73 Effectiveness and cost-effectiveness of e-Exercise low back pain - study protocol Table 1 Continued. Low risk profile Medium risk profile High risk profile Integration face-to-face care – smartphone application First session Provide information about LBP and instruction on home-based exercises addressing patient’s specific functional limitations using the smartphone application Provide information about LBP, instruction on home-based exercises addressing patient’s specific functional limitations, and instruction on 3-day baseline test using the smartphone application Provide information about LBP, instruction on home-based exercises addressing patient’s specific functional limitations, and instruction on 3-day baseline test using the smartphone application Middle sessions Evaluation of progress with smartphone application and optimizing face-to-face care Evaluation of progress with smartphone application and optimizing face-toface care Final session Evaluate the progress with smartphone application and give recommendations to prevent recurrent episodes of LBP and maintain or improve the physical activity level Evaluate the progress with smartphone application and give recommendations to prevent recurrent episodes of LBP and maintain or improve the physical activity level Evaluate the progress with smartphone application and give recommendations to prevent recurrent episodes of LBP and maintain or improve the physical activity level LBP = low back pain, KNGF = Royal Dutch Association for Physiotherapy, Max. = Maximum Face-to-face care During the first face-to-face session, the physiotherapist will tailor the e- Exercise LBP intervention to the patients’ identified risk for developing persistent LBP (i.e. low, medium or high), using the Keele STarT Back Screening Tool (29,39,40) (Figure 1, Table 1). Patients are asked to schedule their exercises and physical activities in the smartphone application, after which the smartphone application will sent automatic pop-up reminders accordingly. Physiotherapists will be able to monitor patients’ use of the smartphone application, monitor evaluated assignments, and select other types of exercises. With this information, the physiotherapist will be able to evaluate the progress and beliefs of the patients between face-to-face sessions, optimize the content of the smartphone application to patients’ individual needs, and tailor face-to-face care. Physiotherapists are recommended to provide two face-to-face physiotherapy sessions to patients labelled as “low risk”, 8 sessions for patients labelled as “medium risk”, and 4
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