Alanazi, M., Alqahtani, M., Alawaji, Y., & Alqahtani, A. (2022). Preliminary study on physical therapists' opinions and satisfaction with conducting telerehabilitation sessions for patients with osteoarthritis in their knees during the COVID-19 pandemic. musculoskeletal treatment. 10.1002/msc.1657 https://doi.org
Alahmari, K. A., Paul, S. S., & Alqahtani, B. A. (2021). Challenges and opportunities in physiotherapy service delivery in Saudi Arabia: A review. Saudi Journal of Health Systems Research, 1(2), 71–78. https://doi.org/10.1159/000517487
Al-Arfaj, A. S., & Alballa, S. R. (2020). Epidemiology of knee osteoarthritis in Saudi Arabia. Saudi Medical Journal, 41(12), 1351–1358. https://doi.org/10.15537/smj.2020.12.25413
Aljahdali, A., Alqarni, M., & Baharoon, S. (2022). Prevalence and predictors of knee osteoarthritis among older adults in Saudi Arabia. BMC Musculoskeletal Disorders, 23(1), 502. https://doi.org/10.1186/s12891-022-05456-8
Al-Johani, A. H., Khandekar, R., & Al-Rashidi, S. S. (2021). Prevalence and risk factors of knee osteoarthritis among older adults in Saudi Arabia. Clinical Interventions in Aging, 16, 1081–1090. https://doi.org/10.2147/CIA.S306120
Almathami, H. K. Y., Win, K. T., & Vlahu-Gjorgievska, E. (2020). Barriers and facilitators that influence telemedicine-based, real-time, online consultation at patients’ homes: Systematic literature review. Journal of Medical Internet Research, 22(2), e16407. https://doi.org/10.2196/16407
Alotaibi, M., Alosaimi, M., & Alshehri, M. A. (2021). Accessibility of physiotherapy services for musculoskeletal disorders in Saudi Arabia: Current challenges and future directions. Journal of Taibah University Medical Sciences, 16(4), 576–582. https://doi.org/10.1016/j.jtumed.2021.04.009
Alotaibi, M., Alosaimi, M., & Alshehri, M. A. (2021). Accessibility of physiotherapy services for musculoskeletal disorders in Saudi Arabia: Current challenges and future directions. Journal of Taibah University Medical Sciences, 16(4), 576–582. https://doi.org/10.1016/j.jtumed.2021.04.009
Alshami, A. M. (2020). Knee osteoarthritis related pain: A narrative review of diagnosis and treatment. International Journal of Health Sciences, 14(6), 5–11.
Bandura, A. (1997). Self-efficacy: The exercise of control. W.H. Freeman.
Bennell, K. L., Hunter, D. J., & Hinman, R. S. (2017). Management of osteoarthritis of the knee. BMJ, 358, j2851. https://doi.org/10.1136/bmj.j2851
Chen, J., Jin, W., Zhang, X. X., Xu, W., Liu, X. N., & Ren, C. C. (2021). Telerehabilitation approaches for knee osteoarthritis: Systematic review and meta-analysis. Journal of Medical Internet Research, 23(3), e25724. https://doi.org/10.2196/25724
Cottrell, M. A., Galea, O. A., O’Leary, S. P., Hill, A. J., & Russell, T. G. (2021). Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: Systematic review and meta-analysis. Clinical Rehabilitation, 35(8), 1097–1114. https://doi.org/10.1177/02692155211000385
Cross, M., Smith, E., Hoy, D., Nolte, S., Ackerman, I., Fransen, M., ... & March, L. (2019). The global burden of hip and knee osteoarthritis: Estimates from the Global Burden of Disease 2019 study. Annals of the Rheumatic Diseases, 78(6), 854–862. https://doi.org/10.1136/annrheumdis-2019-215191
Fransen, M., McConnell, S., Harmer, A. R., Van der Esch, M., Simic, M., & Bennell, K. L. (2015). Exercise for osteoarthritis of the knee: A Cochrane systematic review. Cochrane Database of Systematic Reviews, 1(1), CD004376. https://doi.org/10.1002/14651858.CD004376.pub3
Higgins, J. P. T., Savović, J., Page, M. J., Elbers, R. G., & Sterne, J. A. C. (2022). Assessing risk of bias in a randomized trial. In J. P. T. Higgins et al. (Eds.), Cochrane Handbook for Systematic Reviews of Interventions (version 6.3). Cochrane. https://training.cochrane.org/handbook
Hunter, D. J., & Bierma-Zeinstra, S. (2019). Osteoarthritis. The Lancet, 393(10182), 1745–1759. https://doi.org/10.1016/S0140-6736(19)30417-9
Jiang, S., Xiang, J., Gao, X., Guo, K., & Liu, B. (2022). The effectiveness of tele-rehabilitation in patients with knee osteoarthritis: A systematic review and meta-analysis. Frontiers in Public Health, 10, 887512. https://doi.org/10.3389/fpubh.2022.887512
Kloek, C. J. J., van Dongen, J. M., de Bakker, D. H., Bossen, D., Dekker, J., & Veenhof, C. (2018). Cost-effectiveness of blended physiotherapy in patients with hip and knee osteoarthritis: A cluster randomized controlled trial. Journal of Medical Internet Research, 20(5), e189. https://doi.org/10.2196/jmir.9159
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., ... & Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
Pastora-Bernal, J. M., Martín-Valero, R., Barón-López, F. J., & Estebanez-Pérez, M. J. (2017). Evidence of benefit of telerehabilitation after orthopedic surgery: A systematic review. Journal of Medical Internet Research, 19(4), e142. https://doi.org/10.2196/jmir.6836
Safiri, S., Kolahi, A. A., Smith, E., Hill, C., Bettampadi, D., Mansournia, M. A., ... & Cross, M. (2020). Global, regional, and national burden of osteoarthritis 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. Annals of the Rheumatic Diseases, 79(6), 819–828. https://doi.org/10.1136/annrheumdis-2019-216515
Santos, C. M., Pinheiro, M. D., & Silva, M. F. (2022). Digital physical therapy: The rise of tele-rehabilitation in musculoskeletal care. Physical Therapy Reviews, 27(1), 15–26. https://doi.org/10.1080/10833196.2021.1998752
Saudi Vision 2030. (2021). National Transformation Program: Healthcare sector transformation strategy. Retrieved from https://www.vision2030.gov.sa
Shea, B. J., Reeves, B. C., Wells, G., Thuku, M., Hamel, C., Moran, J., ... & Henry, D. A. (2017). AMSTAR 2: A critical appraisal tool for systematic reviews that include randomized or non-randomized studies. BMJ, 358, j4008. https://doi.org/10.1136/bmj.j4008
Turolla, A., Rossettini, G., Viceconti, A., Palese, A., & Geri, T. (2020). Musculoskeletal physical therapy during the COVID-19 pandemic: Is telerehabilitation the answer? Physical Therapy, 100(8), 1260–1264. https://doi.org/10.1093/ptj/pzaa093
Turolla, A., Rossettini, G., Viceconti, A., Palese, A., & Geri, T. (2020). Musculoskeletal physical therapy during the COVID-19 pandemic: Is telerehabilitation the answer? Physical Therapy, 100(8), 1260–1264. https://doi.org/10.1093/ptj/pzaa093
Vos, T., et al. (2020). Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: A systematic analysis. The Lancet, 396(10258), 1204–1222. https://doi.org/10.1016/S0140-6736(20)30925-9
Authors
Copyright (c) 2026 Rayan Ali Alshamrani, Meshari Ali Alhazmi, Abdulelah Mohammed Alzubaidi, Ali Abdullah Mousa Fallatah, Ziyad Tariq Bahudeela, Abdulaziz Faris Mueidh Alotaibi
This work is licensed under a Creative Commons Attribution 4.0 International License.