Digital interventions for promoting exercise adherence in chronic musculoskeletal pain: a systematic review and meta-analysis

Research output: Contribution to journalReview articlepeer-review


Background: Chronic musculoskeletal disorders are the second largest contributor to disability globally. Exercise is typically recommended by physiotherapists to manage symptoms. However, adherence to the prescribed exercise programme is often poor. Adjunctive digital interventions offer potential to enhance exercise adherence. Objectives: To review evidence on the effectiveness of digital interventions for improving exercise adherence in people with chronic musculoskeletal conditions. The study is reported in line with PRISMA guidance and was registered with PROSPERO (CRD42019124502). Data Sources: MEDLINE, Embase and PsycInfo were searched using a comprehensive search strategy. The reference lists of all included papers and relevant systematic reviews identified during the search were scanned for relevant articles. Study appraisal and synthesis methods: Two researchers independently checked articles for inclusion and extracted data. Results: The search returned a total of 4257 results of which five trials were included in the review and two studies were included in a random effects meta-analysis. There was no statistically significant difference in exercise adherence (SMD: 0.23; 95% CI: −0.10, 0.57). Studies that were not suitable for inclusion in the meta-analysis reported similar results. Heterogeneity of effects was high and study quality ranged from low to moderate. All of the meta-analysed data related to osteoarthritis of the hip and/or knee. Conclusion: We found no evidence that digital interventions enhance adherence to therapeutic exercise in patients with chronic musculoskeletal disorders. However, further, high quality research is required to draw definitive conclusions on their effectiveness and to identify key components that are associated with effectiveness. Systematic Review Registration Number: PROSPERO CRD42019124502

Bibliographic note

Funding Information: The authors would like to thank Yeu-Hui Chuang (School of Nursing, Taipei Medical University) and Adrian Schoo (School of Physiotherapy, La Trobe University) for providing additional data to help in the meta-analysis. Publisher Copyright: © 2020 Copyright: Copyright 2020 Elsevier B.V., All rights reserved.


Original languageEnglish
JournalPhysiotherapy (United Kingdom)
Publication statusAccepted/In press - 2020


  • Digital interventions, Musculoskeletal, Osteoarthritis, Physical activity, Systematic review