Maarten van Egmond

15 General introduction 1 Pre- and postoperative physiotherapy Pre- and postoperative physiotherapy are key elements of enhanced recovery after surgery (ERAS) pathways that show to be effective in reducing length of hospital stay and complication rates. 33 The main objectives of ERAS pathways for physiotherapists are to optimize preoperative physical functioning, reduce the consequences of surgical stress and postoperative complications and to increase speed of recovery, also after discharge from the hospital. Research has shown that improvement of preoperative muscle strength, respiratory muscle strength, exercise capacity, physical activities and HRQL are all associated with a reduction of postoperative complications and an increased postoperative recovery in major thoracic and abdominal surgery. 3,13,34-36 However, not every surgical patient will have the same risks of postoperative complications or poor postoperative recovery and therefore preoperative preventive physiotherapy might not be required for everyone, eventually leading towards tailored care. Postoperative physiotherapy with telerehabilitation It is known that patients suffering from postoperative complications after esophagectomy may be confronted with fatigue, decreased exercise capacity and impaired walking capacity that could take up to a year. 37,38 Therefore, physiotherapists might play an important role in improving a patient’s postoperative physical functioning as well. 2 Patients with postoperative complications are usually referred to outpatient physiotherapy in a primary care setting to further improve their physical functioning. However, these patients often deal with a temporary loss of mobility that makes it challenging or even impossible to visit a physiotherapist. 39 Moreover, these physiotherapists may be confronted with a lack of knowledge to treat patients after highly complex surgery. 40 Therefore, these patients could benefit from a relief in burden of care and increased efficiency, by providing them with physiotherapy via telerehabilitation in their home situation instead of conventional ‘face-to-face’ rehabilitation. Recent evidence has shown that eHealth applications such as telerehabilitation lead to increased patient satisfaction in different patient populations where clinical effects remain 3 to 6months after the intervention. 41,42 However, it is not known to what extent physiotherapy with telerehabilitation may be beneficial for patients with esophageal cancer in the postoperative period. Aims and outline of the thesis The general aim of this thesis is to evaluate the pre- and postoperative course of physical functioning in patients with esophageal cancer undergoing elective surgery. This knowledge contributes to identifying patients at an increased risk for a delayed postoperative recovery