Maarten van Egmond

152 Chapter 7 functioning between 3 months and 1 day before surgery, suggesting that patients were able to recover to baseline physical functioning if they would have suffered from negative effects due to chemoradiation therapy. In our feasibility study described in Chapter 6 we investigated the effectiveness of the eHealth intervention with usual care. Although a randomized controlled trial is considered as the golden standard to investigate the effectiveness of an intervention, we compared the intervention group with a matched historical control group. We performed statistical matching on multiple relevant patient characteristics, but there were still few imbalances present. Therefore, a systematic bias could not completely be ruled out. Outcome measures In the studies described in Chapter 2,3, 4 and 6 we measured physical functioning. Physical functioning as part of functional status contains more aspects than we investigated, but we only selected indicators with good clinical applicability and clinical relevance, that have been shown to have an association with postoperative complications in other surgical populations. 25 This approach allows for assessing patients on relevant physical parameters, and guides tailored physiotherapeutic intervention. In addition, several determinants of physical functioning were compared to currently available reference values, matched for age and gender presented in the peer-reviewed literature. Within physiotherapy, there is a lack of consistency in interpreting these reference values because they have either been based on the means and standard deviations of comparable normative samples or on values from regression equations. 26 This might have led to an incorrect interpretation of high versus low physical functioning although these reference values are widely used in physiotherapy practice to indicate physical functioning. For our systematic review described in Chapter 5 , we decided to include all studies providing surgical patients with an intervention through eHealth in order not to miss any relevant articles . Because of the heterogeneity in intervention- and outcome measures we were not able to compare them on effectiveness in a meta-analysis. Implications for clinical practice Risk stratification The importance of a patient’s physiological and physical functioning to successfully recover from surgery has been emphasized in literature. 2,27 Optimizing preoperative physical functioning may not only improve postoperative outcome, but also enhance quality of life and reduce hospital costs. 3