Exploring telerehabilitation awareness, application, and future outlook in sports rehabilitation among physiotherapy students: a web-based survey

Study design and participants

We conducted a web-based cross-sectional survey targeting the physiotherapy students currently enrolled in undergraduate, postgraduate, and doctoral programs. Given the absence of a global or domestic database of physiotherapy students, the study used a non-probability sampling method to obtain preliminary insights and facilitate the recruitment of targeted physiotherapy students from diverse geographic regions. The data collection was conducted between August 2023 and March 2024. This web-based cross-sectional study adheres to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline (Supplemental File) (STROBE Group, 2007). Ethical approval was obtained from the Institutional Scientific Review Board of Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences (SIMATS), India (Approval No. 03/001/2023/ISRB/UGSR/SCPT). Of the 587 students who completed the survey, 524 met the selection criteria. Sixty-three students were excluded from the study as they had not completed the sports physiotherapy module at the time of the survey (n = 42), had duplicate responses (n = 14), or lacked physiotherapy background (n = 7). We recruited students from various regions of India, including North India (17.4%), South India (23.3%), East India (13.4%), West India (10.5%), Central India (6.9%), North East India (8.4%), and North West India (0.8%). Additionally, we included physiotherapy students from various regions outside India, such as South Asia (2.5%), Southeast Asia (10.9%), the Middle East (4%), Oceania (1.3%), and Europe (0.8%). The participants included current undergraduate students who had completed their sports physiotherapy module, postgraduate students, and students pursuing Ph.D. in Physiotherapy in various institutions within India or globally. These groups were selected to capture a range of academic exposure and practical experience in physiotherapy, contributing to a comprehensive understanding of telerehabilitation perspectives. The participants enrolled in disciplines other than physiotherapy were excluded to maintain the study’s relevance to the field and ensure focused data collection. Additionally, the participants with limited English proficiency were excluded to ensure full comprehension of telerehabilitation terms and concepts, which would enhance response accuracy and data reliability.

Survey development and distribution

A self-constructed validated questionnaire containing 42 questions was divided into four parts: screening, awareness, application, and future outlook. A self-explanatory note accompanied the questionnaire to ensure reproducibility, allowing for consistent administration across different participant groups and study settings (Supplemental Material). The questionnaire began with an informed consent statement, requiring the participants to provide consent by clicking a checkbox before proceeding, and an expert panel validated the questionnaire contents. A pilot test was conducted with 50 participants to assess consistency and identify potential issues. Based on the findings, the questionnaire was revised, and internal consistency was confirmed using Cronbach’s alpha test. A survey form was created using Google Forms and disseminated via several platforms, including Gmail, WhatsApp, LinkedIn, Telegram, Facebook, Line, and Instagram. It was also displayed as a QR code at conferences. In accordance with regulations set by the Institutional Scientific Review Board, we did not collect IP addresses or use cookies to maintain the anonymity of respondents.

Reliability test

Cronbach’s alpha was used to test the reliability of three parts of the questionnaire. Cronbach’s alpha was 0.857 for the awareness part, 0.890 for the application part, and 0.962 for the future outlook. These Cronbach’s alpha values indicate acceptable reliability for the respective constructs.

Demographic characteristics

Table 1 shows the demographic characteristics of the students. The majority, 328 (62.6%) students were in the 21–25 age range. Among the students, 286 (54.6%) were female, while 238 (45.5%) were male. The majority of students, 389 (74.2%), were from the undergraduate category, and 422 (80.5%) were from various regions across India.

Screening questions about telerehabilitation

Screening questions were necessary to filter out students based on their knowledge about telerehabilitation (Table 2). The students with minimal prior knowledge of telerehabilitation, but who had completed the sports module in their physiotherapy curriculum, were included in the survey. Their level of awareness, application, and future outlook are summarized in Table 3.

Although 65.3% of the students were aware of the term ‘telerehabilitation’ and had some knowledge of e-health software, only 19.3% reported having telerehabilitation content in their physiotherapy curriculum. More than 59.4% of the students expressed interest in incorporating telerehabilitation into their curriculum. The students reported having limited exposure to telerehabilitation (23.5%), limited interest (5.7%), and an insufficient educational background (4.8%), primarily due to a lack of awareness. The remaining students were not interested, citing preferences for conventional in-person methods, lack of time or resources, or perceived irrelevance to their career goals.

Awareness of telerehabilitation in sports physiotherapy

The maximum score for awareness was 55 (11 items). The quartiles used in the awareness part are as follows: Quartile 1 (0% to 50%), Quartile 2 (51% to 75%), and Quartile 3 (76% to 100%). Awareness levels were categorized as follows: 0 to 27.5 represents a low level of awareness, 27.51 to 41.25 represents a moderate level, and 41.26 to 55 represents a high level of awareness. A notable number of students were aware of sports telerehabilitation, with 50.3% demonstrating a moderate level of awareness and 32.5% showing a high level of awareness (Table 3).

In Table S1 48.5% of the students agreed that they could be able to differentiate between real-time and store-and-forward telerehabilitation approaches, while a significantly larger proportion (61.1%) of the students could distinguish between telerehabilitation and telemedicine, demonstrating understanding of their unique uses. Awareness of common sports injuries amenable to telerehabilitation was relatively high, with 55.8% of the students agreeing that such conditions are suitable for remote management. Additionally, 59.6% recognized the potential role of telerehabilitation in supporting post-surgical recovery among athletes.

Notably, awareness of professional certification courses related to telerehabilitation remained low, with only 43% of the students indicating agreement. Perceptions regarding the availability of adequate support and resources for students interested in telerehabilitation were divided, as 39.2% agreed while 41.2% disagreed. Regarding the acceptance of telerehabilitation, 65.8% of the students believed that practical physiotherapy techniques are essential for effective sports rehabilitation, suggesting that telerehabilitation may be less suitable. However, 66.3% of the students indicated that incorporating telerehabilitation into the education curriculum would enhance their interest and willingness to use it for sports rehabilitation. Concerning the research and innovations in telerehabilitation, 45.9% of the students were aware of those developments. Moreover, 54.7% viewed telerehabilitation as an environment-friendly replacement for conventional in-person methods. A moderate proportion (43.9%) of the students acknowledged awareness of ethical considerations related to sports telerehabilitation.

Table S2 shows the association between awareness of telerehabilitation and the demographic characteristics of the students, which was analyzed using the chi-square test. Age was significantly associated with awareness of telerehabilitation ( ${\chi }^2$ = 27.541, p = 0.001) with a very strong association (φ = 0.284). Gender ( ${\chi }^2$ = 8.810, p = 0.08) and the academic level ( ${\chi }^2$ = 13.798, p = 0.08) of the students did not establish any significant association with awareness of telerehabilitation. Region was significantly associated with awareness of telerehabilitation ( ${\chi }^2$ = 11.665, p = 0.02), indicating a strong association (φ = 0.185).

The impact of demographic variables on sports telerehabilitation awareness was analyzed using ordinal logistic regression, as this method assesses how demographic factors influence the likelihood of awareness (Table S3). The regression coefficient for female students was –0.29 (p = 0.152), corresponding to an OR of 0.748 (95% CI [0.503–1.113]). This finding suggests that female students were about 25% less likely to report higher awareness compared to male students; however, this difference was not statistically significant. Age was analyzed in three categories, with students over 25 years as the reference group. The students aged 18–20 years had a regression coefficient of 0.472 (p = 0.260), with an OR of 1.60 (95% CI [0.705–3.642]), indicating they were about 1.6 times more likely to report higher awareness compared with the reference group, though this difference was not statistically significant. Similarly, the students aged 21–25 years had a coefficient of –0.210 (p = 0.570), with an OR of 0.811 (95% CI [0.393–1.673]), suggesting they were about 19% less likely to report higher awareness, which also was not statistically significant.

The impact of academic level and region on the students’ awareness of sports telerehabilitation was also analyzed using ordinal logistic regression. When compared to the Ph.D. students (reference group), the undergraduate students had a regression coefficient of –0.173 (p = 0.739), with an OR of 0.841 (95% CI [0.303–2.332]), suggesting they were about 16% less likely to report higher awareness; however, the result was not statistically significant. The postgraduate students had a regression coefficient of –0.403, corresponding to an OR of 0.668 (95% CI [0.240–1.857]), indicating they were about 33% less likely to report higher awareness relative to the Ph.D. students, but this association was also not statistically significant.

By contrast, region was a statistically significant predictor. The students residing in India had a regression coefficient of 0.669 (p = 0.013), with an OR of 1.952 (95% CI [1.153–3.308]), indicating they were nearly twice as likely to have higher awareness compared to students from other countries. This significant regional difference could be attributed to the greater exposure to telerehabilitation practices or varying educational emphases in physiotherapy programs. These findings highlight the need for tailored educational strategies aimed at enhancing telerehabilitation awareness, particularly among students at lower academic levels and in regions with limited exposure.

Application knowledge on telerehabilitation in sports physiotherapy

The maximum score for application knowledge was 65 (13 items). The quartiles used for categorization are as follows: Quartile 1 (0–50%), Quartile 2 (51–75%), and Quartile 3 (76–100%). Application knowledge levels are classified as follows: 0–32.5 represents a low level, 32.51–48.75 represents a moderate level, and 48.76–65 represents a high level. Table 3 presents the distribution of application knowledge levels. A notable number of the students demonstrated application knowledge of telerehabilitation in the sports realm, with 36.5% reporting a moderate level and 47.7% reporting a high level of application knowledge (Table 3).

Table S4 shows that 55.6% of the students believed that offering telerehabilitation as a treatment choice reduces the overall cost of sports rehabilitation for athletes and organizations. Despite that, 44.4% of the students indicated some uncertainty about its cost-effectiveness. When considering the availability of resources, including software and technologies, 58.4% agreed that resource availability affects the effectiveness of telerehabilitation. Other students highlighted their concerns about resource limitations. A majority of the students (76%) agreed that telerehabilitation can bridge geographical gaps, establishing access to high-quality physiotherapy services in remote areas, while 78.9% agreed that telerehabilitation ensures effective communication and motivation for athletes.

The integration of telerehabilitation with virtual reality to create engaging rehabilitation experiences was supported by 65.8% of the students, while some expressed disbelief in this technological advancement. Telerehabilitation achieving the same outcomes as conventional in-person rehabilitation is observed heterogeneously, with 36.2% agreeing and 43% disagreeing. This heterogeneity reveals that the students see the potential aid of telerehabilitation, while others are skeptical of its effectiveness compared to conventional methods. Approximately 55% of the students believed that athletes favor quicker access to telerehabilitation services, indicating a need for further upgrades to enhance its accessibility. A significant number of the students (73.4%) believed that telerehabilitation contributes to a sustainable approach by reducing the need for travel resources.

The statement that telerehabilitation enhances access to sports rehabilitation expertise for amateur athletes and those with economic problems was supported by 54.6% of the students. Approximately 64% of the students agreed on the necessity of ongoing research and evidence-based practice for the implementation of telerehabilitation. Most students (58.5%) favored the development of a specialty course for telerehabilitation within the physiotherapy discipline. However, 27.2% of the students opposed the inclusion of such specialty courses, while 69.6% supported the capability of telerehabilitation to effectively monitor athlete progress, reflecting strong confidence in its tracking potential. Additionally, 55.9% believed that telerehabilitation contributes to reducing recovery time following sports injuries. However, 28.6% disagreed with the previous statement, highlighting diverse perspectives regarding telerehabilitation effectiveness in accelerating rehabilitation.

Table S5 shows the association between the students’ application knowledge of telerehabilitation and the demographic characteristics, which was analyzed using the chi-square test. A significant association was found between age and the application knowledge of telerehabilitation ( ${\chi }^2$ = 35.215, p < 0.0001), with a strength of association (φ = 0.227). Additionally, gender demonstrated a significant association with the application of telerehabilitation ( ${\chi }^2$ = 12.272, p = 0.015), with a strength of association (φ = 0.189). The association between students’ academic level and the application of telerehabilitation was not statistically significant ( ${\chi }^2$ = 13.603, p = 0.093). Also, region had no significant association with the application of telerehabilitation ( ${\chi }^2$ = 6.972, p = 0.137).

The impact of demographic predictors on application knowledge of sports telerehabilitation was examined using ordinal logistic regression, as detailed in Table S6. Gender was not a significant predictor, with a regression coefficient of –0.228 for females (p = 0.261), corresponding to an OR of 0.796. This finding suggests that female students were about 20% less likely to demonstrate higher levels of application knowledge compared to males; however, this difference was not statistically significant. Age was found to be a significant predictor. Students aged 18–20 had a regression coefficient of –1.509 (p < 0.001), OR = 0.221, with a 95% confidence interval (CI) of [0.513–0.950], indicating they were approximately 78% less likely to report higher application knowledge compared with those over 25 years. Conversely, the 21–25 age group had a coefficient of –0.339 (p = 0.367), OR = 0.712, suggesting they were about 29% less likely to report higher application knowledge, though this difference was not statistically significant.

Academic level did not significantly predict application knowledge. The undergraduate students had a coefficient of –0.149 (p = 0.779, OR = 0.862), suggesting they were about 14% less likely to demonstrate higher application knowledge than the Ph.D. scholars. The postgraduate students had a coefficient of –0.522 (p = 0.324, OR = 0.593), indicating they were about 41% less likely to do so. However, neither difference was statistically significant. Region also did not have a statistically significant effect. The students from India had a regression coefficient of –0.305 (p = 0.259), OR = 0.737, suggesting they were about 26% less likely to report higher application knowledge than the students from other countries, though this difference was not statistically meaningful.

These findings highlight age, particularly the 18 to 20 age group, as the most influential demographic factor associated with lower levels of knowledge regarding the application of sports telerehabilitation. This finding underscores the need to integrate telerehabilitation training earlier in physiotherapy education to strengthen the digital rehabilitation competencies of younger students.

Future outlook on telerehabilitation in sports physiotherapy

The maximum score for future outlook was 55 (11 items). The quartiles used for categorization were as follows: Quartile 1 (0–50%), Quartile 2 (51–75%), and Quartile 3 (76–100%). Future outlook levels were classified as follows: 0–27.5 represents a low level, 27.51–41.25 represents a moderate level, and 41.26–55 represents a high level. The distribution of future outlook levels is presented in Table 3. A notable number of students have a positive future outlook on telerehabilitation in the sports realm, with 34.2% showing a moderate outlook and 49.4% demonstrating a high level of application knowledge (Table 3).

In Table S6, 56.4% of the students expressed a willingness to invest time and effort in staying updated on advancements in telerehabilitation technologies. While 45.1% supported the feasibility of telerehabilitation as a standard practice in sports rehabilitation, 54.9% remained neutral or expressed doubt, indicating uncertainty regarding its practical implementation. A majority (57.6%) considered the integration of telerehabilitation into the physiotherapy curriculum to be essential, though 27.2% were neutral and 15.2% disagreed, reflecting mixed opinions. A belief in the growing acceptance and recognition of telerehabilitation within the healthcare sector was held by 60.5% of the students, while 39.4% expressed hesitation or disagreement. Furthermore, 60.8% anticipated that telerehabilitation would evolve to address challenges in sports rehabilitation, although 12.6% were uncertain and 26.6% disagreed. Most students perceived a benefit in utilizing telerehabilitation for personalized AI-guided routines, with 57.9% expressing agreement. Meanwhile, 26.6% remained neutral, and 15.5% disagreed. Regarding the future potential of telerehabilitation for neurofeedback to enhance mental resilience during recovery, 45.9% supported the idea, while 40.6% were neutral and 13.5% expressed disagreement, reflecting diverse perspectives.

Nearly half of the students (44.4%) acknowledged the influence of regulatory or legal aspects on preparedness to incorporate telerehabilitation, while 43.3% remained neutral, indicating notable uncertainty regarding its impact. Of the students, 50.3% perceived telerehabilitation as an effective means of enhancing athlete engagement and promoting active participation in rehabilitation, while 35.1% remained neutral and 14.6% disagreed, indicating varied perceptions among participants. Technical issues, such as poor network connectivity, were seen as a limiting factor by 61.1% of the students, whereas 24.3% were neutral and 14.7% did not view it as a significant barrier. Furthermore, 59.6% identified difficulties in accurately assessing athlete progress through telerehabilitation, though 26.9% were neutral and 13.5% did not perceive this as a concern.

Table S7 shows the association between the future outlook of telerehabilitation and the demographic characteristics of students, which was analyzed using the chi-square test. Age was significantly associated with the future outlook of telerehabilitation ( ${\chi }^2$ = 31.621, p < 0.0001), showing a weak association (φ = 0.215). Gender did not show a significant association ( ${\chi }^2$ = 6.831, p = 0.141). The association between students’ academic level and the future outlook of telerehabilitation was not statistically significant ( ${\chi }^2$ = 9.972, p = 0.267). Also, the region showed no significant association with the future outlook of telerehabilitation ( ${\chi }^2$ = 8.131, p = 0.087).

Table S8 presents the results of a multinomial logistic regression analysis examining demographic predictors of future outlook toward telerehabilitation, with the moderate category used as the reference. The analysis used a quartile-based categorization to assess how various demographic factors influenced participants’ perceptions. The intercept for the low-level future outlook category was not statistically significant (p = 0.365), indicating that, in the absence of demographic influences, the likelihood of having a low future outlook does not significantly differ from the moderate category.

Gender emerged as a statistically significant predictor. The regression coefficient for females was –0.866 (Wald = 6.099, p = 0.014), with an OR of 0.420. This finding indicates that, compared with males, female students were significantly 58% less likely to report a low future outlook on telerehabilitation. In other words, female students showed a more optimistic perspective toward the future of telerehabilitation.

The regression analysis further identified age as a significant predictor of future outlook toward telerehabilitation. For the 18–20 age group, the regression coefficient was 3.423 (Wald = 7.269, p = 0.007), with an OR of 30.676. This finding means that individuals aged 18–20 were over 30 times more likely to report a low future outlook compared to those over 25 years, indicating a significantly more pessimistic perspective. Similarly, for the 21–25 age group, the coefficient was 2.697 (p = 0.023), with an OR of 14.840, meaning they were nearly 15 times more likely to report a low future outlook than those aged over 25, thereby reflecting a significantly less positive perception. Regarding academic level, the undergraduate students had a regression coefficient of –1.255 (p = 0.334), with an OR of 0.285, suggesting they were about 71% less likely to report a low outlook than the Ph.D. students, although this result was not statistically significant. The postgraduate students also showed no significant difference (coefficient = 0.109, p = 0.931), indicating outlook levels similar to the Ph.D. scholars. Region emerged as a significant predictor. The students from India had a regression coefficient of –1.424 (p = 0.002), with an OR of 0.241, indicating they were about 76% less likely to report a low future outlook than the students from other regions. This finding suggests a more positive perception of telerehabilitation among the Indian students.

The intercept for the high level of future outlook category was not statistically significant (p = 0.816), suggesting that, without considering demographic factors, the chances of having a high future outlook are not significantly different from having a moderate one. Gender was a significant predictor, with a regression coefficient of –0.527 (p = 0.047) and an OR of 0.590. This data means that female students were about 41% less likely to report a high future outlook compared to male students. Age also played a significant role. The students aged 18–20 had a coefficient of –1.810 (p = 0.001), with an OR of 0.164, meaning they were about 84% less likely to express a high future outlook compared to those over 25 years. By contrast, the 21–25 age group did not show a significant difference (coefficient = –0.263, p = 0.579, OR = 0.769), indicating similar future outlook levels to the older age group.

Academic level analysis indicated that the undergraduate students had a regression coefficient of 1.056 (p = 0.099), which suggests a potential but not statistically significant association. The OR of 2.875 implies that undergraduates were nearly three times more likely to report a high future outlook than the Ph.D. students, though this result should be interpreted with caution. The postgraduate students also showed no significant association (coefficient = 0.524, p = 0.407, OR = 1.689), indicating only a slight, non-significant increase in the likelihood of a high future outlook. Region was a statistically significant predictor. The students from India had a regression coefficient of 0.733 (p = 0.046) and an OR of 2.082, meaning they were more than twice as likely to report a high future outlook toward telerehabilitation compared to students from other regions. This finding highlights notable regional differences in optimism about the future use of telerehabilitation technologies.

Screening of physiotherapy students about sports telerehabilitation awareness

The screening phase of the study was performed to scrutinize the baseline knowledge of physiotherapy students regarding sports telerehabilitation. A key objective of this screening part was to ensure that the students had sufficient knowledge of sports telerehabilitation to participate in the survey. A substantial number of the students were familiar with the term ‘telerehabilitation,’ having primarily learned about it through social media platforms, highlighting the significant role social media plays in raising awareness about telerehabilitation (Başer Seçer & Çeliker Tosun, 2022). The students who are not familiar with the term indicated a lack of exposure and limited educational background as the major reasons, implying the necessity of incorporating telerehabilitation education into the physiotherapy curriculum to prevent the knowledge gap (Medoff-Cooper et al., 2015). Most students expressed interest in receiving education on telerehabilitation in their curriculum, particularly focusing on practical patient virtual assessment and telecommunication technologies, and this interest indicates an understanding of telerehabilitation’s importance in sports physiotherapy (Başer Seçer & Çeliker Tosun, 2022).

Awareness

The physiotherapy students exhibited varying levels of awareness regarding the multidimensional aspects of telerehabilitation. Most demonstrated a moderate level of awareness of sports telerehabilitation, reflecting a basic understanding of its concepts. This finding highlights the need for more comprehensive education and professional development opportunities. The COVID-19 pandemic further accelerated the integration of telehealth services, emphasizing the importance of preparing future healthcare professionals to effectively utilize advanced technologies (Wosik et al., 2020; Gilmutdinova et al., 2021; Kim et al., 2022). Telerehabilitation is an effective approach for managing various conditions by enabling remote assessment, monitoring, and intervention in chronic disease management. It allows for continuous tracking of vital signs, medication adherence, and lifestyle modifications, ensuring timely and appropriate interventions (Anton et al., 2018).

The students’ levels of awareness were shaped by their prior exposure to telerehabilitation, whether through academic training or informal sources such as research articles, social media, and workshops (Shaw, 2023). Those with greater external exposure demonstrated higher awareness, whereas those with limited exposure showed lower understanding. This discrepancy points to the lack of standardization in physiotherapy curricula, where telerehabilitation is not consistently included, leading to uneven knowledge among the students. Moreover, limited familiarity with digital health technologies likely contributed to lower awareness scores, as the students with less exposure to healthcare innovations struggled to grasp telerehabilitation concepts.

Demographic factors were found to significantly influence the awareness levels of physiotherapy students. Notably, students in the 18–20 age group exhibited a higher level of awareness than those over 25 years old. This trend aligns with the findings of Mbada et al. (2021), who described the younger generation’s status as “digital natives,” individuals who have grown up using smartphones, computers, and other digital platforms, naturally enhancing their comfort and familiarity with emerging technologies (Wosik et al., 2020). However, despite their higher awareness, the younger students demonstrated lower application proficiency, highlighting a gap between theoretical knowledge and practical implementation. This paradox may be due to curriculum limitations. While the younger students acquire theoretical knowledge through informal sources such as social media, they frequently lack structured opportunities to engage with telerehabilitation tools in clinical practice. In addition to age, regional differences also revealed a considerable impact on awareness levels. The students from technologically advanced regions or countries with strong digital infrastructure and established telehealth policies demonstrated a higher level of familiarity with telerehabilitation. By contrast, those from under-resourced or rural areas reported lower levels of awareness, often due to limited access to stable internet connectivity, fewer digital learning platforms, and minimal exposure to telehealth practices during their academic training. The disparity underscores the importance of equitable access to digital resources across institutions, which remains a challenge in many developing countries. These variations further emphasize the critical role of institutional policies and national-level health education strategies. Universities that actively integrate e-health education into their physiotherapy programs tend to produce students who are not only more aware but also more competent in digital health practices. By contrast, lack of institutional emphasis on telehealth reduces opportunities for students to develop essential skills, regardless of their age or interest.

Notably, gender and academic level did not show significant associations with awareness, suggesting that telerehabilitation knowledge is not inherently linked to these variables. Instead, telerehabilitation knowledge is shaped more by individual access to technology, exposure to digital learning environments, and the structure of the educational program itself (Bharath, Sinduja & Lakshmi, 2021; Mbada et al., 2021). The increasing incorporation of digital tools within physiotherapy education, such as online lectures, virtual simulations, and telehealth modules, has contributed to a more equitable distribution of digital health knowledge across genders. As digital literacy becomes more widespread, gender-based differences in familiarity with telerehabilitation have diminished, leading to a more uniform understanding of digital health technologies (Nuara et al., 2022).

Beyond demographic trends, the survey reinforces the practical relevance of sports telerehabilitation, especially in post-surgical rehabilitation and the management of common musculoskeletal injuries. It emerges as a viable complement or even an alternative to conventional in-person physiotherapy. Existing literature, including a systematic review and meta-analysis (Agostini et al., 2015), highlight telerehabilitation’s ability to deliver cost-effective, accessible, and efficient care without compromising treatment outcomes. It offers particular advantages in addressing geographical limitations, enabling remote patient engagement while maintaining comparable improvements in function and recovery (Agostini et al., 2015; Nuara et al., 2022). Given these benefits, integrating e-health platforms into physiotherapy education becomes not just beneficial but essential. The World Health Organization (WHO) recognizes healthcare professionals as key drivers in the adoption and success of e-health solutions, particularly as health systems grow more technologically complex (World Health Organization & Union IT, 2020; Manyazewal et al., 2021). The findings from this study also indicate that the students exposed to e-health training are more likely to advocate for its application in clinical settings. Equipping future physiotherapists with digital competencies will enhance their readiness to utilize telerehabilitation and contribute to its broader acceptance in routine clinical practice (Holland Brown & Bewick, 2023).

However, it is important to acknowledge the influence of potential confounding variables that may have affected the awareness outcomes. One key factor is prior exposure to telerehabilitation, which can vary significantly depending on students’ curriculum, personal interest, and access to external learning resources such as academic publications, online forums, and professional workshops. This uneven exposure likely influenced both their awareness and self-perceived application skills. In some cases, the students may lack understanding simply due to insufficient curriculum coverage, minimal clinical exposure, or a lack of engagement with digital health topics. These discrepancies highlight the pressing need for standardized, inclusive training in telerehabilitation across institutions to ensure that all students, regardless of background, are equally prepared for the evolving demands of digital physiotherapy.

Application

This study observed positive application knowledge among the physiotherapy students, reinforcing the growing acceptance of telerehabilitation in clinical practice. Telerehabilitation’s increasing adoption aligns with broader healthcare trends emphasizing the role of e-health technologies (Saaei & Klappa, 2021; Purushothaman et al., 2024). However, the students aged 18–20 years exhibited lower application proficiency than older students, emphasizing the importance of clinical experience in skill development (Anton et al., 2018). Remarkably, demographic factors such as gender, academic level, and region did not show significant predictive value. These findings align with previous findings suggesting that individual experiences, academic exposure, institutional support, and professional aspirations play a more substantial role in shaping student perspectives (Brennan, Mawson & Brownsell, 2009).

Students’ proficiency in applying telerehabilitation appears to be strongly influenced by hands-on experience and academic training. Those with prior exposure to telerehabilitation through coursework, internships, or independent learning were more likely to demonstrate confidence in implementing telerehabilitation strategies. By contrast, the students with limited or no practical experience struggled to conceptualize real-world applications, resulting in lower competency levels. Access to technological resources also emerged as a critical factor. The students with experience using digital platforms for assessments, consultations, or rehabilitation planning reported greater competence, whereas those unfamiliar with telehealth tools found it difficult to envision its practical integration into physiotherapy.

A significant number of the students acknowledged that telerehabilitation could reduce healthcare costs while expanding service delivery across various domains such as sports rehabilitation, chronic disease management, mental health, and elderly care. This finding highlights telerehabilitation’s potential to enhance accessibility and reduce financial burdens for both institutions and patients, especially in resource-limited settings (Snoswell et al., 2020). It also bridges geographical gaps, proving invaluable during critical times like the COVID-19 pandemic, and improves access to care in remote or underserved regions (Snoswell et al., 2020; Gajarawala & Pelkowski, 2021). Nevertheless, limitations in technological infrastructure and internet reliability remain pressing challenges, echoing barriers identified in global literature (Mumtaz et al., 2023).

The integration of advanced technologies, such as virtual reality, has the potential to further enhance telerehabilitation by increasing engagement, interactivity, and patient motivation, ultimately improving adherence and clinical outcomes (Schröder et al., 2019). Moreover, telerehabilitation can facilitate continuous monitoring and real-time feedback, which are essential for monitoring the patient’s progress (Patel et al., 2021). Despite these advantages, effective implementation still faces multiple challenges. Reliable internet access and the availability of suitable devices remain significant concerns (Mumtaz et al., 2023). Telerehabilitation demands a robust digital infrastructure to support efficient communication between patients and healthcare providers (Brennan, Mawson & Brownsell, 2009). Moreover, the lack of formal training limits its widespread use. Structured educational programs covering technical competencies, remote communication strategies, and best practices for telerehabilitation are essential. Integrating these components into the curriculum, along with practical hands-on training, will better equip future physiotherapists to adopt and apply telerehabilitation effectively in their professional practice.

Future outlook

The physiotherapy students demonstrated a strong willingness to adopt telerehabilitation, reflecting broader advancements in digital healthcare and the increasing role of technology-driven rehabilitation (Phuong et al., 2023). They also expressed readiness to invest time and effort to stay updated on recent advancements in telerehabilitation technology. This data reflects the growing necessity for healthcare professionals to continually upgrade their skills and stay informed about technological innovations.

Gender showed mixed significance, with females less likely to report both low and high future outlooks, suggesting a more neutral stance. These findings align with those of literature suggesting that gender in telerehabilitation often adopts a cautious stance toward new technologies due to concerns about practical feasibility (Veras et al., 2025). Meanwhile, regional differences were a significant predictor of future outlook, potentially due to variations in policy support, professional opportunities, and healthcare infrastructure (Peretti et al., 2017). Access to training programs and the adoption of digital health practices may also contribute to regional disparities in how students perceive the future of telerehabilitation (Shaw, 2023). Age also played a role in shaping students’ perspectives. The students aged 18–20 and 21–25 were less likely to exhibit a high future outlook compared to students over 25, indicating that increased professional experience and exposure to telerehabilitation pathways positively influence confidence in its future application (Stark-Blomeier, Krayter & Dockweiler, 2025). This finding supports earlier findings that profession-related experience deepens understanding and acceptance of telerehabilitation (Başer Seçer & Çeliker Tosun, 2022).

Career aspirations and interest in digital healthcare further influenced students’ future outlooks. Those aiming to work in technology-driven healthcare settings or research environments tended to show more optimism. Conversely, the students favoring conventional physiotherapy approaches appeared more hesitant about integrating telerehabilitation into future practice (Shaw, 2023). A lack of formal curriculum integration may have negatively impacted perceptions of telerehabilitation’s long-term relevance. Limited exposure to digital health content and emerging trends may lead students to underestimate the role of telerehabilitation in physiotherapy education. Structured curriculum integration would help enhance competence and build confidence in future applications (Coetzee et al., 2022).

Despite a generally positive outlook, the students identified several challenges that must be addressed for telerehabilitation to achieve its full potential. Common concerns included network instability, limited access to high-speed internet, and regulatory issues. In regions with weak digital infrastructure, connectivity issues hinder real-time communication and data transfer, reducing the effectiveness of remote interventions. Accurate monitoring of patient progress also emerged as a concern, emphasizing the need for standardized tools to improve remote rehabilitation quality (Bouabida, Lebouché & Pomey, 2022). Many students have reported that telerehabilitation will become a standard practice in sports rehabilitation, supported by growing e-health acceptance across healthcare sectors (Hossain et al., 2019). Studies have predicted continued expansion of telerehabilitation, particularly in overcoming access barriers in underserved regions (Mbada et al., 2021; Coetzee et al., 2022). The integration of advanced technologies such as AI-guided exercise routines and neurofeedback could further enhance rehabilitation outcomes (Afyouni, Einea & Murad, 2019; Le, Loomes & Loureiro, 2023). In sports settings, telerehabilitation encourages athletes to take active roles in their recovery, highlighting how technology supports and optimizes rehabilitation progress (Tenforde et al., 2020).

Nonetheless, the students emphasized that accurate assessment of athlete progress remains a significant challenge. Effective implementation requires enhanced technological infrastructure and dedicated tools for tracking outcomes (Dunphy & Gardner, 2020; Leochico et al., 2020; Gardner, Podbielski & Dunphy, 2024). Ongoing research and development are essential to fully realize the benefits of telerehabilitation. Addressing technical gaps, developing clear policies, and standardizing curriculum content are critical for successful integration into clinical practice (Terrell et al., 2021; Skempes et al., 2022). Policymakers must also resolve key issues such as reimbursement models, data privacy, and telehealth standardization (Watzlaf et al., 2017; Abernethy et al., 2022). Transparent regulatory frameworks will be important to foster trust among healthcare professionals and support the integration of telerehabilitation into physiotherapy education and clinical care (Kim et al., 2022; Al Meslamani, 2023).