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 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. Methods: This 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 24months 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 24months. Discussion: A 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.
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 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. Methods: This 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 24months 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 24months. Discussion: A 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.
INTRODUCTION: Functional capacity tests are standardized instruments to evaluate patients' capacities to execute work-related activities. Functional capacity test results are associated with biopsychosocial factors, making it unclear what is being measured in capacity testing. An overview of these factors was missing. The objective of this review was to investigate the level of evidence for factors that are associated with functional capacity test results in patients with non-specific chronic low back pain.METHODS: A systematic literature review was performed identifying relevant studies from an electronic journal databases search. Candidate studies employed a cross-sectional or RCT design and were published between 1980 and October 2010. The quality of these studies was determined and level of evidence was reported for factors that were associated with capacity results in at least 3 studies.RESULTS: Twenty-two studies were included. The level of evidence was reported for lifting low, lifting high, carrying, and static lifting capacity. Lifting low test results were associated with self-reported disability and specific self-efficacy but not with pain duration. There was conflicting evidence for associations of lifting low with pain intensity, fear of movement/(re)injury, depression, gender and age. Lifting high was associated with gender and specific self-efficacy, but not with pain intensity or age. There is conflicting evidence for the association of lifting high with the factors self-reported disability, pain duration and depression. Carrying was associated with self-reported disability and not with pain intensity and there is conflicting evidence for associations with specific self-efficacy, gender and age. Static lifting was associated with fear of movement/(re)injury.CONCLUSIONS: Much heterogeneity was observed in investigated capacity tests and candidate associated factors. There was some evidence for biological and psychological factors that are or are not associated with capacity results but there is also much conflicting evidence. High level evidence for social factors was absent.
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The impacts of tourism on destinations and the perceptions of local communities have been a major concern both for the industry and research in the past decades. However, tourism planning has been mainly focused on traditions that promote the increase of tourism without taking under consideration the wellbeing of both residents and visitors. To develop a more sustainable tourism model, the inclusion of local residents in tourism decision-making is vital. However, this is not always possible due to structural, economic and socio-cultural restrictions that residents face resulting to their disempowerment. This study aims to explore and interpret the formal processes around tourism decision-making and community empowerment in urban settings. The research proposes a comparative study of three urban destinations in Europe (The Hague in the Netherlands, San Sebastian in Spain and, Ioannina in Greece) that experience similar degree of tourism growth. The proposed study will use a design-based approach in order to understand tourism decision-making and what empowers or disempowers community participation within the destinations. Based on the findings of primary and secondary data, a community empowerment model will be applied in one the destinations as a pilot for resident engagement in tourism planning. The evaluation of the pilot will allow for an optimized model to be created with implications for tourism planning at a local level that can contribute to sustainable destinations that safeguard the interests of local residents and tourists.
In dit onderzoek ontwikkelen we een online leeromgeving voor interactie tussen zorgprofessionals en patiënten met chronische pijn. De aanleiding voor dit onderzoek zijn verzoeken van zorgprofessionals: in hun gesprek met patiënten komt men veelal niet tot overeenstemming over de oorzaken van die chronische pijn. Een dergelijke overeenstemming is echter noodzakelijk voor een succesvol behandelingstraject. Behandelaars geven aan dat veel patiënten terughoudend zijn in het bespreken van de psychologische en sociale oorzaken van hun pijn en de beperkingen die zij daarbij dagelijks ervaren. Patiënten weerleggen bijvoorbeeld voortdurend de ‘beschuldiging’ van zorgprofessionals dat hun klacht ‘tussen de oren’ zou zitten. Dit is een voorbeeld van een patroon in de interactie over chronische pijn. Het blijkt dat de zorgprofessional vaak onvoldoende inzicht heeft in de manier waarop patiënten met chronische pijn communiceren en de effecten van de eigen communicatiepraktijken. Hierdoor sluit de zorgprofessional te weinig aan bij deze doelgroep. Gevolg hiervan is dat er onvoldoende contact gemaakt wordt met de patiënt. Dit leidt er mogelijk toe dat de doeleinden van de behandeling niet gehaald worden. Dat kan beter: de zorgen van een patiënt over het gesprek kunnen onderdeel worden van dat gesprek. Online leeromgevingen voor het oefenen van deze gesprekken kunnen daarbij van pas komen. Behandelaars geven namelijk aan dat ze bij voorkeur tijds- en plaatsonafhankelijk leren. Deze behoefte is versterkt door de maatregelen tijdens de Coronapandemie. Bovendien blijkt uit onderzoek dat een dergelijke omgeving geschikt is voor het ontwikkelen van communicatieve vaardigheden en door gebruikers/lerenden ook als waardevol wordt beschouwd. In dit onderzoek verkennen we de voorwaarden waaraan een online leeromgeving voor de doelgroep ‘behandelaars van patiënten met chronische pijn’ moet voldoen. Daarnaast exploreren we de knelpunten in interactie tussen behandelaars en patiënten met chronische pijn, zodat we kunnen aangeven welke kansen er zijn tot verbetering van de gesprekken.
In dit onderzoek ontwikkelen we een online leeromgeving voor het verbeteren van interactie tussen zorgprofessionals en patiënten met chronische pijn. Doel Zorgprofessionals geven aan dat zij onvoldoende inzicht hebben in de manier waarop patiënten met chronische pijn communiceren en de effecten van hun eigen communicatiepraktijken. Op basis van inzichten in deze gesprekken en in succesfactoren bij online leeromgevingen, ontwikkelen we een online leertool. Resultaten Een online leeromgeving die de zorgprofessional helpt patronen in communicatie met de patiënt met chronische pijn op te merken en inzicht te verwerven in de manier waarop de terughoudendheid van de patiënt verminderd kan worden. Voorlopige resultatenOp basis van de resultaten van de interviews met patiënten en focusgroepen met zorgprofessionals, hebben we de vorm- en inhoudselementen van de leeromgeving en leerdoelen geformuleerd met de partners. Voorbeelden van leerdoelen zijn het ‘valideren van de pijnervaring’ en ‘ruimte geven aan het perspectief van de patiënt. Vervolgens hebben we in cocreatiesessies een ontwerp gemaakt voor de leeromgeving. Gebruikers van de leeromgeving worden uitgedaagd te kiezen hoe te reageren op een uiting van de patiënt, met een meerkeuzeformat. Afhankelijk van de keuze gaat het gesprek verder en elke keuze wordt gevolgd door feedback. Momenteel ontwikkelen we met developers een eerste proof of concepts die in de komende periode wordt getest. Looptijd 01 april 2022 - 31 maart 2024 Aanpak Door interviews met patiënten en zorgprofessionals en een literatuurstudie verwerven we inzicht in de gevoeligheden in de gesprekken en in het huidige aanbod aan leeromgevingen in de zorgpraktijk. In cocreatiesessies met het werkveld ontwikkelen we de leeromgeving. Relevantie van het project Voor de zorgberoepspraktijk levert het project een online leeromgeving waarin ze leren gevoeligheden of knelpunten in gesprekken met patiënten met chronische pijn op te merken en hier anders mee om te gaan. De opbrengsten van het project kunnen worden ingebed in opleidingen als (psychosomatische) fysiotherapie en oefentherapie.
