## 2 Methods
### Study Tools and Protocol  
#### 2.2.1 Evaluation  
We used a demographic questionnaire and retrieved data from medical files to obtain age, gender, occupational performance before injury, and other medical conditions. Then, four evaluations were performed: immediately after the surgery, after one month of intervention, three months post-surgery, and one year post-surgery. Three physical outcome measures were acquired in each evaluation: _Active and passive ROM_ measured using a manual goniometer and _grip strength_ measured in kilograms using a hydraulic hand dynamometer (Jamar, Duluth, MI, USA). The subjects performed three trials while sitting in the same position (elbow in 90\({}^{\circ}\) flexion and arm in mid-position) following standard instructions [25; 26]. The mean of the three measurements was calculated; _The Jebsen-Taylor Hand Function Test_ (JHFT; [27]) which is a standard performance assessment of hand function in seven day-to-day activities, e.g., lifting small objects and eating. Each task is measured by time and performed first by the nondominant hand and then by the dominant hand. Four questionnaires were filled out by the subjects in each evaluation:  
1. _The Disabilities of Arm, Shoulder and Hand_ (DASH; [28]), a self-assessment functional questionnaire used following an upper extremity injury. The questionnaire includes 30 items concerning functioning and severity of the symptoms in the past week. The patient is asked to rate the difficulty level of performing 21 physical activities on a Likert scale (from 1 = no difficulty to 5 = unable to perform) and the influence of the physical injury on the social functioning (1 = not at all to 5 = extreme). The final score ranges from 0 to 100, with a higher score indicating poorer functioning and more severe symptoms. DASH has a high repeatability in subjects with elbow injuries (ICC = 0.92; [29]). It has also been found that the tool is sensitive to post-treatment status changes compared to the pretreatment condition [29]. 2. _The Patient-Rated Elbow Evaluation_ (PREE; [30]), a self-assessment questionnaire following elbow injuries which evaluates the level of pain and level of function of the affected limb on a Likert scale between 0-10 (0 = no pain and no functional limi  
Figure 1: The outline of the study. tations to 10 = the highest pain or highest disability). The questionnaire has three parts: 5 questions are related to the level of pain; 11 questions regarding the ability to perform specific tasks with the elbow, e.g., combing the hair; and 4 questions related to usual daily life activities (dressing, eating, etc.). High scores reflect higher pain and disability. This questionnaire was translated from English to Hebrew as part of this study in a re-translation procedure and expert validation. 3. _Patient satisfaction questionnaire, about self-management of the home program_, a self-completion questionnaire compiled by Dr. [PERSON] from the Department of Occupational Therapy at Tel Aviv University and adapted for this study. The questionnaire consists of 7 questions. Four items used a Likert scale between 1 and 5 (1 = not at all and 5 = very much): satisfaction from the intervention, level of motivation evoked by the intervention, subjective motor improvement of the injured hand, and the duration of the practice. The other 3 items regarded the assistance needed to use the intervention at home (needs help all the time, occasionally needs help, or do not need help at all) [31]. 4. _The System Usability Scale_ (SUS; [32]), a questionnaire filled out by the subjects in the tele-rehabilitation group, intended to examine the degree of convenience of using technological systems. This questionnaire consists of 10 statements on the Likert scale (1 = strongly disagrees to 5 = strongly agrees). The scoring is performed as follows: uneven items (1, 3, 5, 7, 9) are deducted by one point from the subject selection, and even items (2, 4, 6, 8, 10) subtract the subject choice from five.