98 Chapter 5 practices according to the LBP guidelines of the Royal Dutch Society for Physiotherapy (11) and the study procedures. Patients Patients with LBP who contacted a participating physiotherapy practice were orally informed about the study and invited to participate. Interested patients received a patient information letter by email and an informative phone call by one of the researchers (TK or RMA) before the first appointment. When a patient was willing to participate after the phone call, a face-to-face appointment was scheduled (by TK or RMA) to obtain written informed consent and verify eligibility. The eligibility criteria were as follows: (1) being a patient requesting physiotherapy treatment for nonspecific LBP, defined as pain in the lumbosacral region (sometimes associated with radiating pain to the buttock or leg) (11); (2) aged ≥18 years; (3) possessing a smartphone or tablet (iOS or Android operating system) with access to the internet; and (4) mastery of the Dutch language. The exclusion criteria were as follows: (1) a specific cause of LBP determined through medical imaging or a medical physician, (2) serious comorbidities (e.g., malignancy or stroke), and (3) current pregnancy because of the prevalence of pelvic girdle pain as a specific form of LBP. Intervention Experimental: Stratified Blended Physiotherapy (e-Exercise LBP) Patients allocated to the stratified blended physiotherapy group received blended physiotherapy, comprising a smartphone app integrated within face-to-face physiotherapy treatment (23,26). Both the contents of the smartphone app and the face-to-face physiotherapy treatment are based on the recommendations of the LBP guidelines of the Royal Dutch Society for Physiotherapy (11). The duration and content of the stratified blended physiotherapy intervention were based on the patients’ risk for developing persistent LBP (low, medium, or high) using the Keele STarT Back Screening Tool (9,10). The smartphone app contains video-supported self-management information, videosupported exercises, and a goal-oriented physical activity module. Both the contents of face-to-face care and the smartphone app were tailored by the physiotherapists to the patients’ individual needs and progress (Table 1). Although physiotherapists were recommended to treat according to the stratified blended physiotherapy protocol, they were free to deviate from the protocol with respect to their clinical competence. Print screens of the smartphone app are provided in Multimedia Appendix 2.
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