Maarten van Egmond

137 The feasibility of telerehabilitation after surgery 6 DISCUSSION Principal findings To our knowledge, this is the first study demonstrating that postoperative physiotherapy with telerehabilitation is feasible in patients suffering from postoperative complications after esophagectomy, primarily in the first 6 weeks after T0. This is in line with a study by Latham et al. 11 , who stated that telerehabilitation is a valuable tool to manage postoperative outcomes and functional progress directly after T0 in a patient’s home environment. The adherence rates were significantly higher in the first 6 weeks after T0 than in the second period of 6 weeks, where patients reported that they were generally more able to perform their ADL and were less dependent on the telerehabilitation intervention, which might explain the lower adherence rates despite a further incline in functional status. From a functional perspective, these lower adherence rates should be interpreted as a desired outcome, because it illustrates the patient’s gradual independence of physiotherapeutic care. The consistently high patient satisfaction rates of the telerehabilitation intervention in our study are confirmed in a systematic review by Mair et al. 29 , who stated that the greatest advantages experienced by patients were increased accessibility of specialist expertise, increased flexibility, less travel required, and reduced waiting times. This is also in agreement with the study by Moffet et al. 30 , who investigated patient satisfaction with in-home telerehabilitation after total knee arthroplasty and found similar results, concluding that patient satisfaction was at least equal to conventional health care delivery. In this study, we compared patients who underwent the telerehabilitation program with a historical comparison group of patients receiving usual care and found equal functional status outcome measures at T2. This is in line with studies that found telerehabilitation interventions to be equally effective as usual care on at least one outcome measure; however, overall significant evidence in favor of telerehabilitation was still lacking. 31,32 Despite the similar functional outcomes T2, it has to be noted that most of the functional status outcome measures of our intervention group at T0 were significantly lower than those of the matched historical comparison group. It could be argued that the intervention group gained more progress on functional status because of the physiotherapeutic treatment with telerehabilitation, in comparison with the matched historical comparison group, ultimately resulting in equal outcomes T2.