Maarten van Egmond

123 The feasibility of telerehabilitation after surgery 6 METHODS Ethical approval The Medical Ethics Committee (METC) of the Amsterdam University Medical Centers provided ethical approval for this study (NL58388.018.16). All patients provided written informed consent. As this was a feasibility study, sample size calculations have not been performed, and the initial sample size of 30 participants was pragmatically chosen. Patients could leave the study at any time for any reason if they wished to do so without any consequences. Study design A prospective feasibility study was performed in patients treated with esophagectomy. To assess preliminary effectiveness, the patients who underwent the complete treatment were matched with a historical comparison group of patients that underwent esophagectomy and suffered from postoperative complications receiving usual face-to-face care, between March 2012 and October 2014. We decided to match 1 case to 2 patients from a historical comparison group to optimize statistical power. Data collected from this historical comparison group were part of a previous study performed by the same research group, from which the METC waived the need for informed consent. 6 Patients were matched for gender, age, American Society of Anasthesiologists (ASA) - physical status score, comorbidities, body mass index, pulmonary function, surgical procedure, and severity of postoperative complications. Participants Patients were recruited from the surgical wards at the Gastrointestinal Oncologic Center Amsterdam of the Amsterdam University Medical Centers, location Academic Medical Center, just before discharge from the hospital by the supervising physiotherapist or the investigator. Patients who refused to participate were referred to face-to-face physiotherapy in primary care. Inclusion criteria Participants were included if they were aged 18 years or older and the primary reason of hospital stay was status after esophagectomy, they had internet access at home, and they signed the informed consent form. Moreover, participants were included if they suffered from a postoperative complication, grade 3a-4 according to the Clavien-Dindo classification. This 5-scale classification reports surgical complications based on the type of therapy required to treat this complication. 16 Participants were also included if the postoperative length of stay was longer than 9 days because they were physically too weak to be discharged earlier. There was an indication for face-to-face physiotherapy in primary care if a patient was not yet able to walk or transfer independently because of a loss of muscle strength, mobility, or balance at discharge.