Comparing telerehabilitation and home-based exercise for improving physical function, balance, and quality of life in people with multiple sclerosis: a systematic review and meta-analysis

Physical activity is essential for maintaining health and improving quality of life (QOL). However, people with multiple sclerosis (PWMS) are typically less physically active than the general population. Telerehabilitation has increasingly been used as a method of delivering rehabilitation interventions in this population, although direct evidence comparing its effectiveness with home-based exercise on physical function, balance, and QOL remains limited. This systematic review and meta-analysis aimed to compare the effectiveness of telerehabilitation versus home-based exercise on physical function, balance, and QOL in PWMS. A systematic search of PubMed/MEDLINE, Scopus, Web of Science, PEDro, CINAHL, Cochrane Library, and EMBASE was conducted from inception to February 2026. Randomized controlled trials (RCTs) comparing telerehabilitation with home-based exercise in PWMS were included. Outcomes included physical function and balance assessed using clinical performance tests, and QOL measured using validated questionnaires. Two independent reviewers performed study selection, data extraction, and risk of bias assessment using the PEDro scale. Five RCTs were included. The meta-analysis was performed using a random-effects model with restricted maximum-likelihood estimation. No significant differences were observed between telerehabilitation and home-based exercise for physical function (MD = − 0.09, 95% CI: −0.58 to 0.39; p = 0.709), balance (MD = − 1.92, 95% CI: −4.58 to 0.74; p = 0.158), or QOL (SMD = 0.15, 95% CI: −0.18 to 0.48; p = 0.367). Adherence data were limited and showed no between-group differences in the two studies that reported comparative outcomes. Telerehabilitation did not demonstrate greater effectiveness than home-based exercise in improving physical function, balance, or QOL in PWMS. However, limited evidence and inconsistent reporting, including adherence, warrant cautious interpretation. Further high-quality RCTs are needed to confirm these findings. CRD420261323674