Maarten van Egmond

124 Chapter 6 Exclusion criteria Patients were excluded if they were unable to complete self-reported questionnaires, insufficiently able to read or speak Dutch, had cognitive disorders, or had any other severe medical conditions that prevented the patient from doing unsupervised exercises at home. Intervention Participants received a 12-week supervised home-based telerehabilitation intervention after hospital discharge (T0) in their home environment. Before T0, a physiotherapist from the surgical ward instructed the patient on the telerehabilitation intervention. The telerehabilitation intervention was provided with Physitrack (Physitrack Limited). Physitrack is an eHealth platform that enables physiotherapists to design home exercise programs and to track patient adherence. Patients were provided with a goal-oriented exercise program created by the physiotherapist that could be accessed by a tablet, mobile phone, or computer (Figure 1). The physiotherapist accurately monitored the progress of the patient by weekly telephone, email, or video sessions, and exercises were adapted via the eHealth platform if needed. Physitrack had provided their services for this research project free of charge, and they will use the outcomes of this study to improve their services. They were not involved in the design, execution, analysis, and conclusions of this research. Physitrack will only have access to the published paper with its results, with no access to raw data. The postoperative physiotherapeutic intervention with telerehabilitation was aimed at improving functional status. The intervention took 12 weeks of at least two sessions per week depending on if the treatment goals were achieved. The exercises were tailored to the patients’ specific condition and needs, which were determined 1 day before T0. The physiotherapy goals were determined by using the patient-specific complaint list. 17 The exercises were aimed at improving the functional activity level of the patient, by increasing muscle strength, coordination, range of joint motion, and stamina. Intensity and frequency of the functional exercises were determined according to the guidelines of the American College of Sports Medicine. 18 Cardiorespiratory exercises to improve stamina were performed on a moderate-to-vigorous intensity level, measured with the Borg rating of perceived exertion scale (scores 6-20), for at least two sessions per week. Rating of perceived exertion with the Borg scale is a generally used and reliable scale to monitor and evaluate exercise intensity. A score from 13 to 16 relates to the moderate-to-vigorous intensity level, and this allowed us to monitor and adapt the appropriate intensity. 19 Exercises to improve muscle strength were performed 2-3 days per week on 60-70% of the 1 repetition maximum (moderate-to-hard intensity). We used the Holten curve that relates the percentage of the 1 repetition maximum to the estimated repetitions of that intensity. That allowed us to adapt the exercises without using a fitness equipment to measure the 1 repetition maximum directly. 18,20