Maarten van Egmond

121 The feasibility of telerehabilitation after surgery 6 INTRODUCTION Background Surgical resection of the esophagus is the primary curative treatment for patients with esophageal cancer and is associated with a high risk of postoperative complications, varying from 25 to 60%. 1,2 This leads to an increased length of hospital stay (LoS) and a delayed postoperative recovery, with a significant decline in physical function in the first 3 months after surgery. 2,3 It has been demonstrated in many surgical populations that improving preoperative functional status by exercise training had a positive effect on long-term postoperative outcomes. 4,5 However, recent studies have shown that preoperative functional status was not associated with postoperative complications in patients treated with esophagectomy, justifying the need to focus on treating these patients in the postoperative phase. 6,7 Patients with postoperative complications after esophagectomy often suffer from fatigue, decreased exercise capacity, and disability such as impaired walking capacity and their recovery could take up to 1 year and beyond. 3,8 These symptoms are explained by altered cardiopulmonary function, generalized muscle weakness, and malnutrition, and physiotherapists play an important role in improving these aspects of physical functioning. 9 Telerehabilitation as an alternative to face-to-face care Instead of face-to-face care, postoperative physiotherapy can also be streamed by telerehabilitation. Telerehabilitation is a medium to provide physiotherapy with electronic health (eHealth), defined as ‘ the delivery of rehabilitation services to patients at a distance using information and communication technologies’. 10 Telerehabilitation has shown to be a valuable tool in improving postoperative outcomes and functional recovery in surgical patients, where patients considered the reduced traveling barriers, flexible exercise hours, and the ability to directly integrate exercises in daily life as positive. 11,12 Moreover, telerehabilitation interventions have been valuable to overcome discontinuities that may arise in communication between hospital and primary care, where physiotherapists may have a lack of knowledge about how to treat patients after a highly complex surgery. 13 There is evidence showing positive effects of physiotherapy with telerehabilitation on clinical outcomes in cancer patients, cardiac patients, and patients with musculoskeletal disorders, but information on the feasibility of this intervention in the postoperative phase of patients with esophageal cancer treated with esophagectomy is lacking. 14,15