68 Chapter 4 physiotherapy (30) and primary care settings (31,32). Whereas the STarT Back Screening Tool can be used for matching the appropriate content of the face-to-face care to the individual patient, this tool also might have the same potential for matching the right digital content to the individual patient. Up until now, no other groups have used a stratification tool for personalization of blended physiotherapy as a whole. Recently, the authors’ research group developed e-Exercise LBP, a blended and stratified intervention, in co-creation with patients, physiotherapists and experts (33). E-Exercise LBP consists of face-to-face physiotherapy treatment, in which eCoaching is integrated using a smartphone application. E-Exercise LBP aims to improve patients’ physical functioning by offering a blended stratified-care approach, and consequently influencing patients’ self- management skills and adherence to exercise and physical activity recommendations in a positive way. At the long-term, e-Exercise LBP could result in an improved handling of recurrent LBP and direct and indirect costs. This blended care intervention is an adapted version of previously developed and evaluated blended physiotherapy programs (34,35). A pilot study using a prototype of the e-Exercise LBP intervention in 41 patients with LBP demonstrated feasibility and proof-of-concept on functional disability and pain (33). Based on the results of the pilot study and end-user (patients and physiotherapist) usability experiences, the e-Exercise LBP program was further improved in preparation for the current study. This study aims to investigate the short- (3 months) and long-term (12 and 24 months) effectiveness on physical functioning and cost-effectiveness of e-Exercise LBP, a primary care based personalized stratified blended care intervention, in comparison to usual primary care physiotherapy in patients with non-specific LBP. METHOD/DESIGN Study design A prospective, multicentre cluster randomized controlled trial (RCT) will be conducted. The study has been approved by the Medical Research Ethics Committee of the University Medical Center Utrecht, the Netherlands (ISRCTN 94074203) for all centre sites. Within primary care, e-Exercise LBP will be compared to usual physiotherapy care. A flow diagram of the study protocol is shown in Figure 1.
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