Remco Arensman

108 Chapter 5 Is Stratified Blended Physiotherapy Effective Compared With Face-to-face Physiotherapy? In the mixed model analyses, log likelihood ratios of naive models and models that included a random intercept for both physiotherapy practice and physiotherapist were similar. Therefore, physiotherapy practice or physiotherapist was not included as a level in the LMM analyses. At 3 months, LMM analyses showed no clinically relevant or statistically significant between-group difference in the primary outcome of physical functioning (mean difference [MD] −1.96, 95% CI −4.47 to 0.55). For the secondary outcomes, a statistically significant between-group difference was found in favor of stratified blended physiotherapy for fear-avoidance beliefs (MD −4.29, 95% CI −7.22 to −1.37) and patients’ self-reported adherence to prescribed home exercises (MD 0.73, 95% CI 0.06-1.39). Withingroup analyses showed clinically relevant and statistically significant improvements in physical functioning (MD −11.48, 95% CI −15.06 to −7.91), average pain intensity (MD −2.38, 95% CI −3.00 to −1.76), and fear-avoidance beliefs (MD −5.14, 95% CI −9.22 to −1.06) in the stratified blended physiotherapy group. In the face-to-face physiotherapy group, clinically relevant and statistically significant improvements in physical functioning (MD −11.22, 95% CI −14.64 to −7.80) and average pain intensity (MD −2.51, 95% CI −3.11 to −1.90) were found (Table 4). As indicated by a statistically significant interaction term, the patients’ risk of developing persistent LBP was an effect modifier of the between-group differences on the primary outcome of physical functioning. In patients with a high risk of developing persistent LBP, the stratified analysis showed a statistically significant between-group difference in favor of stratified blended physiotherapy on physical functioning (MD–16.39, 95% CI –27.98 to –4.79), average pain intensity (MD–3.43, 95% CI –6.55 to –0.31), and fear-avoidance beliefs (MD–14.51, 95% CI –28.21 to –0.81). In patients with a medium risk of developing persistent LBP, a statistically significant between-group difference was found in favor of stratified blended physiotherapy on fear-avoidance beliefs (MD –5.93, 95% CI –11.45 to –0.40). In patients with a low risk of developing persistent LBP, no statistically significant between-group differences were found (Table 5).

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