Functional recovery with perioperative asynchronous telerehabilitation in colorectal cancer: a randomized clinical trial

Abstract Purpose To determine whether asynchronous digital monitoring, individualized progression, reminders, and physiotherapist support provide additional functional benefit over a content-matched perioperative home rehabilitation program after colorectal cancer surgery. Methods This single-center, assessor-masked randomized clinical trial assigned 80 adults 1:1 to telerehabilitation or booklet-based rehabilitation. Both groups received respiratory, aerobic, and progressive resistance exercise plus perioperative education. The primary outcome was 6-minute walk test (6MWT) at approximately 50 days after surgery (T4). Secondary outcomes included functional mobility, pulmonary function, physical activity, adherence, and satisfaction. Usability was assessed among telerehabilitation participants. Between-group clinical analyses were adjusted for baseline values and age. Results Eighty participants were randomized, 40 per group. The adjusted between-group difference in 6MWT distance at T4 was not significant (P = .180). No significant adjusted between-group differences were observed for functional mobility, pulmonary function, or physical activity. Overall recorded adherence was higher with telerehabilitation than with booklet-based rehabilitation (69.6% vs 52.8%; difference, 16.8 percentage points; P = .002). Satisfaction at T4 favored telerehabilitation (P = .044). Among telerehabilitation participants, total usability increased from 6.24 to 6.68 of 7 (P < .001). Conclusion In adults undergoing colorectal cancer surgery, both rehabilitation strategies were associated with functional recovery, while asynchronous telerehabilitation did not confer additional short-term functional benefit. The digital approach was associated with greater recorded adherence and end-of-program satisfaction, suggesting potential value in engagement and continuity of rehabilitation delivery. Trial registration: ClinicalTrials.gov NCT06593678; registered 29 August 2024. Clinical trial registration ClinicalTrials.gov NCT06593678. Registered 29 August 2024.