Maarten van Egmond

87 The effectiveness of physiotherapy with telerehabilitation 5 The functional outcome measures were based on the International Classification of Functioning, disability and health (ICF). 18 In this framework, health and health-related components are classified in domains, expressed as body functions and structures, activities and participation, and personal and environmental factors. 19 Studies in the different ICF domains that measured any postoperative functional outcome, which represent the effectiveness of telerehabilitation programs, were included in this review. In the domain of body functions and structures, pain, fatigue, joint range of motion, muscle strength, coordination, stamina, and inspiratory and expiratory muscle strength were measured, whereas in the activity and participation domain, limitations in activities of daily living, mobility, employment, education, social and vocational activities, and any other patient-reported outcome measures were measured. 20 Measurements of QoL performed with questionnaires were also taken into account. Secondary outcome measures included patient satisfaction. Data extraction and quality assessment The titles and abstracts of articles identified by the search strategy were screened by two authors (ME and TV), and when there was insufficient information for inclusion, the full text article was obtained. If necessary, the corresponding authors were contacted for additional information. Reasons for exclusion were recorded. Two authors (ME and TV) extracted study data independently and recorded them on a modified data extraction form for intervention studies according to the guidelines of the Cochrane Collaboration. 21 In cases of disagreement, a third author (MS) was consulted to make a final decision. Two authors (ME and TV) assessed the risk of bias for each included study independently using the Cochrane Collaboration’s tool for assessing the risk of bias (Figure A, see online supplementary material). 22 Discrepancies were resolved through discussion. In cases of disagreement, a third author (MS) was consulted to make a final decision. Data synthesis and analysis A meta-analysis was conducted using Cochrane Review Manager (RevMan) software if studies were similar in terms of included patients, intervention and outcome measures. The overall effect size was calculated using the standardized mean difference because the data of all included studies were continuous. Heterogeneity with the I 2 statistic was assessed, with a percentage 40% representing no heterogeneity of importance and a percentage 75% representing considerable heterogeneity. 23 A random effects model was