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Kloek CJJ1,2,3, van Tilburg ML1,2, Staal JB4,5, Bossen D6, Veenhof C1,2
1HU University of Apllied Sciences Utrecht, Research Group Innovation of Human Movement Care, Utrecht, Netherlands, 2University Medical Center Utrecht, Department of Rehabilitation, Physiotherapy Science & Sports, Brain Center Rudolf Magnus, Utrecht, Netherlands, 3Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands, 4Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, Netherlands, 5HAN University of Applied Sciences, Research Group Musculoskeletal Rehabilitation, Nijmegen, Netherlands, 6Amsterdam University of Applied Sciences, ACHIEVE Centre of Expertise, Faculty of Health, Amsterdam, Netherlands
Background: In most countries low back pain (LBP) is the leading cause for disability. Clinical LBP guidelines recommend physiotherapists to identify patients' risk on persistent disabling symptoms in an early stage and stratify treatment to individual needs, for example by using the STarT Back Screening Tool. One of physiotherapists' biggest challenges in general, as well as in the treatment of LBP, is the stimulation of patients' adherence to therapeutic recommendations while they are outside the clinic. Blended care, in which face-to-face contact is combined with an online application, might support adherence through technology which is available regardless from time and place. Recently, we developed and evaluated a successful blended intervention for patients with osteoarthritis of the hip/knee, called e-Exercise. Since the treatment of LBP is similar to osteoarthritis in core treatment elements, we expected that the integration of face-to-face care with online support tailored to patients' risk on disabling symptoms, would be applicable in this population as well.
Purpose: To develop a blended stratified physiotherapeutic intervention for patients with LBP (called e-Exercise LBP) and evaluate its feasibility.
Methods: A mixed methods approach was used. Focus groups with patients, physiotherapists and experts were conducted to investigate values and requirements with respect to the development of e-Exercise LBP. Feasibility was then evaluated in a multicenter 1-group pilot study (N=21 physiotherapists). Feasibility outcome measures included preliminary effectiveness on disability and pain, online adherence, number of face-to-face sessions and patients' and physiotherapists' experienced usability. Semi-structured interviews were conducted to investigate user-experiences of patients and physiotherapists with e-Exercise LBP. Qualitative data were analyzed by a phenomenological approach. Descriptive statistics were used to summarize the quantitative data.
Results: The prototype of e-Exercise LBP consisted of face-to-face physiotherapeutic sessions integrated with a web-application with information lessons, video-supported exercises and physical activity assignments. The number of face-to-face sessions and content of the web-application can be tailored to patients' individual physical capacity and risk on persistent disabling LBP as determined with the STarT Back Tool. After 12 weeks, patients that were treated with e-Exercise LBP (N=41) showed improvement on disability (QBDS: MD=-12.2/100; 95CI [8.3, 16.1]) and pain (NRS: MD=-2.8/10; 95CI [2.1, 3.6]). The average number of logins was 28 (SD:27), alongside on average 7 face-to-face sessions. Usability of the web-based application was 73.2/100 (SD:16.29) by patients and 63.3/100 (SD:12.04) by physiotherapists. The stratified-care approach was only minimally applied by physiotherapists. Interviews revealed that physiotherapists had to invest time and effort to get used to e-Exercise LBP in order to benefit from added values. Patients were generally positive, but addressed the need for a mobile application to increase e-Exercise' attractiveness.
Conclusion(s): This study described the participatory development of a blended physiotherapy intervention for patients with non-specific LBP (e-Exercise LBP). Patients and physiotherapists considered the usability of e-Exercise LBP as acceptable. Various points of improvement regarding education in blended stratified care and functionalities of e-Exercise were mentioned.
Implications: The prototype of e-Exercise LBP will be improved based on feedback of patients and physiotherapists. Next step is to explore the (cost-)effectiveness of e-Exercise LBP compared to usual physiotherapy.
Keywords: eHealth, low back pain, feasibility
Funding acknowledgements: This study was funded by the Scientific College Physical Therapy (WCF) of the Royal Dutch Society for Physical Therapy (KNGF).
Purpose: To develop a blended stratified physiotherapeutic intervention for patients with LBP (called e-Exercise LBP) and evaluate its feasibility.
Methods: A mixed methods approach was used. Focus groups with patients, physiotherapists and experts were conducted to investigate values and requirements with respect to the development of e-Exercise LBP. Feasibility was then evaluated in a multicenter 1-group pilot study (N=21 physiotherapists). Feasibility outcome measures included preliminary effectiveness on disability and pain, online adherence, number of face-to-face sessions and patients' and physiotherapists' experienced usability. Semi-structured interviews were conducted to investigate user-experiences of patients and physiotherapists with e-Exercise LBP. Qualitative data were analyzed by a phenomenological approach. Descriptive statistics were used to summarize the quantitative data.
Results: The prototype of e-Exercise LBP consisted of face-to-face physiotherapeutic sessions integrated with a web-application with information lessons, video-supported exercises and physical activity assignments. The number of face-to-face sessions and content of the web-application can be tailored to patients' individual physical capacity and risk on persistent disabling LBP as determined with the STarT Back Tool. After 12 weeks, patients that were treated with e-Exercise LBP (N=41) showed improvement on disability (QBDS: MD=-12.2/100; 95CI [8.3, 16.1]) and pain (NRS: MD=-2.8/10; 95CI [2.1, 3.6]). The average number of logins was 28 (SD:27), alongside on average 7 face-to-face sessions. Usability of the web-based application was 73.2/100 (SD:16.29) by patients and 63.3/100 (SD:12.04) by physiotherapists. The stratified-care approach was only minimally applied by physiotherapists. Interviews revealed that physiotherapists had to invest time and effort to get used to e-Exercise LBP in order to benefit from added values. Patients were generally positive, but addressed the need for a mobile application to increase e-Exercise' attractiveness.
Conclusion(s): This study described the participatory development of a blended physiotherapy intervention for patients with non-specific LBP (e-Exercise LBP). Patients and physiotherapists considered the usability of e-Exercise LBP as acceptable. Various points of improvement regarding education in blended stratified care and functionalities of e-Exercise were mentioned.
Implications: The prototype of e-Exercise LBP will be improved based on feedback of patients and physiotherapists. Next step is to explore the (cost-)effectiveness of e-Exercise LBP compared to usual physiotherapy.
Keywords: eHealth, low back pain, feasibility
Funding acknowledgements: This study was funded by the Scientific College Physical Therapy (WCF) of the Royal Dutch Society for Physical Therapy (KNGF).
Topic: Robotics & technology; Musculoskeletal: spine; Primary health care
Ethics approval required: No
Institution: University Medical Center Utrecht
Ethics committee: University Medical Center Utrecht
Reason not required: Ethics approval was not required since e-Exercise contains the same treatment elements as usual care, only in a new delivery mode.
All authors, affiliations and abstracts have been published as submitted.
