T. Koppenaal1,2,3, M.F. Pisters1,2,3, C.J.J. Kloek2,4, R.M. Arensman2,3, R.W.J.G. Ostelo5,6, C. Veenhof2,3,4
1Fontys University of Applied Sciences, Department of Health Innovations and Technology, Eindhoven, Netherlands, 2Julius Health Care Centers, Center for Physical Therapy Research and Innovation in Primary Care,, Utrecht, Netherlands, 3Brain Center, University Medical Center Utrecht, Utrecht University, Physical Therapy Research, Department of Rehabilitation, Physiotherapy Science and Sport, Utrecht, Netherlands, 4HU University of Applied Sciences, Research Group Innovation of Human Movement Care, Utrecht, Netherlands, 5Faculty of Science, VU University Amsterdam, Amsterdam Public Health research institute, Department of Health Sciences, Faculty of Science, Amsterdam, Netherlands, 6VU University Amsterdam, Amsterdam Movement Sciences research institute Amsterdam, Department of Health Sciences, Faculty of Science, Amsterdam, Netherlands

Background: Patient education, advice on returning to normal activities and (home-based) exercise therapy are established treatment options for patients with non-specific low back pain (LBP). However, the effectiveness of physiotherapy interventions on health-related outcomes and prevention of recurrent events largely depends on patient self-management, adherence to prescribed (home-based) exercise and recommended physical activity behaviour. E-Exercise LBP is a newly developed blended care intervention, consisting of face-to-face physiotherapy treatment in which eCoaching is integrated using a smartphone application. In the short-term e-Exercise LBP aims to improve patients’ physical functioning and health-related outcomes by offering a blended stratified-care approach and consequently influencing patients’ self-management skills and adherence. In the long-term e-Exercise LBP could result in improved handling of recurrent LBP.

Purpose: The primary aim of this study is to investigate the short-term (3 months) effectiveness of e-Exercise LBP on physical functioning in comparison to usual primary care physiotherapy in patients with LBP. Secondary, the effects of e-Exercise LBP on pain intensity, health-related quality of life, physical activity, fear avoidance beliefs, pain catastrophizing, self-efficacy, and patient activation will be investigated.

Methods: The design was a prospective, multicentre cluster randomized controlled trial conducted in 58 primary care physiotherapy practices. Patients with non-specific LBP aged 18 years and older were asked to participate in the study. The patients were treated with either e-Exercise LBP or usual primary care physiotherapy. E-Exercise LBP was stratified based on the risk for developing persistent LBP. The smartphone application contains video-supported self-management information, video-supported exercises and a goal-oriented physical activity module. Physiotherapists were able to monitor and evaluate treatment progress between face-to-face sessions using patient input from the smartphone application in order to optimize physiotherapy care. Usual physiotherapy care was conducted according to the Dutch physiotherapy guideline for the treatment of non-specific LBP. Physical functioning was assessed using the Oswestry Disability index (ODI) 2.1a, and measured at baseline and after 3 months. Secondary outcomes were measured using the Numeric Pain Rating Scale, Activ8 Activity Monitor, Fear Avoidance Beliefs Questionnaire, Pain Catastrophizing Scale, Patient Activation Measure, General Self-efficacy Scale, and the EQ-5D-5L respectively.

Results: The e-Exercise LBP group (n = 104) received, on average, 4.80 face-to-face sessions; the
usual primary care physiotherapy group (n = 104) received 4.86 sessions. Preliminary analysis showed no significant difference in physical functioning between the e-Exercise group and the usual primary care physiotherapy group on the short-term. For the secondary outcomes, a significant between group difference was found for fear avoidance beliefs. Within-group analyses showed a clinically relevant and significant improvement in physical function, pain intensity, and fear avoidance beliefs in both groups.

Conclusion(s): The personalized stratified blended care intervention ‘e-Exercise LBP’ was not more effective as usual primary care physiotherapy in patients with non-specific LBP to improve physical functioning after 3 months.

Implications: In the short-term e-Exercise LBP can be considered a valid treatment alternative for patients with LBP next to usual primary care physiotherapy. Forthcoming long-term results should indicate the long-term effectiveness and cost-effectiveness of e-Exercise LBP and influence policy-making and implementation of blended physiotherapy care for patients with LBP.

Funding, acknowledgements: This study is funded by the Taskforce for Applied Research SIA (RAAK.PRO02.063), part of the Dutch Research Council (NWO).

Keywords: E-health, Non-specific low back pain, Physiotherapy

Topic: Musculoskeletal: spine

Did this work require ethics approval? Yes
Institution: University Medical Center Utrecht, the Netherlands
Committee: Medical Research Ethics Committee of the University Medical Center Utrecht
Ethics number: 18-085/D

All authors, affiliations and abstracts have been published as submitted.

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