96 Chapter 5 INTRODUCTION Low back pain (LBP)–related disability and the related socioeconomic burden remain high despite the many treatment options and health care resources available for LBP (1). LBP can be caused by a specific pathology or trauma; however, in >90% of cases, an underlying disease is absent (2). The clinical course of this so-called nonspecific LBP varies and, as expected, is often less favorable; some patients recover within a couple of days or weeks, and other patients experience persistent disabling symptoms leading to chronic LBP. Up to 65% of primary care patients with LBP still experience pain 1 year after onset (3,4). Clinical practice guidelines recommend a patient-centered approach for the management of LBP (5,6). This approach identifies patients with an increased likelihood of delayed recovery at an early stage and stratifies the treatment accordingly (6–8). An example of a tool for identifying individuals at risk of delayed recovery is the Keele STarT Back Screening Tool (9,10). In general, in patients who have a low risk for delayed recovery, early management comprises advice, reassurance, and education about the nonspecific nature of their LBP and encouragement to stay active. For individuals at medium risk for developing persistent LBP, personalized and supervised exercise therapy should be considered. For the high-risk group, this exercise therapy can be supported by a graded activity approach or cognitive behavioral components (8,11). In addition to a patientcentered and stratified approach, patients’ adherence to prescribed (home-based) exercises and recommended physical activity behavior is crucial for the effectiveness of care (12). Earlier research showed that 45% to 70% of patients do not adhere to prescribed exercises and physical activity recommendations, whereas adherent patients with LBP have a reduced risk of recurrent LBP (13,14). Within the treatment of patients with LBP, blended care is a promising new and understudied field (15). Blended care refers to the integration of web-based and offline components within the treatment process and requires that both components contribute equally to the treatment process (16,17). The integration of web-based components, such as websites and apps, provides new solutions to monitor and coach patients’ individual health behaviors and support the optimization of face-to-face care tailored to the patients’ individual needs (18–20). Thereafter, web-based components can be an effective means of stimulating adherence to prescribed exercises at home between face-to-face sessions and possibly increase self-management of LBP (21,22). Until now, evidence on patient-centered and stratified care has not been integrated into blended care. Therefore, we recently developed e-Exercise LBP, a stratified blended intervention in which a smartphone app is integrated within face-to-face physiotherapy treatment, and established its feasibility and proof of concept for the treatment of functional disability and pain (23). e-Exercise LBP is an adapted version of previously developed and evaluated
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