Remote Rehabilitation and Virtual Reality Interventions Using Motion Sensors for Chronic Low Back Pain: A Systematic Review of Biomechanical, Pain, Quality of Life, and Adherence Outcomes

Background: Chronic low back pain (CLBP) is a leading cause of disability, impacting quality of life (QoL), function, and work productivity. Traditional rehabilitation faces challenges in accessibility and adherence. Remote rehabilitation and virtual reality (VR) interventions using motion sensors offer real-time movement tracking, biofeedback, and personalized exercises. This systematic review evaluates their effectiveness in pain reduction, functional improvement, adherence, and QoL. Methods: A systematic search was performed across PubMed, Scopus, Web of Science, and PEDro (2015-2025), including randomized controlled trials, observational, and feasibility studies on adults with CLBP undergoing sensor-based digital rehabilitation. The primary outcomes included pain, functional mobility, and movement biomechanics; secondary outcomes included adherence, QoL, and cost-effectiveness. Eight studies involving 7166 participants were included. Overall, sensor-based remote rehabilitation and VR interventions demonstrated positive effects on pain, function, and adherence. Pain reductions ranged from modest short-term decreases to over 60% in long-term programs (e.g., -68.5% in VAS). Functional improvements included lumbar ROM gains up to +9.9 degrees and better movement control. Adherence was consistently high, with some programs reporting completion rates between 73% and 90%, particularly those incorporating gamification or real-time feedback. Selected studies also showed QoL improvements (e.g., +9.10 points on SF-36) and reductions in work impairment by over 60%. A few trials reported significant decreases in inflammatory markers (e.g., CRP -1.16 mg/L, TNF-alpha -8.9 pg/mL). Conclusions: Motion sensor-based remote rehabilitation and VR interventions show promising results in pain management, mobility, and adherence for individuals with CLBP. Gamification and biofeedback features enhance engagement, addressing a key challenge of conventional rehabilitation. However, more long-term RCTs and economic evaluations are needed to confirm their effectiveness and cost-efficiency.