{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:54:04Z","timestamp":1792086844550,"version":"4.4.0"},"reference-count":43,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Exercise therapy is effective in managing chronic nonspecific neck pain (CNP). Nevertheless, the high burden of CNP continues to place pressure on existing rehabilitation services, especially in remote or resource-constrained settings where continuous and standardized physical therapy may be difficult to access. By combining home-based exercise with remote supervision and movement feedback, AI-enabled telerehabilitation may broaden access to rehabilitation and support the continued management of CNP.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study examined whether an AI-enabled telerehabilitation program was noninferior to standard outpatient rehabilitation for improving neck-related disability in individuals with CNP and compared the effects of the 2 interventions on pain, health-related quality of life, and cervical range of motion.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This multicenter, prospective, parallel-group randomized noninferiority trial was conducted at Peking Union Medical College Hospital and Beijing Jishuitan Hospital. Patients with CNP of at least 3 months\u2019 duration were randomized 1:1 to a telerehabilitation group (TG) or outpatient rehabilitation group (OG) using concealed, web-based, variable blocks stratified by center and baseline Neck Disability Index (NDI) severity. Both groups completed identical 24-week strengthening and stretching programs (3 sessions per wk; \u224830 min per session) and were assessed at weeks 0, 4, 8, 12, and 24. TG trained at home using sensor-based movement recognition and threshold rules; OG received face-to-face outpatient rehabilitation. Week-24 NDI was the primary outcome; Numeric Pain Rating Scale (NPRS), EQ-5D, and cervical range of motion were secondary. Noninferiority required the upper 95% CI bound of the TG-OG NDI difference to be <10 percentage points (5\/50). Analyses were intention-to-treat; assessors and statisticians were blinded.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 312 individuals screened, 116 were randomized (58 per group). At week 24, 55 TG and 53 OG participants completed assessments; all 116 participants were included in the primary intention-to-treat analysis using observed or imputed data. The between-group differences in NDI (TG \u2212 OG) were \u22122.8 (95% CI \u22126.3 to 0.7;\n P<\/jats:italic>\n =.11) at week 12 and \u22122.5 (95% CI \u22126.2 to 1.2;\n P<\/jats:italic>\n =.15) at week 24. At week 24, the upper 95% CI bound was below the prespecified noninferiority margin of 10 percentage points on the 0 to 100 NDI scale, equivalent to 5 points on the original 0 to 50 scale, demonstrating noninferiority of TG. Both groups showed clinically meaningful reductions in NDI, with comparable improvements in NPRS, EQ-5D, and cervical range of motion. No intervention-related harms occurred.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Over 24 weeks, AI-enabled telerehabilitation was noninferior to exercise-matched outpatient rehabilitation for neck-related disability, with broadly comparable improvements in pain, health-related quality of life, and cervical range of motion. AI-enabled telerehabilitation may be a practical alternative for patients with CNP who are unable to attend outpatient rehabilitation.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/87487","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:41:55Z","timestamp":1792086115000},"page":"e87487-e87487","source":"Crossref","is-referenced-by-count":0,"title":["AI-Enabled Telerehabilitation for Chronic Nonspecific Neck Pain: Multicenter Randomized Controlled Trial"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3935-5637","authenticated-orcid":false,"given":"Yiwei","family":"Zhao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7779-4775","authenticated-orcid":false,"given":"Yanbin","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8195-9042","authenticated-orcid":false,"given":"Ye","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7372-0098","authenticated-orcid":false,"given":"Di","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2766-2645","authenticated-orcid":false,"given":"Jiamin","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0274-1825","authenticated-orcid":false,"given":"Siyi","family":"Cai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"issue":"9","key":"R1","doi-asserted-by":"publisher","first-page":"A1","DOI":"10.2519\/jospt.2008.0303","article-title":"Neck pain: clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopedic Section of the American Physical Therapy Association","volume":"38","author":"Childs","journal-title":"J Orthop Sports Phys Ther"},{"issue":"2","key":"R2","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1016\/j.mayocp.2014.09.008","article-title":"Epidemiology, diagnosis, and treatment of neck pain","volume":"90","author":"Cohen","journal-title":"Mayo Clin Proc"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m791","article-title":"Global, regional, and national burden of neck pain in the general population, 1990-2017: systematic analysis of the Global Burden of Disease Study 2017","volume":"368","author":"Safiri","journal-title":"BMJ"},{"issue":"3","key":"R4","doi-asserted-by":"publisher","first-page":"e142","DOI":"10.1016\/S2665-9913(23)00321-1","article-title":"Global, regional, and national burden of neck pain, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021","volume":"6","author":"Wu","journal-title":"Lancet Rheumatol"},{"issue":"1","key":"R5","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-021-04957-4","article-title":"Neck pain: global epidemiology, trends and risk factors","volume":"23","author":"Kazeminasab","journal-title":"BMC Musculoskelet Disord"},{"issue":"12","key":"R6","doi-asserted-by":"publisher","first-page":"2804","DOI":"10.1097\/j.pain.0000000000003298","article-title":"Temporal trends and projections in the global burden of neck pain: findings from the Global Burden of Disease Study 2019","volume":"165","author":"Cheng","journal-title":"Pain"},{"issue":"1","key":"R7","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-025-08331-6","article-title":"Global burden of neck pain and its gender and regional inequalities from 1990 to 2021: a comprehensive analysis from the Global Burden of Disease Study 2021","volume":"26","author":"Wu","journal-title":"BMC Musculoskelet Disord"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.7189\/jogh.14.04066","article-title":"Burden of neck pain in general population of China, 1990-2019: an analysis for the Global Burden of Disease Study 2019","volume":"14","author":"Xia","journal-title":"J Glob Health"},{"issue":"9","key":"R9","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1001\/jama.2020.0734","article-title":"US health care spending by payer and health condition, 1996-2016","volume":"323","author":"Dieleman","journal-title":"JAMA"},{"key":"R10","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j3221","article-title":"Advances in the diagnosis and management of neck pain","volume":"358","author":"Cohen","journal-title":"BMJ"},{"issue":"12","key":"R11","doi-asserted-by":"publisher","first-page":"1658","DOI":"10.1177\/02692155241268373","article-title":"Prognostic factors of pain, disability, and poor outcomes in persons with neck pain - an umbrella review","volume":"38","author":"Gerard","journal-title":"Clin Rehabil"},{"issue":"20","key":"R12","doi-asserted-by":"publisher","first-page":"552","DOI":"10.3238\/arztebl.m2025.0119","article-title":"Clinical practice guideline: nonspecific neck pain","volume":"122","author":"El-Allawy","journal-title":"Dtsch Arztebl Int"},{"key":"R13","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.1028235","article-title":"Regional maldistribution of human resources of rehabilitation institutions in China Mainland based on spatial analysis","volume":"10","author":"Chen","journal-title":"Front Public Health"},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.929675","article-title":"Study on the rehabilitation therapist estimation under institutional perspective by applying the Workload Indicators of Staffing Needs in the aging context","volume":"10","author":"Jing","journal-title":"Front Public Health"},{"issue":"3","key":"R15","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/pzaf014","article-title":"Current and projected future supply and demand for physical therapists from 2022 to 2037: a new approach using microsimulation","volume":"105","author":"Zarek","journal-title":"Phys Ther"},{"issue":"3","key":"R16","doi-asserted-by":"publisher","DOI":"10.22605\/RRH6614","article-title":"Values that influence employment acceptance among physical therapists practicing in primary care shortage and non-urban designation areas","volume":"21","author":"Berg-Poppe","journal-title":"Rural Remote Health"},{"issue":"4","key":"R17","doi-asserted-by":"publisher","first-page":"434","DOI":"10.34172\/ijhpm.2020.150","article-title":"Is physical rehabilitation need associated with the rehabilitation workforce supply? An ecological study across 35 high-income countries","volume":"11","author":"Jesus","journal-title":"Int J Health Policy Manag"},{"issue":"6","key":"R18","doi-asserted-by":"publisher","first-page":"815","DOI":"10.2105\/AJPH.2020.305579","article-title":"Transportation barriers to health care in the United States: findings from the National Health Interview Survey, 1997-2017","volume":"110","author":"Wolfe","journal-title":"Am J Public Health"},{"issue":"1","key":"R19","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-022-14149-x","article-title":"Transportation barriers to care among frequent health care users during the COVID pandemic","volume":"22","author":"Cochran","journal-title":"BMC Public Health"},{"issue":"1","key":"R20","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-024-10947-8","article-title":"Identifying barriers to outpatient appointment attendance in patient groups at risk of inequity: a mixed methods study in a London NHS trust","volume":"24","author":"Sung","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"R21","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-024-07952-7","article-title":"Exercise-based telerehabilitation in chronic low back pain: a scoping review","volume":"25","author":"Sivertsson","journal-title":"BMC Musculoskelet Disord"},{"issue":"12","key":"R22","doi-asserted-by":"publisher","first-page":"1734","DOI":"10.1089\/tmj.2021.0599","article-title":"Efficacy of e-health interventions in patients with chronic low-back pain: a systematic review with meta-analysis","volume":"28","author":"Lara-Palomo","journal-title":"Telemed J E Health"},{"issue":"2","key":"R23","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1089\/tmj.2023.0018","article-title":"Effects of interactive telerehabilitation practices in office workers with chronic nonspecific neck pain: randomized controlled study","volume":"30","author":"\u00d6zl\u00fc","journal-title":"Telemed J E Health"},{"issue":"6","key":"R24","doi-asserted-by":"publisher","first-page":"361","DOI":"10.2519\/jospt.2024.12216","article-title":"Which remote rehabilitation interventions work best for chronic musculoskeletal pain and depression? A Bayesian network meta-analysis","volume":"54","author":"Bobos","journal-title":"J Orthop Sports Phys Ther"},{"issue":"7","key":"R25","first-page":"409","volume":"14","author":"Vernon","journal-title":"J Manipulative Physiol Ther"},{"issue":"5","key":"R26","doi-asserted-by":"publisher","first-page":"400","DOI":"10.2519\/jospt.2009.2930","article-title":"Measurement properties of the neck disability index: a systematic review","volume":"39","author":"MacDermid","journal-title":"J Orthop Sports Phys Ther"},{"issue":"2","key":"R27","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1016\/S0304-3959(01)00349-9","article-title":"Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale","volume":"94","author":"Farrar","journal-title":"Pain"},{"issue":"6","key":"R28","doi-asserted-by":"publisher","first-page":"1523","DOI":"10.1007\/s11136-004-7713-0","article-title":"Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D","volume":"14","author":"Walters","journal-title":"Qual Life Res"},{"key":"R29","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7525-5-70","article-title":"Estimation of minimally important differences in EQ-5D utility and VAS scores in cancer","volume":"5","author":"Pickard","journal-title":"Health Qual Life Outcomes"},{"key":"R30","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2024-081123","article-title":"CONSORT 2025 statement: updated guideline for reporting randomised trials","volume":"389","author":"Hopewell","journal-title":"BMJ"},{"issue":"4","key":"R31","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.1923","article-title":"CONSORT-EHEALTH: improving and standardizing evaluation reports of web-based and mobile health interventions","volume":"13","author":"Eysenbach","journal-title":"J Med Internet Res"},{"issue":"2","key":"R32","doi-asserted-by":"publisher","DOI":"10.1002\/msc.70119","article-title":"Effectiveness of telerehabilitation exercise programme on disability and pain in patients with chronic non-specific neck pain: randomised controlled trial assessor-blinded","volume":"23","author":"Barbosa","journal-title":"Musculoskeletal Care"},{"issue":"7","key":"R33","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare12070796","article-title":"Effects of telerehabilitation on pain and disability in patients with chronic neck pain: a systematic review and meta-analysis","volume":"12","author":"Valenza-Pe\u00f1a","journal-title":"Healthcare (Basel)"},{"key":"R34","doi-asserted-by":"publisher","DOI":"10.12688\/f1000research.160247.2","article-title":"Effects of 6-week telerehabilitation exercise programme on chronic non-specific neck pain in women: a pilot randomized controlled trial","volume":"14","author":"Ahmed","journal-title":"F1000Res"},{"issue":"24","key":"R35","doi-asserted-by":"publisher","DOI":"10.3390\/s24248069","article-title":"Effectiveness of a telerehabilitation-based exercise program in patients with chronic neck pain-a randomized clinical trial","volume":"24","author":"Guerra-Arencibia","journal-title":"Sensors (Basel)"},{"issue":"1","key":"R36","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-025-09010-2","article-title":"Effects of combined supervised and telerehabilitation exercise programs on pain and disability in dentists with chronic neck pain: a randomized controlled trial","volume":"26","author":"Alkan","journal-title":"BMC Musculoskelet Disord"},{"issue":"23","key":"R37","doi-asserted-by":"publisher","first-page":"1971","DOI":"10.3109\/09638288.2012.665128","article-title":"Effects of long-term home-based exercise on health-related quality of life in patients with chronic neck pain: a randomized study with a 1-year follow-up","volume":"34","author":"Salo","journal-title":"Disabil Rehabil"},{"key":"R38","doi-asserted-by":"publisher","DOI":"10.2196\/56580","article-title":"The physical and psychological effects of telerehabilitation-based exercise for patients with nonspecific low back pain: prospective randomized controlled trial","volume":"12","author":"Shi","journal-title":"JMIR mHealth uHealth"},{"key":"R39","doi-asserted-by":"publisher","DOI":"10.2196\/44316","article-title":"Engagement and utilization of a complete remote digital care program for musculoskeletal pain management in urban and rural areas across the United States: longitudinal cohort study","volume":"11","author":"Scheer","journal-title":"JMIR mHealth uHealth"},{"key":"R40","doi-asserted-by":"publisher","DOI":"10.2196\/68681","article-title":"The safety of telerehabilitation: systematic review","volume":"12","author":"Shnitzer","journal-title":"JMIR Rehabil Assist Technol"},{"key":"R41","doi-asserted-by":"publisher","DOI":"10.2196\/66037","article-title":"Effect of digital exercise therapy on the pain and physical function of patients with osteoarthritis: systematic review and meta-analysis","volume":"27","author":"Long","journal-title":"J Med Internet Res"},{"key":"R42","doi-asserted-by":"publisher","DOI":"10.2196\/47172","article-title":"Economic evaluation of telerehabilitation: systematic literature review of cost-utility studies","volume":"10","author":"Baffert","journal-title":"JMIR Rehabil Assist Technol"},{"key":"R43","doi-asserted-by":"publisher","DOI":"10.2196\/49673","article-title":"Managing musculoskeletal pain in older adults through a digital care solution: secondary analysis of a prospective clinical study","volume":"10","author":"Areias","journal-title":"JMIR Rehabil Assist Technol"}],"container-title":["JMIR Formative Research"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:41:56Z","timestamp":1792086116000},"score":1,"resource":{"primary":{"URL":"https:\/\/formative.jmir.org\/2026\/1\/e87487"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,15]]},"references-count":43,"URL":"https:\/\/doi.org\/10.2196\/87487","relation":{},"ISSN":["2561-326X"],"issn-type":[{"value":"2561-326X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,15]]},"article-number":"v10i9e87487"}}