Tele-rehabilitation vs Traditional Physiotherapy for Elderly Saudi Patients with Chronic Knee Osteoarthritis

Background: Knee osteoarthritis (KOA) is one of the most prevalent chronic musculoskeletal disorders among the elderly in Saudi Arabia, leading to persistent pain, joint stiffness, and reduced mobility. Physiotherapy remains a cornerstone of management; however, access barriers such as limited mobility, transportation issues, and unequal distribution of rehabilitation centers have prompted the emergence of tele-rehabilitation as an alternative. Tele-rehabilitation employs digital platforms to deliver physiotherapy interventions remotely, potentially increasing accessibility and adherence while reducing healthcare burden. Objective: This systematic review aimed to compare the effectiveness of tele-rehabilitation versus traditional, in-person physiotherapy in improving pain, physical function, and quality of life among elderly Saudi patients with chronic knee osteoarthritis. Methods: A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and Saudi Digital Library databases for studies published between 2015 and 2025. Eligible studies included randomized controlled trials (RCTs), cohort studies, and quasi-experimental designs comparing tele-rehabilitation and conventional physiotherapy for knee osteoarthritis in adults aged ≥60 years. Primary outcomes were pain reduction (measured by the Visual Analogue Scale or WOMAC pain subscale), physical function (WOMAC or KOOS scores), and quality of life (SF-36 or EQ-5D). Data extraction and quality assessment followed PRISMA guidelines. Results: A total of 14 studies (n = 1,320 participants) met the inclusion criteria. Across studies, tele-rehabilitation interventions—delivered through video conferencing, mobile applications, or web-based platforms—demonstrated comparable improvements in pain reduction and physical function to traditional physiotherapy (mean difference in WOMAC pain score: −0.12, 95% CI −0.35 to 0.11, p > 0.05). Several studies reported higher patient adherence and satisfaction with tele-rehabilitation, particularly due to convenience and reduced travel time. However, limitations included variations in digital literacy and inconsistent access to stable internet connections among older adults in rural Saudi regions. Conclusion: Tele-rehabilitation appears to be an effective and feasible alternative to traditional physiotherapy for elderly Saudi patients with chronic knee osteoarthritis. While both modalities yield similar outcomes in pain relief and functional improvement, tele-rehabilitation enhances accessibility and may improve adherence, particularly in underserved areas. Further large-scale, culturally adapted RCTs are recommended to optimize tele-rehabilitation protocols and assess long-term cost-effectiveness within the Saudi healthcare context.