Maarten van Egmond

109 The effectiveness of physiotherapy with telerehabilitation 5 Second, patients’ pre-operative functional status was not taken into account as an inclusion criterion. As the telerehabilitation intervention could have less impact in patients with a higher functional status prior to surgery compared with patients with a lower functional status, the results on effectiveness could be skewed. This was also illustrated by Barnason et al. 25 , who found that the degree of functional status in patients undergoing coronary artery bypass surgery was related to survival after surgery. This emphasized the importance of identifying and intervening in cases with poor functioning. Therefore, organizing patients by functional status before surgery can be an important factor to consider when applying a telerehabilitation intervention or investigating its effectiveness. Finally, only one study reported patient satisfaction. It may have been possible to collect more data on patient satisfaction if non-randomized feasibility studies had been included. Clinical implications and conclusions This systematic review found that physiotherapy with telerehabilitation is feasible in surgical patients, and is at least equally effective compared with usual care. This systematic review with meta-analysis showed that QoL in surgical populations increased with telerehabilitation. As the effectiveness of telerehabilitation compared with usual care on physical outcomes is considered to be at least equal, this may be an important reason to choose physiotherapy with telerehabilitation instead of usual care for surgical populations. Despite methodological shortcomings within the included studies, this review illustrates the feasibility of telerehabilitation in surgical patients, but research relating to the (cost-) effectiveness and patient satisfaction of telerehabilitation requires further exploration. As telerehabilitation is developing continuously, and technology changes and improves at a high rate, it is recommended that alternative trials should be designed that allow iterations of new releases of technology.