Clinical effectiveness of telerehabilitation for chronic low back pain in Sub-Saharan Africa: a systematic review

Chronic low back pain (CLBP) is a leading cause of disability in Sub-Saharan Africa (SSA). While telerehabilitation (TR) is an emerging solution, its regional efficacy and implementation requirements are not well-synthesized. This systematic review primarily evaluates the clinical effectiveness of TR for managing CLBP in SSA. Additionally, it investigates the extent of possible sociocultural adaptation and identifies systemic barriers to implementation. A systematic search was conducted in accordance with PRISMA guidelines across PubMed, Google Scholar, Scopus, African Journal Online (AJOL), Web of Science, and CINAHL from inception to February 5, 2026. Eligibility was determined using the PICO framework, targeting randomized controlled trials (RCTs) of telerehabilitation for CLBP in Sub-Saharan Africa. Two reviewers independently performed title/abstract screening, full-text review, and quality assessment. Data were synthesized narratively to evaluate clinical effectiveness and categorize implementation barriers. Three RCTs involving 147 participants were included. All studies were conducted in Nigeria and evaluated TR programs incorporating McKenzie therapy or core stability exercises. TR demonstrated significant improvements in pain intensity, disability, and quality of life (p < 0.05), comparable to in-person interventions. Notably, none of the interventions incorporated sociocultural adaptation. Reported implementation barriers included limited smartphone penetration, intermittent internet connectivity, low digital literacy, and insufficient healthcare worker training, reflecting broader infrastructural limitations in the region. Telerehabilitation for CLBP demonstrated clinical effectiveness in SSA, yet significant infrastructural and cultural challenges were mentioned to constrain its scalability. The lack of sociocultural tailoring in existing studies represents a critical gap. Future research and development should prioritize low-bandwidth, culturally adapted solutions that address local health beliefs to ensure the sustainability and regional adoption of digital spine care.