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| SYSTEMATIC REVIEW |
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| Year : 2023 | Volume
: 5
| Issue : 1 | Page : 14-23 |
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Selection of outcome measures in oncology telerehabilitation in post-COVID times: A systematic review
Renu B Pattanshetty, Vrushali Krushna Athawale
Department of Oncology Physiotherapy, KAHER Institute of Physiotherapy, Belagavi, Karnataka, India
| Date of Submission | 16-May-2022 |
| Date of Decision | 18-Aug-2022 |
| Date of Acceptance | 29-May-2023 |
| Date of Web Publication | 11-Aug-2023 |
Correspondence Address:
Dr. Renu B Pattanshetty
Department of Oncology Physiotherapy, KAHER Institute of Physiotherapy, Belagavi - 590 010, Karnataka
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijptr.ijptr_85_22
The aim of the study is to emphasize the choice of appropriate outcome measures in oncology telerehabilitation during post-COVID times from December 2019 to January 2022. This systematic review was carried out on the studies published in the English literature retrieved from electronic databases (PubMed, Google Scholar, CINAHL, Pedro, and COCHRANE). Manual search was done on the reference list of the studies included. Studies were selected according to the inclusion criteria assessed through PEDro Rating Scale. Eleven studies were reviewed for the risk of bias. Clinical outcome measures were significantly improved after giving intervention through telerehabilitation services. There was increased in functional exercise capacity, decrease in anxiety score, and improvement in quality of life (QOL) in cancer patients. The outcome measures are vital tools in evaluating cancer patients. This systematic review advocates the used of 6 min walk, timed up and go, and timed stair test to evaluate functional exercise capacity. Hospital anxiety and depression and generalized anxiety disorder scales for anxiety and depression, cancer related fatigue scale, European Organization for Research and Treatment of Cancer QOL, and functional assessment of cancer therapy scales for QOL as a outcome measures in oncology telerehabilitation. This systematic review provides a comprehensive view regarding the choice of outcome measures used in oncology telerehabilitation.
Keywords: Cancer, Cancer related pain and fatigue, Depression and anxiety, Quality of life, Telerehabilitation
How to cite this article:
Pattanshetty RB, Athawale VK. Selection of outcome measures in oncology telerehabilitation in post-COVID times: A systematic review. Indian J Phys Ther Res 2023;5:14-23 |
How to cite this URL:
Pattanshetty RB, Athawale VK. Selection of outcome measures in oncology telerehabilitation in post-COVID times: A systematic review. Indian J Phys Ther Res [serial online] 2023 [cited 2023 Oct 1];5:14-23. Available from: https://www.ijptr.org/text.asp?2023/5/1/14/383684 |
| Introduction | |  |
The coronavirus disease 2019 (COVID-19) pandemic has bought challenges to the entire globe and caused economic loss.[1] The COVID-19 patients have shown to develop pneumonia, severe symptoms of acute respiratory distress syndrome, and multiple organ failure in chronic stages.[2] In January 2020, the WHO notified the outbreak of COVID-19 (respiratory disease) having clinical features of fever, dyspnea, and dry cough.[3] To prevent the spread of COVID-19, strategies such as travel restrictions, quarantine, and social distancing have been implemented globally.[3]
Cancer is ranked at the first leading cause of death worldwide and first and fourth leading cause of death in urban and rural India. The incidence of cancer in India is estimated at 1.15 million new patients in 2018.[4] Health-care services are declined because of increase in strategies to prevent COVID-19 symptoms, as a result patients with cancer are fighting against the disease and are placed in high risk group. There is a need to discover an innovative care to deliver health-care services for cancer patients in the pandemic, the use of telehealth came into existence, a new concept in oncology.[5],[6],[7]
Rehabilitation is the old branch of medicine, but now because of recent advances, telecommunication methods have been developed worldwide. These approaches in the field of rehabilitation are more abtly termed as telerehabilation.[5],[6] Telerehabilitation may be broadly classified into two types: synchronous and asynchronous.[7],[8],[9]
Standardized outcome measures tools are used to access patient functional, performances, participation in rehabilitation over times, and also stimulate the evidenced base practice along with recommended a time of the national health policy. In physical therapy, the good clinical practice comprises of appropriate monitoring of health status of patients using organized outcome measures.
Telerehabilitation is the new concept in oncology rehabilitation. For this innovative program, the choice of outcome measures that are used should be reliable, valid, and precise. The selection of outcome measures becomes extremely important as to identify the patient who are at high risk. Hence, the objective of the present study is to select the appropriate outcome measures in oncology telerehabilitation in post-COVID times.
| Methodology | | |
The PRISMA checklist was used to state this review. In the development search strategy, Problem/Population, Intervention, Comparison, and Outcome (PICO) format was utilized with proper search terminology related to cancer telerehabilitation.[10] The studies including clinical designs/experimental designs between December 2019 and January 2022 published in the English language involving cancer telerehabilitation as a mode of delivering treatment with participants aged more than 6 years with outcome measures used an quality of life (QOL) scales, functional assessment of chronic illness therapy fatigue (FACIT-F) scale, Hospital Anxiety and Depression Scale (HADS), generalized anxiety disorder (GAD) scale, Cancer-Related Pain Scale, Functional Exercise Testing Scale like 6 min walk test, and Timed up and Go test, Timed stair test Studies containing Japanese therapy, Chinese therapy, study protocols, case reports, Gray literature are excluded in this systematic review.
The search strategy was prepared with the discussion among the authors who searched the five databases independently which included PubMed, CINAHL, Google Scholar, Pedro, and Cochrane in the period of December 2019–January 2022 using the keywords telerehabilitation, cancer, quality of Life, cancer-related pain, cancer-related fatigue, depression, and anxiety. Articles were selected according to the eligibility criteria from these databases. The articles were screened. Both the authors assessed the abstract and title of each study. According to the inclusion criteria, full version of the text was retrieved. The reference lists were checked from the included studies for any relevant studies that were not identified using the electronic search.
Study design
Quantitative studies comprising clinical trials including experimental research, randomized controlled trials published between December 2019 and January 2022 were considered for inclusion in the study.
Population
The studies consisting of diagnosed with any type of cancer receiving any of the treatment such as radiotherapy, chemotherapy, and surgery with age (>6 years) were included.
Outcome
Outcomes of interest were QOL scale which include functional assessment of cancer therapy-general (FACT-G), European Organization for Research and Treatment of Cancer (EORTC quality of life questionnaire [QLQ-C30]) Scale with their supplementary scale for different type of cancers, health-related QOL scale, FACIT-F scale, HADS, cancer-related pain scale, cancer-related fatigue scale, functional exercise testing test like 6-min walk test, and timed up and go test and timed stair test, and GAD scale.
Literature search
Once the search strategy was expanded, a review protocol was customized. Duplicates were eliminated for the study through searching over databases. The appropriate studies of full texts were then individually reviewed by the authors to define the adequacy for the PICO criteria. Any dispute was solved by discussion or with other reviewer, when and where necessary.
Data extraction
Data extraction was done by Pattanshetty and Athawale. It was carried out using Microsoft Excel that comprised participants demographic data, study design, selection of outcome measure, statistical analysis, and conclusion. Any disagreement was resolved through discussion.
Quality assessment
Studies included in the review were surveyed independently using PEDro Rating Scale developed by center for evidence-based physiotherapy which is most commonly used scale for systematic review and meta-analysis across physiotherapy, health and medical research. Items in the scale were rated yes or no (1 or 0) based on the criteria clearly satisfied in the study. Higher score of the study stated superior methodological quality. The studies were autonomously rated by the reviewer and dispute were resolved by discussion[11] [Table 1].
| Results | | |
Study selection
Searching through the databases, 994 results found 191 duplicates were removed. The selected 904 studies were screened and 878 studies were excluded (abstract and title) and 26 full-text studies screened according to the criteria and 15 studies excluded and 11 studies fit the eligibility criteria and was included in the systematic review.[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22] PRISMA flow chart [Figure 1].
Study characteristics: Data extraction shows overview of all the studies included for the systematic review. Three studies from Canada, 1 study from Belgium, 1 study from China, 1 study from Netherland, 1 study from Australia, 1 study from Korea, 2 studies from Israel, and 1 study from Switzerland were included. All the studies were published in the year ranging from December 2019 to January 2022.[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22] All studies conducted telerehabilitation program as a source of rehabilitation in various cancer populations.
Participant's characteristics
Four hundred and sixty-five participants were included in the study who underwent telerehabilitation program with sample size ranging from 1 to 99 participants. The age of the participants was >6 years. There is variation in the pathology of the participants, which included esophagogastric cancer, unresectable thoracic neoplasia receiving chemotherapy, esophageal cancer surgery, prostate cancer, and acute lymphoblastic leukemia. The telerehabilitation program was held at home. The summary of participant's characteristics is given in [Table 2]. | Table 2: Summary of the studies[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22]
Click here to view |
Characteristics of telerehabilitation
The technologies employed in the studies are seen as an overview in the [Table 2]. Software and hardware were employed for monitoring, assessment, and video-conferencing. In one study, telerehabilitation platform was carried using Virtuagym fitness application.[12] In another study, telerehabilation intervention comprised of utilization of a mobile application called (Physitrack) and wearable technology (Fitbit) to track the physical activity.[13] Another provided telerehabilitation program through online training videos.[14] In another study, intervention was carried out using the eChez-Soi Telerehabilitation program.[15] Telerehabilitation program was set up through teleconferencing system with a kinesiologist at the hospital and participants with their parents at home. Telerehabilitation was also given in form of live interactions program that authorized direct guidance and immediate correction or alteration of intervention when required.[16] Telerehabilitation was carried through video-conferencing and telephone technology.[17] Telerehabilitation was carried through Smart after Care program.[18] ReMind application was another application of Telerehabilitation which work on Ios systems of iPad devices (Apple Inc).[19] In one study, telerehabilitation set up through video-conferencing sessions.[20] Telerehabilitation session comprises of CogniMotion tele-system.[21] In another study, telerehabilitation was administered through Zoom Pro application.[22]
Exercise intervention regime
Online tele-prerehabilitation platform using Virtuagym fitness app was set up, that include aerobic and resistance training three times a week and inspiratory muscle training five times a week. Aerobic exercises were performed for 30 min at an intensity of 65%–74% of maximum heart rate. Patients chose an activity such as walking, rowing, and cycling according to their capabilities. The resistance training consists of 8–10 exercises for 30 min. Inspiratory muscle training was administered with an inspiratory threshold loading device for 15 min.[12] Telerehabilitation set up was conduct for 8 weeks with a mobile application (Physitrack) and wearable technology (Fitbit). Based on the assessment, individualized exercises were prescribed and progressed according to the ACSM guidelines. Exercises included were aerobic exercise, resistance exercise, and flexibility training for 150 min per week.[13] Home-based telerehabilitation intervention was administered through daily online consultation and training videos, that included nutritional support, swallowing function training, respiratory training and guidance related to patient current vital signs, medications, wound status, and sleep status.[14] Telerehabilitation intervention carried out for 8 weeks (3 sessions of 75 min per week) using eChez-Soi platform, which included stretching exercise, resistance training, cardiorespiratory training, and educational intervention.[15] Telerehabilitation program was administered through zoom video communication with 16 weeks of intervention and progression after every 4 weeks, along with whole body resistance exercises combined with plyometric exercises has proved beneficial in COVID times.[16] The telerehabilitation program was carried for 8-week through phone or videoconference. Intervention include aerobic exercise, resistance training, flexibility training, and health coaching.[17] Telerehabilitation program was set up with Smart After Care System a web-based platform, which include 12-week personalized exercise program consisted of aerobic and resistance training based on the patient's level of physical activity.[18] Telerehabilitation program was set up through ReMind application which include strategy training, pscyhoeducation and attention retraining game. The strategy training and pscyhoeducation consists 6 modules for higher mental functions. The retraining game contains game like graded exercises with different forms of attention.[19] Telerehabilitation intervention consists a combination of two remotely delivered interventions which includes computerized cognitive training and cognitive orientation to functional performance by video-conferencing.[20] Telerehabilitation intervention was given through CogniMotion telesystem which include cognitive rehabilitation sensory motor training and strengthening exercises for 6 weeks.[21] Telerehabilitation intervention was administered through Zoom Pro application. Metacognitive and self-management strategies was given for 6 weeks.[22]
Outcome measures
Outcome measures used in all the eleven studies were varied. In five studies, the primary outcome measure used is feasibility of outcomes during telerehabilitation program and secondary outcome measures in terms of QOL using FACT-G, health-related QOL (EuroQol 5 Dimension) EORTC QLQ-30 for lung specific QLQ-LC13 and numeric pain rating scale for pain.[12],[13],[15],[16],[17] Functional capacity was assessed by six minute walk test, Timed up and go test, Timed stair test, Anxiety and depression disorders using HADS.[12],[13],[15],[16] In two studies QOL was assessed through EORTC QLQ-C30 and its esophageal cancer and prostate cancer supplementary scale EORTC QLQ-OES18, EORTC QLQ-PR25.[14],[18] In one study, Multidimensional Fatigue Inventory and HADS was used to access the level of fatigue and anxiety and depression.[19] In one study, FACT general practitioner scale is used to assess QOL and GAD to screen anxiety symptoms.[20] In one study, FACT-breast is used to assess the QOL [Table 3].[21],[22]
Results of individual studies
Results of eleven included studies in the systematic review are described in [Table 4]. The QOL is the most concerning domain for Oncology patients. In this systematic review almost all studies evaluated QOL before and after the rehabilitation which is screened. Specifically, in oncology settings, there are appropriate QOL scales. FACT-G and EORTC QLQ-C30 are the general scale which has supplementary scales for different cancer types. QOL post Telerehabilitation has shown to improve in cancer patients[12],[14],[15],[17],[18],[20],[21],[22] Cancer patients encounter with decrease in functional exercise capacity, In four studies 6 min walk test, timed up and go test and timed stair test are used as an outcome measures and there was significant improvement in functional exercise capacity.[12],[13],[15],[16] HADS and GAD scales are used four studies to measure the anxiety and depression in cancer patients after telerehabilitation anxiety and depression symptoms decreases. These scales are feasible for patient and therapists to evaluate anxiety and depression symptoms.[12],[15],[19],[20] Fatigue that often comes after surgeries, radiation therapy and chemotherapy in cancer patients. Cancer related fatigue has been assessed in two studies and the scales used are FACIT and modified fatigue impact (MFI), respectively.[12],[19]
| Discussion | | |
Interventions for cancer survivors with health technologies have grown systematically over past few years using the wide usage of outcome measures. This review summarized the outcome measures used in oncology Telerehabilitation. Six min walk test is the submaximal exercise test and has been widely used for preoperatively and postoperatively evaluation in pulmonary and cardiac diseases. Six min walk test is a reliable, low-cost and valid measure of physical performance to assess functional capacity in cancer patients.[23] Interventions through Telerehabilitation source had shown improvement in functional exercise capacity which were assessed through 6 min walk test, timed up and go test and timed stair test in cancer survivors.[24] This systematic review is supported by the study done in the breast cancer patients after chemotherapy to determine the effectiveness of an web-based therapeutic exercise program on improving the functional capacity, strength, anthropometric parameters, and body composition.[25] Another study done on Idiopathic Pulmonary Fibrosis. Tele-rehabilitation was delivered using a virtual autonomous physiotherapist agent. Six-min walk test distance, forced vital capacity and general anxiety disorder scale used as an outcome measures. Suggesting as improvement in functional exercise capacity in patients after giving exercise through Telerehabilitation.[26]
The timed up and go test and timed stair test are the very simple tests used to evaluate individual mobility.[27] In this review, both the tests show significant improvement in cancer patients after giving intervention with telerehabilitation supported by the study done on total hip and knee replacement. Interventions through telerehabilitation source to THR patients using scales such as QOL scale, pain, and functional capacity was measured through 6-min walk test, timed up and go test, five-timed-chair-rise test. The study has demonstrated that there was improvements in 6 min walk test, timed up and go test, stair ascend test respectively.[28] Another study performed on stroke patients using timed up and go test, berg balance scale and 10 min walk test as outcome measures along with telerehabilitation interventions in form of balance training, cognitive behavioral therapy and speech therapy has demonstrated significant improvements.[29] Preoperative rehab through telerehabilitation was form for 3 weeks using Western Ontario and McMaster Universities Osteoarthritis Index Scale, Dynamometer for quadriceps strength, timed up and go test, knee flexion range of motion, and pressure pain threshold has demonstrate significant improvement in terms of outcome measures.[30]
HADS is the self-administered questionnaire and it is effective for screening anxiety and depression in cancer patients.[31] In this review anxiety and depression symptoms have shown reduce after rehabilitation. This study is supported by the study done on breast cancer patients. The intervention was administered through Apple ipad. The outcome measures such as HADS and mini mental adjustment to cancer have demonstrated to decrease anxiety and depression with telerehabilitation.[32] Cognitive rehabilitation in meningioma and glioma, patients using ReMind application with a retraining module comprising of exercise for attention deficits, visual and auditory stimulus has shown to improve HADS.[33] Telerehabilitation in multiple sclerosis was administered through videoconferencing. Dynamic gait index, limits of stability test, MFI scale, HADS, and Multiple Sclerosis International QOL questionnaire have demonstrate improvement after rehabilitation.[34] Another study done on brain tumor and telerehabilitation platform used was video-conferencing which include cognitive rehabilitation and cognitive behavioral therapy. Outcome measures used were GAD scale, McGill QOL Questionnaire, FACT. The study concluded that telerehabilitation sessions had a positive impact on patient psychological factor.[35]
QOL of cancer patients before and after the intervention is an important domain for cancer survivors.[36] Cancer-related pain may be due to tumor as it compressing nerves, bones, organs giving rise to nagging pain with a wide impact on patient QOL making to use feasible scale to evaluate QOL and cancer-related pain scale.[37] This review is supported by the study done on breast cancer with e-CUIDATE system. Outcome measures used were EORTC QLQ-C30 and its breast cancer supplementary scale for QOL, brief pain inventory, and piper fatigue scale-revised for fatigue showing improvements in terms of QOL scale.[38]
To conclude, choice of outcome measures is critical in terms of the type of cancer and hypothesis to be answered in trials and choice of the researcher. The choice of outcome measures should be based on its feasibility, easy reporting and easy interpreted. The limitation of this systematic review may be due to the assignment of inclusion of studies published in the English language only. The authors may have failed the evidence published in gray literature and other languages. There was the presence of variations in the studies selected that may have result in the lack of homogeneity in the quality assessment. In all the studies, there is heterogeneity observed among the patients in terms of type of cancer and type of surgery performed during the administration of telerehabilitation. The patients consent, understanding to telerehabilitation, availability of sources, knowledge of technologies, and patient comfort during entire rehabilitation must also be reviewed while implementing telerehabilitation in oncology patients.
| Conclusion | | |
This summary of the systematic review provides the comprehensive systematic synthesis of evidence regarding the outcome measures used in oncology telerehabilitation during the COVID-19. The findings from this review provide supervision to clinicians and researchers for evidence-based selection of outcome measures. Altogether in all the outcome measures which set up the criteria, the six minute walk test, HADS, and QOL scale cover a wide spectrum of evaluation in oncology telerehabilitation.
Acknowledgment
We would like to thank Pawar N, Patil S for their support throughout searching process and data extraction.
Financial support and sponsorship
This was a self-funded study.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Tanner LR. Oncology telerehabilitation: A race to access and outcomes. Rehabilitation Oncology (American Physical Therapy Association. Oncology Section); 2020.  |
| 2. | Yang L, Liu S, Liu J, Zhang Z, Wan X, Huang B, et al. COVID-19: Immunopathogenesis and immunotherapeutics. Signal Transduct Target Ther 2020;5:128. |
| 3. | Monaghesh E, Hajizadeh A. The role of telehealth during COVID-19 outbreak: A systematic review based on current evidence. BMC Public Health 2020;20:1193. |
| 4. | Smith RD, Mallath MK. History of the growing burden of cancer in India: From antiquity to the 21 st century. J Glob Oncol 2019;5:1-15. |
| 5. | Paterson C, Bacon R, Dwyer R, Morrison KS, Toohey K, O'Dea A, et al. The role of telehealth during the COVID-19 pandemic across the interdisciplinary cancer team: Implications for practice. Semin Oncol Nurs 2020;36:151090. |
| 6. | Peretti A, Amenta F, Tayebati SK, Nittari G, Mahdi SS. Telerehabilitation: Review of the State-of-the-Art and Areas of Application. JMIR Rehabil Assist Technol 2017;4:e7. |
| 7. | Parmanto B, Saptono A. Telerehabilitation: State-of-the-Art from an Informatics Perspective. Int J Telerehabil 2009;1:73-84. |
| 8. | Jachak SP, Phansopkar PA, Naqvi WM, Kumar K. Great awakening – Telerehabilitation in physiotherapy during pandemic and impact of COVID-19. J Evol Med Dent Sci 2020;9:3387-93. |
| 9. | Patel MI. Collaborative telerehabilitation-A smart move for patients with advanced cancer. JAMA Oncol 2019;5:652-3. |
| 10. | Tawfik GM, Dila KA, Mohamed MY, Tam DN, Kien ND, Ahmed AM, et al. A step by step guide for conducting a systematic review and meta-analysis with simulation data. Trop Med Health 2019;47:46. |
| 11. | Cashin AG, McAuley JH. Clinimetrics: Physiotherapy evidence database (PEDro) scale. J Physiother 2020;66:59. |
| 12. | Piraux E, Caty G, Reychler G, Forget P, Deswysen Y. Feasibility and preliminary effectiveness of a tele-prehabilitation program in esophagogastric cancer patients. J Clin Med 2020;9:2176. |
| 13. | MacDonald AM, Chafranskaia A, Lopez CJ, Maganti M, Bernstein LJ, Chang E, et al. CaRE @ home: Pilot study of an online multidimensional cancer rehabilitation and exercise program for cancer survivors. J Clin Med 2020;9:3092. |
| 14. | Chen K, Yao F, Chen X, Lin Y, Kang M. Effectiveness of telerehabilitation on short-term quality of life of patients after esophageal cancer surgery during COVID-19: A single-center, randomized, controlled study. J Gastrointest Oncol 2021;12:1255-64. |
| 15. | Coats V, Moffet H, Vincent C, Simard S, Tremblay L, Maltais F, Saey D. Feasibility of an eight-week telerehabilitation intervention for patients with unresectable thoracic neoplasia receiving chemotherapy: A pilot study. Can J Respir Crit Care Sleep Med 2020;4:14-24. |
| 16. | Lambert G, Alos N, Bernier P, Laverdière C, Kairy D, Drummond K, et al. Home-based telehealth exercise intervention in early-on survivors of childhood acute lymphoblastic leukemia: Feasibility study. JMIR Cancer 2021;7:e25569. |
| 17. | Dennett A, Harding KE, Reimert J, Morris R, Parente P, Taylor NF. Telerehabilitation's safety, feasibility, and exercise uptake in cancer survivors: Process evaluation. JMIR Cancer 2021;7:e33130. |
| 18. | Park YH, Lee JI, Lee JY, Cheong IY, Hwang JH, Seo SI, et al. Internet of things-based lifestyle intervention for prostate cancer patients on androgen deprivation therapy: A prospective, multicenter, randomized trial. Am J Cancer Res 2021;11:5496-507. |
| 19. | van der Linden SD, Rutten GM, Dirven L, Taphoorn MJ, Satoer DD, Dirven CM, et al. eHealth cognitive rehabilitation for brain tumor patients: Results of a randomized controlled trial. J Neurooncol 2021;154:315-26. |
| 20. | Maeir T, Nahum M, Makranz C, Hoba A, Peretz T, Nagary SN, et al. The feasibility of a combined model of online interventions for adults with cancer-related cognitive impairment. Br J Occup Ther 2021;84:430-40. |
| 21. | Loubani K, Kizony R, Milman U, Schreuer N. Hybrid Tele and in-clinic occupation based intervention to improve women's daily participation after breast cancer: A pilot randomized controlled trial. Int J Environ Res Public Health 2021;18:5966. |
| 22. | Loubani K, Schreuer N, Kizony R. Telerehabilitation for managing daily participation among breast cancer survivors during COVID-19: A feasibility study. J Clin Med 2022;11:1022. |
| 23. | Galiano-Castillo N, Arroyo-Morales M, Ariza-Garcia A, Sánchez-Salado C, Fernández-Lao C, Cantarero-Villanueva I, et al. The six-minute walk test as a measure of health in breast cancer patients. J Aging Phys Act 2016;24:508-15. |
| 24. | Hooke MC, Garwick AW, Neglia JP. Assessment of physical performance using the 6-minute walk test in children receiving treatment for cancer. Cancer Nurs 2013;36:E9-16. |
| 25. | Ariza-Garcia A, Lozano-Lozano M, Galiano-Castillo N, Postigo-Martin P, Arroyo-Morales M, Cantarero-Villanueva I. A web-based exercise system (e-CuidateChemo) to counter the side effects of chemotherapy in patients with breast cancer: Randomized controlled trial. J Med Internet Res 2019;21:e14418. |
| 26. | Cerdán-de-Las-Heras J, Balbino F, Løkke A, Catalán-Matamoros D, Hilberg O, Bendstrup E. Tele-rehabilitation program in idiopathic pulmonary fibrosis-A single-center randomized trial. Int J Environ Res Public Health 2021;18:10016. |
| 27. | Huisman MG, van Leeuwen BL, Ugolini G, Montroni I, Spiliotis J, Stabilini C, et al. “Timed Up & Go”: A screening tool for predicting 30-day morbidity in onco-geriatric surgical patients? A multicenter cohort study. PLoS One 2014;9:e86863. |
| 28. | Eichler S, Salzwedel A, Rabe S, Mueller S, Mayer F, Wochatz M, et al. The Effectiveness of telerehabilitation as a supplement to rehabilitation in patients after total knee or hip replacement: Randomized controlled trial. JMIR Rehabil Assist Technol 2019;6:e14236. |
| 29. | Chen SC, Lin CH, Su SW, Chang YT, Lai CH. Feasibility and effect of interactive telerehabilitation on balance in individuals with chronic stroke: A pilot study. J Neuroeng Rehabil 2021;18:71. |
| 30. | An J, Ryu HK, Lyu SJ, Yi HJ, Lee BH. Effects of preoperative telerehabilitation on muscle strength, range of motion, and functional outcomes in candidates for total knee arthroplasty: A single-blind randomized controlled trial. Int J Environ Res Public Health 2021;18:6071. |
| 31. | Carroll BT, Kathol RG, Noyes R Jr., Wald TG, Clamon GH. Screening for depression and anxiety in cancer patients using the hospital anxiety and depression scale. Gen Hosp Psychiatry 1993;15:69-74. |
| 32. | Foley NM, O'Connell EP, Lehane EA, Livingstone V, Maher B, Kaimkhani S, et al. PATI: Patient accessed tailored information: A pilot study to evaluate the effect on preoperative breast cancer patients of information delivered via a mobile application. Breast 2016;30:54-8. |
| 33. | van der Linden SD, Sitskoorn MM, Rutten GM, Gehring K. Feasibility of the evidence-based cognitive telerehabilitation program remind for patients with primary brain tumors. J Neurooncol 2018;137:523-32. |
| 34. | Kahraman T, Savci S, Ozdogar AT, Gedik Z, Idiman E. Physical, cognitive and psychosocial effects of telerehabilitation-based motor imagery training in people with multiple sclerosis: A randomized controlled pilot trial. J Telemed Telecare 2020;26:251-60. |
| 35. | Ownsworth T, Cubis L, Prasad T, Foote M, Kendall M, Oram J, et al. Feasibility and acceptability of a telehealth platform for delivering the making sense of brain tumour programme: A mixed-methods pilot study. Neuropsychol Rehabil 2022;32:378-406. |
| 36. | Coster S, Poole K, Fallowfield LJ. The validation of a quality of life scale to assess the impact of arm morbidity in breast cancer patients post-operatively. Breast Cancer Res Treat 2001;68:273-82. |
| 37. | World Health Organization Staff, World Health Organization. Cancer Pain Relief: With a Guide to Opioid Availability. Oxford University Press, Geneva: World Health Organization; 1996. |
| 38. | Galiano-Castillo N, Cantarero-Villanueva I, Fernández-Lao C, Ariza-García A, Díaz-Rodríguez L, Del-Moral-Ávila R, et al. Telehealth system: A randomized controlled trial evaluating the impact of an internet-based exercise intervention on quality of life, pain, muscle strength, and fatigue in breast cancSSer survivors. Cancer 2016;122:3166-74. |
[Figure 1]
[Table 1], [Table 2], [Table 3], [Table 4]
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