Abstract
BackgroundPatient 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 physical functioning and prevention of recurrent events largely depends on patient self-management, adherence to prescribed (home-based) exercises and recommended physical activity behaviour. Therefore we have developed e-Exercise LBP, a blended intervention in which a smartphone application is integrated within face-to-face care. E-Exercise LBP aims to improve patient self-management skills and adherence to exercise and physical activity recommendations and consequently improve the effectiveness of physiotherapy on patients’ physical functioning. The aim of this study is to investigate the short- (3 months) and long-term (12 and 24 months) effectiveness on physical functioning and cost-effectiveness of e-Exercise LBP in comparison to usual primary care physiotherapy in patients with LBP.MethodsThis paper presents the protocol of a prospective, multicentre cluster randomized controlled trial. In total 208 patients with LBP pain were treated with either e-Exercise LBP or usual care physiotherapy. E-Exercise LBP is stratified based on the risk for developing persistent LBP. Physiotherapists are 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. The smartphone application contains video-supported self-management information, video-supported exercises and a goal-oriented physical activity module. The primary outcome is physical functioning at 12-months follow-up. Secondary outcomes include pain intensity, physical activity, adherence to prescribed (home-based) exercises and recommended physical activity behaviour, self-efficacy, patient activation and health-related quality of life. All measurements will be performed at baseline, 3, 12 and 24 months after inclusion. An economic evaluation will be performed from the societal and the healthcare perspective and will assess cost-effectiveness of e-Exercise LBP compared to usual physiotherapy at 12 and 24 months.DiscussionA multi-phase development and implementation process using the Center for eHealth Research Roadmap for the participatory development of eHealth was used for development and evaluation. The findings will provide evidence on the effectiveness of blended care for patients with LBP and help to enhance future implementation of blended physiotherapy.Trial registrationISRCTN, ISRCTN94074203. Registered 20 July 2018 – Retrospectively registered.
Highlights
Patient education, advice on returning to normal activities and exercise therapy are established treatment options for patients with non-specific low back pain (LBP)
The aim of the presented study is to investigate the short-term as well as the long-term effectiveness and cost-effectiveness of e-Exercise LBP compared to usual physiotherapy in patients with LBP
E-Exercise LBP is a stratified blended care intervention in which an eCoaching smartphone application is integrated into primary care face-to-face physiotherapy
Summary
Advice on returning to normal activities and (home-based) exercise therapy are established treatment options for patients with non-specific low back pain (LBP). The effectiveness of physiotherapy interventions on physical functioning and prevention of recurrent events largely depends on patient self-management, adherence to prescribed (home-based) exercises and recommended physical activity behaviour. The clinical course of this so-called ‘non-specific LBP’ varies; some people recover within a couple of days or weeks, and other people experience persistent disabling symptoms leading to chronic LBP [2, 5, 6] Both national and international clinical LBP guidelines endorse patient education, advice on returning to normal activities and the prescription of home-exercises and/or supervised exercise therapy [7,8,9,10]. The effectiveness of physiotherapy in patients with LBP does not solely depend on providing the most adequate physiotherapy interventions It highly depends on patients’ adherence to prescribed (home-)exercises and recommended physical activity behaviour [11, 12]. Supporting self-management and adherence in patients with LBP is expected to be essential for the effectiveness of physiotherapy interventions on patients’ physical functioning and prevention of recurrent events
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
