Background: Neck and shoulder complaints are common in primary care physiotherapy. These patients experience pain and disability, resulting in high societal costs due to, for example, healthcare use and work absence. Content and intensity of physiotherapy care can be matched to a patient’s risk of persistent disabling pain. Mode of care delivery can be matched to the patient’s suitability for blended care (integrating eHealth with physiotherapy sessions). It is hypothesized that combining these two approaches to stratified care (referred to from this point as Stratified Blended Approach) will improve the effectiveness and cost-effectiveness of physiotherapy for patients with neck and/or shoulder complaints compared to usual physiotherapy. Methods: This paper presents the protocol of a multicenter, pragmatic, two-arm, parallel-group, cluster randomized controlled trial. A total of 92 physiotherapists will be recruited from Dutch primary care physiotherapy practices. Physiotherapy practices will be randomized to the Stratified Blended Approach arm or usual physiotherapy arm by a computer-generated random sequence table using SPSS (1:1 allocation). Number of physiotherapists (1 or > 1) will be used as a stratification variable. A total of 238 adults consulting with neck and/or shoulder complaints will be recruited to the trial by the physiotherapy practices. In the Stratified Blended Approach arm, physiotherapists will match I) the content and intensity of physiotherapy care to the patient’s risk of persistent disabling pain, categorized as low, medium or high (using the Keele STarT MSK Tool) and II) the mode of care delivery to the patient’s suitability and willingness to receive blended care. The control arm will receive physiotherapy as usual. Neither physiotherapists nor patients in the control arm will be informed about the Stratified Blended Approach arm. The primary outcome is region-specific pain and disability (combined score of Shoulder Pain and Disability Index & Neck Pain and Disability Scale) over 9 months. Effectiveness will be compared using linear mixed models. An economic evaluation will be performed from the societal and healthcare perspective. Discussion: The trial will be the first to provide evidence on the effectiveness and cost-effectiveness of the Stratified Blended Approach compared with usual physiotherapy in patients with neck and/or shoulder complaints.
Background Providing individualized care based on the context and preferences of the patient is important. Knowledge on both prognostic risk stratification and blended eHealth care in musculoskeletal conditions is increasing and seems promising. Stratification can be used to match patients to the most optimal content and intensity of treatment as well as mode of treatment delivery (i.e. face-to-face or blended with eHealth). However, research on the integration of stratified and blended eHealth care with corresponding matched treatment options for patients with neck and/or shoulder complaints is lacking. Methods This study was a mixed methods study comprising the development of matched treatment options, followed by an evaluation of the feasibility of the developed Stratified Blended Physiotherapy approach. In the first phase, three focus groups with physiotherapists and physiotherapy experts were conducted. The second phase investigated the feasibility (i.e. satisfaction, usability and experiences) of the Stratified Blended Physiotherapy approach for both physiotherapists and patients in a multicenter single-arm convergent parallel mixed methods feasibility study. Results In the first phase, matched treatment options were developed for six patient subgroups. Recommendations for content and intensity of physiotherapy were matched to the patient’s risk of persistent disabling pain (using the Keele STarT MSK Tool: low/medium/high risk). In addition, selection of mode of treatment delivery was matched to the patient’s suitability for blended care (using the Dutch Blended Physiotherapy Checklist: yes/no). A paperbased workbook and e-Exercise app modules were developed as two different mode of treatment delivery options, to support physiotherapists. Feasibility was evaluated in the second phase. Physiotherapists and patients were mildly satisfied with the new approach. Usability of the physiotherapist dashboard to set up the e-Exercise app was considered ‘OK’ by physiotherapists. Patients considered the e-Exercise app to be of ‘best imaginable’ usability. The paper-based workbook was not used. Conclusion Results of the focus groups led to the development of matched treatment options. Results of the feasibility study showed experiences with integrating stratified and blended eHealth care and have informed amendments to the Stratified Blended Physiotherapy approach for patients with neck and/or shoulder complaints ready to use within a future cluster randomized trial.
OBJECTIVES: Knee osteoarthritis (OA) is characterized by its heterogeneity, with large differences in clinical characteristics between patients. Therefore, a stratified approach to exercise therapy, whereby patients are allocated to homogeneous subgroups and receive a stratified, subgroup-specific intervention, can be expected to optimize current clinical effects. Recently, we developed and pilot tested a model of stratified exercise therapy based on clinically relevant subgroups of knee OA patients that we previously identified. Based on the promising results, it is timely to evaluate the (cost-)effectiveness of stratified exercise therapy compared with usual, "nonstratified" exercise therapy.METHODS: A pragmatic cluster randomized controlled trial including economic and process evaluation, comparing stratified exercise therapy with usual care by physical therapists (PTs) in primary care, in a total of 408 patients with clinically diagnosed knee OA. Eligible physical therapy practices are randomized in a 1:2 ratio to provide the experimental (in 204 patients) or control intervention (in 204 patients), respectively. The experimental intervention is a model of stratified exercise therapy consisting of (a) a stratification algorithm that allocates patients to a "high muscle strength subgroup," "low muscle strength subgroup," or "obesity subgroup" and (b) subgroup-specific, protocolized exercise therapy (with an additional dietary intervention from a dietician for the obesity subgroup only). The control intervention will be usual best practice by PTs (i.e., nonstratified exercise therapy). Our primary outcome measures are knee pain severity (Numeric Rating Scale) and physical functioning (Knee Injury and Osteoarthritis Outcome Score subscale daily living). Measurements will be performed at baseline, 3-month (primary endpoint), 6-month (questionnaires only), and 12-month follow-up, with an additional cost questionnaire at 9 months. Intention-to-treat, multilevel, regression analysis comparing stratified versus usual care will be performed.CONCLUSION: This study will demonstrate whether stratified care provided by primary care PTs is effective and cost-effective compared with usual best practice from PTs.
De zorgbehoeftes van patiënten met nek- en/of schouderklachten kunnen per persoon verschillen. We onderzoeken of de fysiotherapie verbeterd kan worden door dit te personaliseren en met een online programma te combineren.Doel Het doel van dit project is het verbeteren van de fysiotherapeutische zorg voor patiënten met nek- en/of schouderklachten. Door de vorm en inhoud aan te passen aan de behoeftes van de individuele patiënt denken we de therapie (kosten-)effectiever te maken. We willen dat zoveel mogelijk fysiotherapeuten deze behandeling kunnen toepassen. Daarnaast gebruiken we de kennis uit dit onderzoek in het opleiden van professionals in de gezondheidszorg. Resultaten Dit onderzoek loopt nog. Na afronding vind je hier een samenvatting van de resultaten. Looptijd 01 juni 2018 - 01 juni 2023 Aanpak We bieden de fysiotherapeut hulpmiddelen om te bepalen of een patiënt geschikt is voor blended fysiotherapie en om te bepalen hoe de behandeling er dan uit zou moeten zien. Blended fysiotherapie is een integratie van consulten fysiotherapie en een digitaal programma waarmee patiënten thuis aan de slag gaan, zoals het bestaande E- Excercise. Deze zogenoemde gestratificeerde blended fysiotherapie behandeling vergelijken we met gebruikelijke fysiotherapie op (kosten-)effectiviteit. Lees hier het wetenschappelijk artikel dat Mark van Tilburg en collega-onderzoekers erover publiceerden: Stratified care integrated with eHealth versus usual primary care physiotherapy in patients with neck and/or shoulder complaints: protocol for a cluster randomized controlled trial
De zorgbehoeftes van patiënten met nek- en/of schouderklachten kunnen per persoon verschillen. We onderzoeken of de fysiotherapie verbeterd kan worden door dit te personaliseren en met een online programma te combineren.Doel Het doel van dit project is het verbeteren van de fysiotherapeutische zorg voor patiënten met nek- en/of schouderklachten. Door de vorm en inhoud aan te passen aan de behoeftes van de individuele patiënt denken we de therapie (kosten-)effectiever te maken. We willen dat zoveel mogelijk fysiotherapeuten deze behandeling kunnen toepassen. Daarnaast gebruiken we de kennis uit dit onderzoek in het opleiden van professionals in de gezondheidszorg. Resultaten Dit onderzoek loopt nog. Na afronding vind je hier een samenvatting van de resultaten. Looptijd 01 juni 2018 - 01 juni 2023 Aanpak We bieden de fysiotherapeut hulpmiddelen om te bepalen of een patiënt geschikt is voor blended fysiotherapie en om te bepalen hoe de behandeling er dan uit zou moeten zien. Blended fysiotherapie is een integratie van consulten fysiotherapie en een digitaal programma waarmee patiënten thuis aan de slag gaan, zoals het bestaande E- Excercise. Deze zogenoemde gestratificeerde blended fysiotherapie behandeling vergelijken we met gebruikelijke fysiotherapie op (kosten-)effectiviteit. Lees hier het wetenschappelijk artikel dat Mark van Tilburg en collega-onderzoekers erover publiceerden: Stratified care integrated with eHealth versus usual primary care physiotherapy in patients with neck and/or shoulder complaints: protocol for a cluster randomized controlled trial
