Abstract
<jats:p>Background: Osteoarthritis (OA) of the knee and hip is a leading cause of disability worldwide, commonly associated with pain, reduced physical function, and decreased quality of life. Exercise therapy is a cornerstone of OA management; however, adherence to exercise programs remains a major challenge. Telehealth-delivered interventions have emerged as a potential solution to improve accessibility and engagement, yet their effectiveness in promoting adherence is not well established. Objective: To evaluate adherence to telehealth-delivered exercise interventions compared to conventional physiotherapy in individuals with knee and/or hip osteoarthritis. Methods: A systematic review was conducted in accordance with PRISMA guidelines. PubMed was searched for randomized controlled trials (RCTs) published between January 2015 and February 2026. Studies including adults with knee and/or hip OA, comparing telehealth-based exercise interventions with conventional physiotherapy or usual care, and reporting adherence outcomes were included. Methodological quality was assessed using the PEDro scale. Data were extracted and synthesized narratively, with a primary focus on adherence rates, session completion, and retention. Results: Nine RCTs involving sample sizes ranging from 29 to 208 participants were included. Overall, telehealth interventions demonstrated moderate to high adherence levels. High adherence (>80–95%) was reported in several studies, particularly those incorporating supervision, feedback, or behavioral support. Some studies showed comparable adherence between telehealth and conventional physiotherapy, while others reported either slightly higher or lower adherence in telehealth groups. Self-directed or minimally supervised interventions were associated with lower adherence. Factors such as real-time supervision, personalized feedback, and patient engagement strategies positively influenced adherence outcomes. Conclusion: Telehealth-delivered exercise interventions can achieve adherence levels comparable to conventional physiotherapy in individuals with knee and hip osteoarthritis. However, adherence is influenced more by intervention design than delivery mode alone. Incorporating supervision, behavioral support, and interactive components appears essential for optimizing adherence. Further research is needed to standardize adherence measures and evaluate long-term outcomes in telehealth-based rehabilitation. Key words: Adherence, Exercise Therapy, Digital Health, Osteoarthritis, Patient Compliance, Telerehabilitation, Telemedicine, Rehabilitation</jats:p>