97 The short-term effectiveness of e-Exercise low back pain – a cluster RCT blended physiotherapy programs (24,25). Following the promising effects of web-based applications for patients’ self-management skills and adherence to exercise and physical activity recommendations, it is hypothesized that e-Exercise LBP will improve patients’ physical functioning. However, the effectiveness of e-Exercise LBP in comparison with primary care physiotherapy still needs to be determined. The primary aim of this study is to investigate the short-term (3 months) effectiveness of stratified blended physiotherapy (e-Exercise LBP) on physical functioning in comparison with face-to-face physiotherapy in patients with nonspecific LBP. METHODS Design and Ethical Considerations The e-Exercise LBP study was a prospective multicenter cluster randomized controlled trial. The study protocol was approved by the medical research ethics committee of the University Medical Center Utrecht, the Netherlands (18-085/D), and registered at the onset of patient enrollment (ISRCTN 94074203). From January 2018 to June 2018, 122 physiotherapists working in 58 primary care physiotherapy practices were recruited and randomized to either stratified blended physiotherapy (e-Exercise LBP) or face-to-face physiotherapy. Details of the design and methods of the study have been published previously (26). This study is reported according to the CONSORT (Consolidated Standards of Reporting Trials) statement for cluster randomized trials (Multimedia Appendix 1). Recruitment Setting and Randomization Physiotherapists were recruited by an invitational letter sent to the professional network of the authors and physiotherapists who participated in a previous e-Exercise study (24). In addition, an advertisement was placed in the web-based newsletter of the Royal Dutch Society for Physiotherapy. Physiotherapy practices could participate with ≥ 1 physiotherapist, regardless of professional experience and education or specialization (eg, manual therapy). Physiotherapists were cluster randomized at the level of practice to avoid contamination. Treatment allocation was concealed and performed by an independent researcher using a computer-generated, a priori created, random sequence table and in a 1:1 allocation ratio. Physiotherapists and patients were not blinded to the group allocation. The physiotherapists in the stratified blended physiotherapy group received two 4-hour training sessions on e-Exercise LBP and the study procedures. In the face-to-face physiotherapy group, physiotherapists received a 4-hour training session in current best 5
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