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This systematic review and meta-analysis investigated the safety of physical rehabilitation and exercise interventions delivered via videoconferencing compared with traditional in-person sessions. The review focused on adults with chronic disease or a history of restorative or reconstructive surgery, examining whether remote exercise delivery increased the risk of adverse events. Four databases (PubMed, Web of Science, Embase, and CINAHL) were searched from inception to June 2025. Eligible trials compared videoconferencing-based rehabilitation with in-person exercise programs and reported adverse events. Between-group differences were analyzed using incidence rate ratios (IRR), and study quality was assessed with the Cochrane Risk of Bias 2 tool. Certainty of evidence was rated using the GRADE framework. Of 3,436 records screened, 22 trials were included. Another 28 otherwise eligible studies were excluded because they did not report adverse events. The analysis found no significant difference in adverse event rates between videoconferencing and in-person interventions for either minor or moderate events (IRR = 1.00, 95% CI 0.71–1.41, p = 1.00) or major events (IRR = 1.77, 95% CI 0.55–5.70, p = 0.98). Overall incidence was low—approximately one adverse event per 410 videoconferencing sessions and one per 414 in-person sessions. However, 82% of included trials were rated as having “some concerns” or “high” risk of bias, largely due to incomplete or inconsistent reporting of adverse events. The certainty of evidence for safety outcomes was rated as low. The findings indicate that videoconferencing-based rehabilitation appears comparably safe to in-person delivery, but improved reporting standards are essential to strengthen future evidence. Citation: Clinical Rehabilitation 2025; 39(9):1219–1242. doi: 10.1177/02692155251361916