Maarten van Egmond

85 The effectiveness of physiotherapy with telerehabilitation 5 INTRODUCTION Delayed postoperative recovery is one of the main problems after surgery. 1 Postoperative complications contribute highly to postoperative morbidity, and may lead to increased length of hospital stay and mortality, and reduced cost-effectiveness. 2-4 In surgical patients, handgrip strength, inspiratory muscle strength, physical activities and quality of life (QoL) are risk factors for postoperative complications and poor postoperative functional recovery. 5,6 Physiotherapists play an important role in reducing and preventing the decrease in physiological and functional capacity due to surgery by physical exercise training, and maintenance of physical activity levels over the pre- and postoperative course. These interventions are potentially effective for postoperative functioning. 7 Health systems are currently engaged in a process of innovation to improve efficacy and efficiency in healthcare services. 8,9 Telerehabilitation is one of these developments, defined as ‘the delivery of rehabilitation services to patients at a distance using information and communication technologies’. 10 Telerehabilitation may contain assessment, education, monitoring and exercise interventions. 9,10 Over the last few years, telerehabilitation services have developed rapidly, and have the potential to be a more cost-effective alternative for outpatient assessment and treatment in hospital due to the ability to reach people in remote areas or at home. Telerehabilitation interventions have been used with success in areas of preventive care and management of chronic diseases, where patients positively valued benefits such as reduced travelling barriers, flexible exercise hours and the possibility to better integrate skills into daily life. Telerehabilitation interventions decrease travelling costs, are significantly less time consuming and are generally more convenient. 11 People also have the opportunity to train more intensively than is possible at a healthcare institution. The feasibility and acceptability of such technology have demonstrated significant patient and clinician satisfaction and improvements in QoL. 9,12,13 Physiotherapy or exercise interventions can be streamed through telerehabilitation, and are valuable in the pre- and postoperative phase for surgical patients. There is evidence showing the positive effects of physiotherapy with telerehabilitation on clinical outcomes in cancer patients, cardiac patients, and patients with musculoskeletal disorders and depression. 14,15 Moreover, the effects of telerehabilitation on QoL seem to be promising. 16 How- ever, research that demonstrates the effects of physiotherapy with telerehabilitation on postoperative functional outcomes and QoL compared with conventional care in surgical populations is still inconclusive. 16 Therefore, this systematic review aimed to study the effectiveness of physiotherapy with telerehabilitation on postoperative functional outcomes and QoL in surgical patients. The secondary objective was to determine whether telerehabilitation in surgical patients increased patient satisfaction.