## 4 Discussion  
We compared tele-rehabilitation treatment outcomes with conventional rehabilitation in individuals post-elbow fractures. While no statistically significant differences were found between the two groups, the number of patients that attained functional ROM following 1 month of intervention was higher in the tele-rehabilitation group compared to the control group. The subjects in the tele-rehabilitation group also reported a higher level of satisfaction and needed less help from a family member during practice. Sufficient active elbow ROM is important to maintain normal daily activity. In a study that restricted active ROM at the elbow, forearm, wrist, or fingers in healthy subjects, the authors reported that elbow and forearm restriction caused a similar decrease in hand function as restricted active ROM at the wrist and hand [38]. This indicates that the positioning of the limb via the elbow joint is as important to the successful completion of daily tasks as the ROM of the hand fingers. Although there were no between-group differences in the percentage of improvement in the ROM, the number of subjects who attained functional ROM immediately following the intervention was higher in the tele-rehabilitation group compared to the control group, implying that certain tasks of ADLs might have been less demanding for them. This is also supported by the higher number of subjects from the tele-rehabilitation group that improved their JHFT score by more than the MCID in the JHFT score compared to the control group. Our results suggest that, although not statistically significant, the tele-rehabilitation group showed a tendency toward larger improvement in the PREE and DASH scores immediately following intervention (Figure 3 and Table S1), while in the control group, a slower and constant improvement was apparent over the period of a year. The pain following elbow surgery was found to be a predictor of disability, even when ROM was considerably improved [10]. Pain may occur due to swelling and immobilization, so exercises that incorporate movements usually result in pain relief [4; 35]. We therefore assume that the tele-rehabilitation group which reported a high level of usability and a higher level of enjoyment of the self-practice and needed less help from a family member during the self-practice, were able to practice more, thereby alleviating the pain during the intervention. Overall, this pilot study suggests that both interventions, whether they did or did not incorporate tele-rehabilitation, induced effective outcomes of pain reduction and increased functionality and ROM. There were no dropouts during the intervention, suggesting that the subjects were satisfied with their treatment. Additionally, during the first month of treatment, the subjects in the tele-rehabilitation group received more sessions compared to the conventional rehabilitation group, suggesting that when sessions are available for the patients at the comfort of their home, they choose to schedule these sessions more frequently compared to patients who must arrive at a clinic to receive treatment. It should be noted in this regard that age can be a determinant for the success of tele-rehabilitation, as younger people are more prone to use new technologies. Previous research also reported no differences in the satisfaction levels of individuals who received tele-rehabilitation treatment versus conventional treatment, even when the tele-rehabilitation treatment was not combined with treatment in the clinic, as done in this study [39; 40; 41; 42]. Patient satisfaction is an important measure of the efficacy of an intervention plan, affecting the patient's motivation and responsiveness [42; 43]. Patient satisfaction is also affected by the therapist-patient relationship [44]. One might expect that this relationship would be impaired when the patient and therapist are situated in different locations and no physical contact exists; however, this was not the case, according to our results.