113 The short-term effectiveness of e-Exercise low back pain – a cluster RCT weekly information modules and daily reminders to exercise and physical activity recommendations during a 3- or 12-week duration (26); the duration in other studies ranged from 3 weeks to 1 year. In addition, the delivery modes showed large variation; that is, from no specific recommendations to multiple web- or telephone-based coaching sessions (15,22,51). Thus, looking at the different characteristics of web-based applications, such as the role of the health care professional within the intervention and the delivery mode and duration, future research needs to focus on the comparison of web-based applications with different characteristics to obtain a better understanding of which elements work the best. In our study, the short-term within-group improvements in physical functioning and average pain intensity of stratified blended physiotherapy were comparable with faceto-face physiotherapy, both of which were statistically significant and clinically meaningful. Patients in the stratified blended physiotherapy group improved on average 11.48 (95% CI−15.06 to −7.91) points (59.5%) in physical functioning, and patients in the face-to-face physiotherapy group improved by an average of 11.22 (95% CI −14.64 to −7.80) points (56%). For average pain intensity, these improvements were 2.38 (95% CI −3.00 to −1.76) points (42.8%) and 2.51 (95% CI −3.11 to −1.90) points (46.9%), respectively. As physical functioning and average pain intensity decreased by >30%, the improvements in both groups were considered clinically meaningful (52). At the moment, e-Exercise LBP cannot be considered an alternative to face-to-face physiotherapy as this study was conducted as a superiority trial. To be able to value the true potential of e-Exercise LBP, the meaningful within-group improvements must be considered from the perspective of the additional effort and costs needed to implement such an intervention in daily physiotherapy practice. Future cost-effectiveness analyses will provide more insight into the long-term economic benefits of stratified blended physiotherapy. On the other hand, given the additional effort and costs, the potential of e-Exercise LBP needs to be considered from the perspective of future health care. It is expected that technology will be increasingly integrated into care for patients who are suitable to use it. Future studies need to determine which patients benefit most from a stratified blended physiotherapy approach. The e-Exercise LBP intervention significantly increased patients’ self-reported adherence to prescribed home exercises, as hypothesized. In addition, it resulted in a significant reduction of fear-avoidance beliefs when compared with face-to-face physiotherapy. The between-group difference in patients’ self-reported adherence to prescribed home exercises was 3.3% points in favor of the e-Exercise LBP intervention. For fear-avoidance beliefs, the between-group difference was −4.6% points in favor of the e-Exercise LBP intervention. Although there are no established cutoffs for the minimum clinically 5
RkJQdWJsaXNoZXIy MTk4NDMw