Remco Arensman

70 Chapter 4 Patients All patients with LBP who visit a participating physiotherapy practice will be invited to participate in the study. Eligibility criteria of patients include: (i) being a patient requesting physiotherapy treatment for LBP, defined as pain in the lumbosacral region (sometimes associated with radiating pain to the buttock or leg) (10,36), (ii) age 18 years or older, (iii) possessing a smartphone or tablet with access to the internet, (iv) mastery of the Dutch language. Exclusion criteria include: (i) a specific cause of LBP determined through medical imaging or a medical doctor (e.g. osteoporotic fractures, spinal nerve compromise, malignancy, ankylosing spondylitis, canal stenosis, or severe spondylolisthesis), (ii) serious comorbidities (e.g., malignancy, stroke), (iii) current pregnancy, because of the prevalence of pelvic girdle pain as a specific form of LBP. Study procedure Physiotherapy practices that are willing to participate in the study will be screened on eligibility by a researcher (TK or RA). Cluster randomization will be performed at the level of the participating physiotherapy practices. Each practice will be randomly assigned to the intervention (e- Exercise LBP) or the usual care group by an independent researcher using an a priori created computer-generated random sequence table. Physiotherapists in the intervention group will receive two 4-h training sessions about e-Exercise LBP and the study procedures. In the usual care group, physiotherapists will receive one 4-h training session in current best evidence practice according to the guideline LBP of the Royal Dutch Association for Physiotherapy (KNGF) (10) and the study procedures. Physiotherapists, or their colleagues who will handle the initial registration of the patient, will orally inform potentially eligible patients about the study. Interested patients will receive the patient information letter by e-mail and will be contacted by one of the researchers (TK or RA) by phone prior to the first physiotherapy appointment. When a patient is willing to participate, a face-to-face appointment with one of the researchers (TK or RA) will be scheduled to screen in- and exclusion criteria and to provide written informed consent. After signing informed consent, the patient’s physiotherapist will be informed about the patient’s participation. During the study period, both patient groups can still receive care from any other healthcare professional.

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