Maarten van Egmond

165 Summary S quasi-experimental studies with similar control groups were eligible without restriction on language or publication date. The methodological quality was investigated with the Cochrane Risk of Bias tool. Twenty-three studies were eligible for qualitative analysis and 7 studies for meta-analysis. Despite the variation in treatment and outcome measures, this literature review shows that physiotherapy with telerehabilitation has the potential to improve quality of life in patients who have undergone surgery. In addition, physiotherapy with telerehabilitation proved to be feasible and at least as effective as conventional physiotherapy. These may be sufficient reasons to consider physiotherapy with telerehabilitation, even though the overall effectiveness on physical outcome measures remains unclear. In Chapter 6 a feasibility study was conducted on a postoperative physiotherapy intervention with telerehabilitation in patients who have undergone esophageal resection with a postoperatively complicated recovery. In addition, the effectiveness of this intervention on functional recovery was investigated by comparing the intervention group with a historical cohort of comparable patients who did not undergo this intervention. Finally, 15 out of 22 patients underwent a 12-week physiotherapy treatment in their own home situation directly after discharge from the hospital, where exercise therapy and support were offered via an eHealth application. Patient adherence, patient satisfaction and duration of treatment was investigated. In addition, the effect of this intervention on physical functioning was investigated. Patient adherence was particularly high in the first 6 weeks of the intervention and then declined. No difference was found in physical functioning after the treatment between the intervention group and the historical control group. Because of the high patient satisfaction and adherence, this study shows that physiotherapy in the home situation with eHealth should be considered in patients with esophageal cancer who have undergone complicated surgery, especially in the first 6 weeks after discharge. In Chapter 7 the most important findings, methodological considerations and clinical implications are discussed. In addition, recommendations are made for future follow-up research into the physiotherapy assessment and treatment process for patients who undergo high-risk surgery. This thesis demonstrates the importance of systematically evaluating pre- and postoperative physical functioning, before determining which patients are at risk of a delayed postoperative recovery. Based on this, patients can be identified who may benefit from tailor-made pre- or postoperative physiotherapy treatment to enhance postoperative recovery.