Impact of Patient-Specific, Performance-Driven Rehabilitation Strategies on Treatment Adherence and Clinical Outcomes: A Systematic Review

Background:  Individualized, performance-driven rehabilitation systems characterized by dynamic adaptation of exercise dosage, feedback, and progression based on patient-specific performance have emerged as a promising approach to improve adherence and clinical outcomes. However, their effectiveness compared with conventional rehabilitation remains unclear due to heterogeneity in intervention design and clinical populations. Methods: A systematic review was conducted in accordance with PRISMA 2020 and Cochrane Handbook recommendations. Electronic databases, including MEDLINE, Embase, Scopus, Web of Science, and Cochrane CENTRAL, were searched from inception to the final search date (to be inserted). Eligible studies included randomized and non-randomized comparative studies evaluating individualized, performance-driven rehabilitation interventions versus conventional therapy. Primary outcomes were adherence and clinical effectiveness. Study selection, data extraction, and risk-of-bias assessment were performed independently by two reviewers.. Results: A total of 27 studies were included, of which 25 contributed adherence and/or clinical outcome data. Interventions varied from web-based platforms to advanced systems incorporating wearable sensors, real-time biofeedback, and artificial intelligence–driven adaptation. Adherence outcomes demonstrated substantial heterogeneity. Individualized systems generally improved adherence compared with minimal-contact or unsupervised care, with some studies reporting large effects (e.g., 141% vs. 50% adherence; 100% vs. 30% session completion). Significant improvements were observed in functional mobility, exercise capacity, and disease-specific outcomes in several populations, including post-surgical, cardiovascular, and neurological rehabilitation. In highly supervised settings, outcomes were typically comparable between groups. The certainty of evidence ranged from low to moderate, with downgrading primarily due to heterogeneity, risk of bias, and imprecision. Conclusions: Individualized, performance-driven rehabilitation systems demonstrate moderate-certainty evidence for improving adherence in specific contexts and achieving comparable or superior clinical outcomes relative to conventional therapy.