Comparative Effectiveness of Technology-Assisted Rehabilitation on Patient-Reported Outcomes in Breast Cancer: A Systematic Review and Network Meta-Analysis (Preprint)

BACKGROUND Breast cancer survivors frequently suffer from debilitating physical and psychological burdens during and after treatment. While technology-assisted rehabilitation has emerged as a promising solution to overcome barriers in traditional care, the comparative effectiveness of different digital modalities remains unclear. This study aimed to evaluate and rank the efficacy of various technology-assisted interventions on Patient-Reported Outcomes (PROs). OBJECTIVE This study aimed to evaluate and rank the efficacy of various technology-assisted interventions on Patient-Reported Outcomes (PROs). METHODS A systematic review and network meta-analysis (NMA) was conducted following PRISMA guidelines. Five electronic databases (PubMed, Embase, CENTRAL, Scopus, and Web of Science) were searched from inception to February 24, 2025. Randomized controlled trials assessing digital interventions (Virtual Reality [VR], Serious Games, Wearable Devices, Web-based platforms, Mobile Apps, and Real-Time Interactive Platforms [RTIP]) in breast cancer patients were included. The primary outcome was quality of life (QoL), with secondary outcomes including depression, anxiety, fatigue, and insomnia. Data were synthesized using a frequentist random-effects model, and interventions were ranked using the Surface Under the Cumulative Ranking (SUCRA) curve. This systematic review protocol was registered in PROSPERO(CRD42024582402). RESULTS Thirty-six RCTs involving 3,016 participants were included. Digital interventions significantly improved PROs compared to standard care. Mobile Apps were ranked as the most effective intervention for improving QoL (SUCRA = 85.1%), followed by VR (84.2%). For symptom management, VR demonstrated the highest probability of being the most effective intervention for depression (99.6%), anxiety (98.2%), fatigue (98.7%), and insomnia (85.2%). RTIP also showed significant efficacy, particularly for insomnia and depression. Serious games and wearable devices generally showed lower comparative efficacy or non-significant differences from controls. CONCLUSIONS Technology-assisted rehabilitation is superior to usual care for improving health outcomes in breast cancer patients. A "precision rehabilitation" approach is recommended: Mobile Apps are optimal for enhancing global QoL, while VR appears to be the most robust modality for managing high-arousal symptoms and psychological distress. Future research should focus on high-quality trials to validate these symptom-specific hierarchies.