Maarten van Egmond

164 Appendix In Chapter 3 , the pre- and postoperative course of physical functioning was investigated in patients with esophageal cancer who undergo surgery, in order to better determine whether a physiotherapy intervention is indicated, when it should take place and who might benefit from this intervention. For this purpose, 155 patients with esophageal cancer were examined between March 2012 and June 2016, twice preoperatively (3 months and 1 day before surgery) and twice postoperatively (5 days and 3 months after surgery) for physical functioning and quality of life. Changes in physical functioning over time have been analyzed with longitudinal regression techniques. In 60 of the 155 patients who underwent surgery, all measurements were performed. Three months postoperatively, physical functioning returned to the level of 3 months preoperatively, with the exception of handgrip strength and fatigue. Moreover, no difference was found in the course of physical functioning over time between the group of patients with and without postoperative complications. This study has shown that, on average, patients with esophageal cancer had a good preoperative condition related to reference values. In addition, all patients appeared to return to the old level of physical functioning 3 months after the operation, regardless of the occurrence of postoperative complications. This study shows that the level of preoperative physical functioning is not necessarily an indicator of postoperative recovery for every patient. It is therefore important to first evaluate the pre- and postoperative functioning of high-risk surgical populations before determining whether physiotherapy treatment is necessary. In Chapter 4 we investigated whether there is an association between preoperative muscle strength and muscle mass in patients with esophageal cancer indicated for surgery, because previous research has shown that these aspects are independent predictors of delayed postoperative recovery. One hundred twenty-five patients were eligible for this cross-sectional study, of which the CT scans of 93 patients were suitable for analyzing muscle mass at the level of the third lumbar vertebra (L3). The measured muscle mass from the CT scans was then compared with handgrip strength, in- and expiratory muscle strength of the respiratory muscles and functional leg muscle strength. The associations were determined using linear regression techniques. The results show that gender, weight, handgrip strength and inspiratory muscle strength were independently associated with muscle mass measured at L3. All of these variables together explain 66% of the variability in muscle mass measured at L3. This study shows that there is a clear association between muscle strength and muscle mass in patients with esophageal cancer who undergo surgery and that enables physiotherapists to make an estimation about the amount of muscle mass and the functional consequences, by assessing muscle strength. Chapter 5 concerns a systematic literature review with meta-analysis, in which an overview is provided of scientific literature on the effectiveness of physiotherapy through tele- rehabilitation on postoperative functional outcomes and quality of life in surgical populations. For this, randomized controlled studies, clinically controlled studies, quasi-randomized and