Maarten van Egmond

150 Chapter 7 Therefore, treating patients in their home situation with eHealth, directly after discharge from the hospital is a promising alternative in terms of managing a patient’s postoperative functional recovery from a distance. 16 In our systematic review of intervention studies in surgical patients, we already concluded that physiotherapy through eHealth is feasible and at least equally effective compared to usual care (Chapter 5). Moreover, based on a meta-analysis, we concluded that physiotherapy through eHealth has the potential to enhance quality of life. As a result, we performed a study to investigate the feasibility of postoperative physiotherapy through eHealth in patients with postoperative complications after an esophagectomy. We confirmed its feasibility, predominantly in the first six weeks after discharge (Chapter 6) . Patients were more able to self-manage their health condition and to integrate this into their physical functioning by performing functional exercises under supervision of a physiotherapist through eHealth. Moreover, patient satisfaction rates on the physiotherapy intervention through eHealth in our study were consistently high. This was also confirmed in other studies, where the main contributors to patients’ satisfaction were the reduced travel times, increased access to specialist care and increased flexibility in performing exercises. 17,18 This was further confirmed in the high adherence rates up to almost hundred percent, mainly in the first 6 weeks after discharge from the hospital. We also investigated the effectiveness of the eHealth intervention by comparing the intervention group with a matched historical control group receiving usual care. We concluded that there were no significant differences in outcomes of physical functioning after three months, which is in agreement with the conclusions of our systematic review (Chapter 5) and similar to previous studies that found eHealth interventions to be equally effective as usual care on at least one functional outcome measure. 19,20 However, most of the functional status outcome measures of our intervention group at baseline were significantly lower than those of the matched control group. It could therefore be hypothesized that the intervention group gained more progress on physical functioning than the matched controls, finally resulting in equal outcomes 3 months postoperatively.