48 Chapter 3 METHODS Design This study was performed using qualitative methods associated with phenomenology and an interpretivist approach. Data were collected by interviewing a sample of patients with LBP who used Physitrack (Physitrack Limited) during treatment in a primary care physical therapy practice. Ethics Approval The Medical Research Ethics Committee of the University Medical Center Utrecht ruled that the Medical Research Involving Human Subjects Act does not apply to this study (protocol number 17-034/C). This study complies with the Declaration of Helsinki, and the standards for reporting qualitative research were followed in reporting this work (13). Study Procedures and Recruitment All patients were recruited from January to April 2018 from 2 participating primary care physical therapy practices in the Netherlands. For each participating practice, a physical therapist specializing in the treatment of spinal pain volunteered to recruit patients. Both physical therapists had 2 years of experience working with Physitrack. Physitrack allows physical therapists to create and share personalized exercise programs with patients through the Physitrack app, email, or paper handouts (see Figures 1 and 2 for examples). The app allows patients to set reminders to perform their exercises, track their adherence, rate pain scores during the exercises, and send direct messages to their physical therapists. To be eligible for participation, a patient had to have been treated by one of the participating physical therapists, their treatment had to have ended less than 2 weeks prior to participation in the study, and the physical therapist had to have sent the patient HBE recommendations using the Physitrack app during treatment. Patients were excluded if they had insufficient command of the Dutch language for casual conversation. Patients interested in the study were contacted by a researcher (RA) and were provided with information about the study and procedures. An appointment for the interview was made with interested patients, and written informed consent was obtained prior to the interview. A purposive sampling method was chosen to include a heterogeneous sample based on age and gender. Additionally, the participants were asked to complete the Systems Usability Scale (SUS) to provide an objective measure of usability for Physitrack (14). The SUS consists of 10 items rated on a 5-point scale ranging from strongly agree to strongly disagree. The SUS score ranges from 0 to 100, and usability of the app is acceptable for ratings of 70 or higher (15). The goal was to recruit similar numbers of males and females with a high variation in age until saturation of the data was achieved. Data saturation was reached when new data repeated previous data without adding new information, and saturation was checked during data analysis in an iterative process (16).
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