Tele-Rehab for MS: Boosting Exercise Adherence and Outcomes from Home

For our patients with Multiple Sclerosis, the challenge of maintaining a consistent and effective exercise routine is a familiar story. Barriers such as fatigue, mobility limitations, and the simple logistics of travel can make attending in-person physiotherapy a significant hurdle. However, a growing body of high-quality evidence is demonstrating that we can bring the clinic to the patient through tele-rehabilitation, with impressive results. A recent systematic review and meta-analysis published in 2025 by Najafi and colleagues provides a robust confirmation of this approach. The study, which synthesized data from 13 randomized controlled trials (RCTs) involving 832 participants, found that tele-exercise interventions led to significant improvements across a range of crucial outcomes for people with MS. Specifically, the meta-analysis revealed a moderate to large effect size for improvements in depression (Standardized Mean Difference [SMD] = -0.51), fatigue (SMD = -0.58), physical health (SMD = 0.62), and mental health (SMD = -0.48). The impact on overall quality of life (QoL) was also statistically significant, though with a slightly smaller effect size (SMD = 0.38). What’s particularly insightful for us as clinicians is the breakdown of which tele-exercise modalities seem to be most effective. The meta-analysis categorized interventions into two main types: Mind-Body Training (such as yoga and Pilates) and Combination Training (which typically includes a mix of aerobic, strength, and balance exercises). The results consistently showed that Mind-Body Training had a larger positive impact across all measured outcomes compared to Combination Training. This suggests that for our MS patients struggling with fatigue, depression, and overall well-being, a remotely delivered yoga or Pilates program could be a particularly powerful tool. Another key piece of the puzzle comes from a 2024 systematic review and meta-analysis by Doherty and colleagues, which focused specifically on mobility and balance. This study, which included five RCTs with 225 participants, found that telerehabilitation had a statistically significant positive effect on both mobility (SMD = 0.41) and balance (SMD = 0.64). This is a critical finding, as mobility and balance are often primary concerns for our MS patients. The review also highlighted the role of biofeedback systems in increasing patient motivation and adherence, a crucial factor for long-term success. The authors even suggested that real-time, remotely supervised Pilates could be a highly effective approach for MS rehabilitation. So, what does this look like in practice? The interventions in these studies varied, but they often involved a combination of real-time video conferencing with a physiotherapist and pre-recorded exercise videos. Some studies also incorporated wearable technology to monitor activity levels and provide feedback. The key is that these approaches offer a level of flexibility and convenience that traditional in-person therapy cannot match. Patients can exercise in the comfort and safety of their own homes, at times that work best for them, while still receiving expert guidance and support. Of course, it's not a one-size-fits-all solution. Patient selection is key. We need to consider factors such as the patient's comfort level with technology, their cognitive function, and their home environment. However, for many of our MS patients, tele-rehabilitation offers a promising and evidence-based way to overcome the barriers to exercise and achieve meaningful improvements in their health and well-being. The research is clear: we can effectively deliver high-quality physiotherapy remotely, and in doing so, empower our patients to take a more active role in managing their condition.