The Digital Pediatric Physiotherapy Framework (DPPF): A Systematic Review of Digital Health Integration in Pediatric Physiotherapy

Background: Technology such as telerehabilitation, virtual reality, robotics, and wearable systems are reshaping pediatric physiotherapy. While evidence remains fragmented, there is little guidance on how these approaches can be integrated into coherent, family-centered care pathways. Objective: To develop the Digital Pediatric Physiotherapy Framework (DPPF) based on a systematic review of randomized evidence on digital interventions in pediatric physiotherapy. Methods: Several databases were searched for randomized trials published after 1 January 2020, including PubMed, Web of Science Core Collection, and Google Scholar. The included studies assessed the results of physiotherapist-delivered or physiotherapist-supervised digital interventions in children and adolescents aged 18 and younger. Population, intervention, outcome, implementation, and safety data were extracted. Considering the substantial heterogeneity of the findings, they were synthesized narratively. Cochrane RoB 2 was used to assess risk of bias, and GRADE was used to evaluate certainty of evidence. Results: Twenty-nine trials involving 1196 participants were included. Most studies examined virtual reality and gaming-based interventions, with fewer evaluating telerehabilitation/tele-exercise and robotic or wearable technologies. Digital interventions were most often directed at body-function and activity-level outcomes, while participation outcomes were less frequently studied. The strongest evidence supported short-term benefits in balance, gross motor function, upper-limb activity, pain, and selected fitness outcomes, particularly in children with cerebral palsy. Evidence for telerehabilitation and robotic or wearable approaches was more limited but generally promising. Implementation, equity, cost, and long-term outcomes were rarely reported. No eligible trial directly evaluated electronic patient-reported outcome measures, digital triage, or clinical decision support as stand-alone interventions. Conclusions: Digital interventions have the potential to strengthen pediatric physiotherapy, particularly for short-term motor and functional outcomes. The proposed DPPF provides an implementation-informed structure to guide future research, pathway design, and more purposeful integration of digital health into pediatric rehabilitation practice.