74 Chapter 4 12 sessions for patients labelled as “high risk”. The objective of face-to-face care is to reassure the patient, provide information about LBP, instruct on self-management options, and underline the importance of adequate physical activity behaviour in accordance with the guideline LBP of the Royal Dutch Association for Physiotherapy (KNGF) (10). Additionally, in medium- and high risk patients, the physiotherapist can consider to provide evidence-based interventions (e.g., passive or active joint mobilization) as recommended by the guideline LBP of the Royal Dutch Association for Physiotherapy (KNGF) (10). In high risk patients, the physiotherapist will address patient specific psychosocial risk factors using a cognitive behavioural therapy approach, and pain education will be given (41,42). However, with respect to the physiotherapists’ clinical competences, physiotherapists are allowed to deviate from the e-Exercise protocol. After completing e-Exercise LBP, the patient will receive fortnightly reminders from the smartphone application for up to 6 months to continue a physically active lifestyle. Usual care Patients in the usual care group will receive face-to-face usual care following the recommendations of the guideline LBP of the Royal Dutch Association for Physiotherapy (KNGF) (10). Although eCoaching applications are not recommended in the guideline, physiotherapists from the usual care group are instructed to treat people without using any eCoaching applications. According to the guideline, the physiotherapy treatment includes information, exercises, and recommendations regarding physical activity. Practical content considerations will be made by the physiotherapists themselves with respect to their clinical expertise. The number of sessions will differ per patient. Measurements Four time points (baseline, 3, 12 and 24 months) will be used for data collection of the primary and secondary outcomes using an online questionnaire. Baseline measurement will be conducted face-to-face and follow-up measurements preferably through online communication, e.g., Skype or FaceTime. When follow-up measurements through online communication are not possible, follow-up measurements will be conducted face-toface. At all four time points participants will receive an accelerometer (Activ8) for the objective measurement of physical activity. Participants will be instructed to wear the Activ8 for five consecutive weeks at baseline and eight consecutive days at all following time points, except during sleeping, showering, bathing or swimming. For the economic evaluation, patients will be asked to complete eight retrospective 3-monthly online cost questionnaires. All of these questionnaires will have a 3-month recall period to cover the full duration of follow-up (i.e., 24 months). No financial incentives to complete questionnaires or to wear accelerometers will be offered. Table 2 gives a summary of all outcome measures and time points.
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