183 Summary demonstrated excellent intrarater reliability (Kappa quadratic weights = 0.87) for the quality of performance score, though interrater reliability was significantly lower (Kappa quadratic weights = 0.36), suggesting poor agreement across different raters. The newly developed EXAS allowed us to investigate patient adherence to HBE recommendations during treatment in the e-Exercise LBP trial. Chapter 3 investigates the patient’s perspectives on the use of a smartphone app to support HBE during physiotherapy for LBP. Through qualitative interviews with nine participants, the study explored themes of acceptability, satisfaction, and performance. Our findings indicate that patients are willing to accept the app as part of their treatment, particularly valuing its ease of use, integration into daily routines, and the benefits it provides. Satisfaction with the app is primarily influenced by its perceived support in facilitating exercise adherence and enhancing exercise performance at home. Important features of the app that contribute to its effective performance include video and text instructions, reminder functions, and self-monitoring capabilities. However, the study also highlights the important role of physiotherapists in instructing patients on how to optimally utilize the app, underlining the app’s role as a complement to, rather than a replacement for, physiotherapy intervention. Chapter 4 introduces the methodology for a cluster randomized controlled trial aiming to evaluate the effectiveness and cost-effectiveness of the e-Exercise LBP intervention against usual physiotherapy care for patients with LBP. E-Exercise LBP combines face-toface physiotherapy with support from a smartphone app to enhance self-management, adherence to HBE recommendations, and overall physical activity levels in patients with LBP. This innovative blended care intervention is hypothesized to not only improve short-term physical functioning but also to demonstrate sustained benefits and costeffectiveness after 12 and 24 months. The aim was to include 208 patients with LBP to compare outcomes such as physical functioning, pain intensity, exercise adherence, self-efficacy, and health-related quality of life across these timelines. Measurements were scheduled at baseline, 3, 12, and 24 months, with additional economic evaluation from the societal and healthcare perspectives through retrospective self-reported questionnaires every 3 months. Although the trial was designed to investigate the short term and long term (cost-)effectiveness, we focused on the short term (3-month) effectiveness on physical functioning (chapter 5), with a particular focus on the role of adherence to HBE recommendations in patient recovery (chapter 6 and 7). Chapter 5 presents the evaluation of the short-term (3 months) effectiveness of the e-Exercise LBP intervention in comparison to face-to-face physiotherapy for patients LBP. Our analysis revealed that while both the e-Exercise LBP and face-to-face physiotherapy groups showed statistically significant and clinically meaningful improvements in 9
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