Utilization and Perceived Effectiveness of Telerehabilitation Services in Musculoskeletal Disorders: A Cross-Sectional Study Among Physiotherapists

Background: Telerehabilitation is increasingly used in musculoskeletal (MSK) physiotherapy, yet clinician-level evidence on utilization, perceived effectiveness, and implementation barriers in low- and middle-income urban settings remains limited. Objective: To assess telerehabilitation utilization patterns, perceived clinical effectiveness, and predictors of high perceived effectiveness among physiotherapists managing MSK disorders in Lahore. Methods: A cross-sectional survey of 510 physiotherapists was conducted using a structured questionnaire capturing demographics, telerehabilitation utilization, perceived effectiveness across clinical domains (Likert 1–5), implementation barriers, and contextual practice characteristics. Multivariable logistic regression identified predictors of high perceived effectiveness, reporting adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Results: Overall, 68.2% reported ever using telerehabilitation and 54.9% used it in the past three months; weekly/daily use was 37.6%, and the median MSK share managed remotely was 22% (IQR 10–35). Perceived effectiveness was highest for patient education (4.18 ± 0.71; 83.5% agreement) and exercise adherence (4.02 ± 0.76; 78.6%), while shoulder assessment confidence was lowest (2.91 ± 0.88; 34.5%). The leading barriers were limited hands-on assessment (4.12 ± 0.73; 70.2% major barrier) and internet instability (3.89 ± 0.84; 61.0%). High perceived effectiveness was independently associated with prior training (AOR 2.41, 95% CI 1.68–3.46), weekly/daily use (AOR 2.98, 95% CI 2.01–4.41), and good internet quality (AOR 1.72, 95% CI 1.15–2.58). Conclusion: Telerehabilitation is widely utilized for MSK care in Lahore and is perceived as particularly effective for education and adherence support; however, assessment limitations and connectivity barriers remain central. Training and infrastructure strengthening may improve clinician-perceived effectiveness and implementation. Keywords: telerehabilitation; telehealth; musculoskeletal disorders; physiotherapy; perceived effectiveness; barriers; Pakistan.