Maarten van Egmond

108 Chapter 5 Telerehabilitation has been shown to be a valuable tool in managing postoperative outcomes and functional progress in surgical patients. 32 Patients often deal with a temporary loss of mobility directly after surgery, and are confronted by integrated care from multiple health providers. Telerehabilitation allows patients to perform their exercises more frequently without extra face-to-face visits. 10,32,39,42,43 Therefore, these patients might benefit from a relief in burden of care and increased efficiency by providing them with telerehabilitation at home instead of conventional ‘face-to-face’ rehabilitation, leading to an increased perception of QoL. Kairy et al. 48 stated that telerehabilitation in patients with physical disabilities could lead to similar clinical outcomes compared with usual care, with possible positive effects on areas of healthcare utilization. As restrictions in physical functioning of surgical patients are profound, physiotherapeutic interventions with telerehabilitation could be recommended to improve QoL after complex surgery. On the basis of the secondary objective of this review, patient satisfaction was only reported in the feasibility study by Eakin et al. 36 , where patient satisfaction ratings were high but exact numbers related to usual care were missing. This is in line with the significant outcomes of patient satisfaction with telerehabilitation illustrated in studies by Beaver et al. 11 and Cleeland et al. 49 , where helpfulness in dealing with concerns at an appointment with telerehabilitation were reported as more helpful in meeting patient’s needs. Although the populations in these studies were not exclusively surgical, and the interventions were not always exercise related, there is still sufficient indication for telerehabilitation interventions to be satisfactory in surgical patient groups, taking into account positive adherence and retention rates. 11,31,32,49 Study limitations and strengths The main strength of this review is its extended search and detailed assessment of articles according to the Cochrane Collaboration’s tool for assessing risk of bias. 22 This revealed considerable variation in standards of reporting across studies, but contributed to the interpretation of results. A limitation of this study is the variety in contents of intervention and outcome measures that were used in studies. In order not to miss relevant articles, no restrictions were placed on these intervention and outcome parameters. However, this limits generalization to specific surgical groups, and restricted the performance of a meta-analysis on clinical outcome measures. However, despite this variety, QoL was measured with the same questionnaire in all studies, and was therefore eligible to be pooled by means of a random effects model.