Effects of Digital Health Interventions in Chronic Musculoskeletal Pain: Systematic Review and Bayesian Network Meta-Analysis of Randomized Controlled Trials.

چکیده اصلی

BACKGROUND: Chronic musculoskeletal pain is a major public health problem, and access to continuous, long-term care remains challenging. Digital health interventions may extend care beyond conventional settings; however, their comparative effects across delivery modalities and core therapeutic components remain uncertain. OBJECTIVE: This study aimed to synthesize evidence and compare the effects of different digital health intervention modalities on pain, functional disability, and health-related quality of life in adults with chronic musculoskeletal pain. METHODS: This systematic review and Bayesian network meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. PubMed, the Cochrane Central Register of Controlled Trials, Embase, Web of Science, CINAHL, MEDLINE, and Scopus were systematically searched from database inception to January 29, 2026. Randomized controlled trials comparing digital health interventions with control conditions in adults with chronic musculoskeletal pain were included. Interventions were classified according to digital delivery format and core therapeutic components. Standardized effect sizes (Hedges g) were used, and pairwise meta-analyses and Bayesian random-effects network meta-analyses were conducted. Subgroup analyses explored effect modification by core components. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework adapted for network meta-analysis. RESULTS: Ninety-two randomized controlled trials involving 12,595 participants were included. Pairwise meta-analyses suggested small to moderate favorable average effects of app-based, virtual reality-based, and telerehabilitation interventions on pain and functional disability, whereas estimates for wearable device and multimodal interventions were imprecise. However, the prediction intervals crossed the null, suggesting that benefits may not be consistent across settings. Component-based analyses suggested larger effects for exercise or motor function training than for interventions centered primarily on education or cognitive behavioral therapy; however, several subgroups included few studies. In the Bayesian network meta-analyses, motor function-oriented virtual reality and exercise-based telerehabilitation showed potentially favorable effects across pain and disability outcomes, while some virtual reality interventions ranked relatively highly for pain. However, these rankings remained uncertain because of heterogeneity, imprecision, and limited direct evidence for some comparisons. Network meta-regression suggested that intervention duration may be associated with functional disability outcomes, whereas the corresponding association for pain was less certain. The certainty of evidence was predominantly low or very low. CONCLUSIONS: Digital health interventions may provide small to moderate average improvements in pain and disability, but their clinical importance and comparative effects remain uncertain. Unlike previous reviews focused on individual technologies or broad delivery categories, this systematic review integrated delivery modality with core therapeutic content. This dual-dimensional framework provides a more clinically interpretable basis for comparing interventions and prioritizing future head-to-head trials. Exercise-based virtual reality and telerehabilitation appear promising but cannot be considered superior. Future research should standardize intervention content and conduct high-quality head-to-head trials to confirm long-term effects.

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