The Role of Telerehabilitation-Based Exercises in the Management of Knee Osteoarthritis: A Narrative Review

Öz

Knee osteoarthritis (KOA) is a progressive disease characterized by joint cartilage degeneration, with prevalence increasing with age. This condition causes pain and reduces quality of life. Traditional face-to-face rehabilitation may be limited by geographical and financial barriers. Telerehabilitation (TR) has emerged as a modern therapy method using digital platforms for remote exercise monitoring. This narrative review was conducted by searching PubMed and Google Scholar databases for studies published between 2010 and 2026 using keywords such as "knee osteoarthritis" and "telerehabilitation". Studies have shown that TR exercises may lead to reduced pain and improved joint function and quality of life. In conclusion, TR offers an effective treatment alternative, especially for those facing barriers to in-person care.

Anahtar Kelimeler

• Knee osteoarthritis
• telerehabilitation
• exercise therapy
• remote rehabilitation
• physical therapy modalities

Diz Osteoartriti Yönetiminde Telerehabilitasyon Yoluyla Uygulanan Egzersizlerin Rolü: Bir Anlatı İncelemesi

Öz

Diz osteoartriti (KOA), eklem kıkırdağının dejenerasyonu ile karakterize ilerleyici bir hastalıktır. Bu durum, ağrıya neden olur ve yaşam kalitesini düşürür. Geleneksel yüz yüze rehabilitasyon, coğrafi ve finansal engeller nedeniyle kısıtlanabilir. Telerehabilitasyon (TR), dijital platformlar aracılığıyla uzaktan egzersiz takibi sağlayan modern bir yöntemdir. Bu anlatı incelemesi, 2010-2026 yılları arasında PubMed ve Google Scholar veri tabanlarında “diz osteoartriti” ve “telerehabilitasyon” anahtar kelimeleri kullanılarak yapılan taramalarla hazırlanmıştır. Araştırmalar, TR'nin ağrıyı azaltmaya ve fonksiyonları ve yaşam kalitesini iyileştirmeye yol açabileceğini göstermiştir. Sonuç olarak TR, yüz yüze tedaviye erişimde zorluk yaşayan bireyler için umut vadeden bir alternatiftir.

Anahtar Kelimeler

• Diz osteoartriti
• telerehabilitasyon
• egzersiz tedavisi
• uzaktan rehabilitasyon
• fiziksel terapi modaliteleri

Kaynakça

1. 1. Esmer AF, Başarır K, Binnet M. Diz ekleminin cerrahi anatomisi. TOTBİD Dergisi. 2011;10(1):38-44.
2. 2. Katz JN, Arant KR, Loeser RF. Diagnosis and treatment of hip and knee osteoarthritis: A review. JAMA. 2021;325(6):568-578.
3. 3. Luyten FP, Zeinstra-Zeinstra S, Dell’Accio F, et al. Toward classification criteria for early osteoarthritis of the knee. Semin Arthritis Rheum. 2018;47(4):457-463.
4. 4. Hansen H, Bieler T, Beyer N, et al. COPD online rehabilitation versus conventional COPD rehabilitation—rationale and design for a multicenter randomized controlled trial study protocol (CORe trial). BMC Pulm Med. 2017;17(1):1-14.
5. 5. Tousignant M, Moffet H, Boissy P, Corriveau H, Cabana F, Marquis F. A randomized controlled trial of home telerehabilitation for post-knee arthroplasty. J Telemed Telecare. 2011;17(4):195-198.
6. 6. Jang S, Lee K, Ju JH. Recent updates of diagnosis, pathophysiology, and treatment on osteoarthritis of the knee. Int J Mol Sci. 2021;22(5):2619.
7. 7. Dieppe PA, Lohmander LS. Pathogenesis and management of pain in osteoarthritis. Lancet. 2005;365(9463):965-973.
8. 8. O’Brien T, Breivik H. The impact of chronic pain—European patients’ perspective over 12 months. Scand J Pain. 2012;3(1):23-29.

9. 9. Neogi T. The epidemiology and impact of pain in osteoarthritis. Osteoarthritis Cartilage. 2013;21(9):1145-1153.
10. 10. Yu H, Huang T, Lu WW, Tong L, Chen D. Osteoarthritis pain. Int J Mol Sci. 2022;23(9):5072.
11. 11. Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019;393(10182):1745-1759. doi:10.1016/S0140-6736(19)30417-9.
12. 12. Taruc-Uy RL, Lynch SA. Diagnosis and treatment of osteoarthritis. Prim Care. 2013;40(4):821-836.
13. 13. Felson DT, McLaughlin S, Goggins J, et al. Bone marrow edema and its relation to progression of knee osteoarthritis. Ann Intern Med. 2003;139(5 Pt 1):330-336.
14. 14. Hawker GA, Stewart L, French MR, et al. Understanding the pain experience in hip and knee osteoarthritis: An OARSI/OMERACT initiative. Osteoarthritis Cartilage. 2008;16(4):415-422.
15. 15. Fautrel B, Hilliquin P, Rozenberg S, et al. Impact of osteoarthritis: Results of a nationwide survey of 10,000 patients consulting for OA. Joint Bone Spine. 2005;72(3):235-240.
16. 16. Hinton R, Moody RL, Davis AW, Thomas SF. Osteoarthritis: Diagnosis and therapeutic considerations. Am Fam Physician. 2002;65(5):841-848.
17. 17. Losina E, Paltiel AD, Weinstein AM, et al. Lifetime medical costs of knee osteoarthritis management in the United States: Impact of extending indications for total knee arthroplasty. Arthritis Care Res (Hoboken). 2015;67(2):203-215.
18. 18. Li D, Li S, Chen Q, Xie X. The prevalence of symptomatic knee osteoarthritis in relation to age, sex, area, region, and body mass index in China: A systematic review and meta-analysis. Front Med (Lausanne). 2020;7:304.
19. 19. Hong JW, Noh JH, Kim DJ. The prevalence of and demographic factors associated with radiographic knee osteoarthritis in Korean adults aged >50 years: The 2010-2013 Korea National Health and Nutrition Examination Survey. PLoS One. 2020;15(3):e0230613.
20. 20. Yesil H, Hepguler S, Ozturk C, Capaci K, Yesil M. Prevalence of symptomatic knee, hand and hip osteoarthritis among individuals 40 years or older: A study conducted in İzmir city. Acta Orthop Traumatol Turc. 2013;47(4):231-235.
21. 21. Kaçar C, Gilgil E, Urhan S. et al. The prevalence of symptomatic knee and distal interphalangeal joint osteoarthritis in the urban population of Antalya, Turkey. Rheumatol Int. 2005;25:201–204.
22. 22. Bakırhan S, Bozan O, Unver B, Karatosun V. Evaluation of functional characteristics in patients with knee osteoarthritis. Acta Ortop Bras. 2017;25(6):248-252.
23. 23. Alkan H, Ardıç F. Güncel kılavuzlar eşliğinde osteoartritte non-farmakolojik tedavi. In: Hepgüler AS, editor. Osteoartrit. 1st ed. Ankara: Türkiye Klinikleri; 2020. p.70-77.
24. 24. Bijlsma JWJ, Berenbaum F, Lafeber FPJG. Osteoarthritis: An update with relevance for clinical practice. Lancet. 2011;377:2115-2126.
25. 25. Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Rheumatol. 2020;72(2):220-233.
26. 26. Odole AC, Ojo OD. A telephone-based physiotherapy intervention for patients with osteoarthritis of the knee. Int J Telerehabil. 2013;5(2):11-20.
27. 27. Laver KE, Adey-Wakeling Z, Crotty M, et al. Telerehabilitation services for stroke. Cochrane Database Syst Rev. 2020;1(1):CD010255.
28. 28. Mousavi Baigi SF, Kimiafar K, Ghaddaripouri K, et al. The effect of telerehabilitation on improving the physical activity of patients with osteoarthritis: A systematic review. J Educ Health Promot. 2023;12:408.
29. 29. van Egmond MA, van der Schaaf M, Vredeveld T, et al. Effectiveness of physiotherapy with telerehabilitation in surgical patients: A systematic review and meta-analysis. Physiotherapy. 2018;104(3):277-298.
30. 30. Naeemabadi M, Fazlali H, Najafi S, Dinesen B, Hansen J. Telerehabilitation for patients with knee osteoarthritis: A focused review of technologies and teleservices. JMIR Biomed Eng. 2020;5(1):e16991.
31. 31. Xiang W, Wang JY, Ji BJ, Li LJ, Xiang H. Effectiveness of different telerehabilitation strategies on pain and physical function in patients with knee osteoarthritis: Systematic review and meta-analysis. J Med Internet Res. 2023;25:e40735.
32. 32. Azma K, RezaSoltani Z, Rezaeimoghaddam F, Dadarkhah A, Mohsenolhosseini S. Efficacy of tele-rehabilitation compared with office-based physical therapy in patients with knee osteoarthritis: A randomized clinical trial. J Telemed Telecare. 2018;24(8):560-565.
33. 33. Aily JB, Barton CJ, Mattiello SM, De Oliveira Silva D, De Noronha M. Telerehabilitation for knee osteoarthritis in Brazil: A feasibility study. Int J Telerehabil. 2020;12(2):137-148.
34. 34. Turolla A, Rossettini G, Viceconti A, Palese A, Geri T. Musculoskeletal physical therapy during the COVID-19 pandemic: Is telerehabilitation the answer? Phys Ther. 2020;100(8):1260-1264.
35. 35. Shenoy MP, Shenoy PD. Identifying the challenges and cost-effectiveness of telerehabilitation: A narrative review. J Clin Diagn Res. 2018;12(12):1-4.
36. 36. Dâvalos ME, French MT, Burdick AE, Simmons SC. Economic evaluation of telemedicine: Review of the literature and research guidelines for benefit-cost analysis. Telemed J E Health. 2009;15(10):933-948.
37. 37. Kidholm K, Rasmussen MK, Andreasen JJ, et al. Cost-utility analysis of a cardiac telerehabilitation program: The Teledialog Project. Telemed J E Health. 2016;22(7):553-563.
38. 38. Tousignant M, Moffet H, Nadeau S, et al. Cost analysis of in-home telerehabilitation for post-knee arthroplasty. J Med Internet Res. 2015;17(3):e83.
39. 39. Aloyuni S, Alharbi R, Kashoo F, et al. Knowledge, attitude, and barriers to telerehabilitation-based physical therapy practice in Saudi Arabia. Healthcare (Basel). 2020;8(4).
40. 40. Horsley S, Schock G, Grona SL, et al. Use of real-time videoconferencing to deliver physical therapy services: A scoping review of published and emerging evidence. J Telemed Telecare. 2019;26(10):581-589.
41. 41. Anton D, Berges I, Bermúdez J, Goñi A, Illarramendi A. A telerehabilitation system for the selection, evaluation and remote management of therapies. Sensors. 2018;18(5):1459.
42. 42. Russell TG. Physical rehabilitation using telemedicine. J Telemed Telecare. 2007;13(5):217-220.
43. 43. Matijevic V, Secic A, Masic V, et al. Virtual reality in rehabilitation and therapy. Acta Clin Croat. 2013;52(4):453-457.
44. 44. Jiang S, Xiang J, Gao X, Guo K, Liu B. The comparison of telerehabilitation and face-to-face rehabilitation after total knee arthroplasty: A systematic review and meta-analysis. J Telemed Telecare. 2018;24(4):257-262.
45. 45. Aily JB, de Noronha M, Selistre LFA, 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):232-239.
46. 46. Kim JY, Lee DW, Jeong MB. Effect of a telerehabilitation exercise program on the gait, knee function and quality of life in patients with knee osteoarthritis. J Korean Soc Phys Med. 2020;15(1):143-152.
47. 47. Tedeschi R, Platano D, Pillastrini P, Berti L, Benedetti MG. Effectiveness of tele-rehabilitation in patients with knee osteoarthritis: A randomized controlled trial. Digit Health. 2024;10:20552076241286186.
48. 48. Plavoukou T, Iosifidis M, Papagiannis G, Stasinopoulos D, Georgoudis G. The effectiveness of telerehabilitation in managing pain, strength, and balance in adult patients with knee osteoarthritis: Systematic review. JMIR Rehabil Assist Technol. 2025;12(1):e72466.
49. 49. Cottrell MA, Galea OA, O'Leary SP, Hill AJ, Russell TG. Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: A systematic review and meta-analysis. Clin Rehabil. 2017; 31(5):625-638.
50. 50. Kloek CJ, 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, 560-70.
51. 51. Tore NG, Oskay D, Haznedaroglu S. The quality of physiotherapy and rehabilitation program and the effect of telerehabilitation on patients with knee osteoarthritis. Clinical Rheumatology. 2023; 42(3), 903-915.
52. 52. Plavoukou T, Kasnesis P, Syropoulou AC, Papagiannis G, Stasinopoulos D, Georgoudis G. Wearable sensor–based telerehabilitation versus conventional physiotherapy in knee OA: Insights from the KneE-PAD pilot study. Appl Sci. 2025; 15:12988.
53. 53. Cai C, Tiang PG, Ng A, Xian Fei FN, Koh WL. An assessor-blinded randomized controlled trial comparing a tele-rehabilitation program with wearable technology to conventional face-to-face physiotherapy in patients with knee osteoarthritis. Physiother Theory Pract. 2026.
54. 54. Kotnik P, Hussein M. Does physical therapist contact matter? A randomised controlled trial comparing telerehabilitation and booklet-based exercise for knee osteoarthritis. Eur J Transl Myol. 2026; 36(2):15253.