Feasibility of a stratified blended physiotherapy intervention for patients with non-specific low back pain: a mixed methods study

ABSTRACT

Introduction: Integrating web-based or mobile components and face-to-face components within a treatment process is called blended care. As part of the participatory development of a blended physiotherapeutic intervention for patients with low back pain (e-Exercise LBP), a proof of concept study was carried out and showed promising results.

Objective: To investigate the feasibility of the e-Exercise LBP prototype for patients and physiotherapists to improve the intervention.

Methods: A mixed methods study was executed, embedded in the development phase of e-Exercise LBP. 21 physiotherapists treated 41 patients with e-Exercise LBP. Quantitative data consisted of: patients’ satisfaction on a five-point Likert Scale; patients’ and physiotherapists’ experienced usability of the web-based application (System Usability Scale) and; patients’ experiences with e-Exercise LBP (closed-ended questions and statements related to the elements and goals of e-Exercise LBP). Semi-structured interviews about experiences with e-Exercise LBP were conducted with seven patients and seven physiotherapists. Qualitative data were analyzed by a phenomenological approach. Quantitative data were analyzed with descriptive statistics.

Results: Patients were satisfied with e-Exercise LBP (mean: 4.0; SD:0.8; range: extreme dissatisfaction (1)-extreme satisfaction (5)). Usability of the web-based application was acceptable (patients: mean: 73.2 (SD:16.3); physiotherapists: mean: 63.3 (SD:12.0); range: 0–100). Interviews revealed that physiotherapists’ training is essential to successfully integrate the web-based application and face-to-face sessions within physiotherapy treatment. Also, patients addressed the need of reminder messages to support long-term (exercise) adherence.

Conclusion: e-Exercise LBP appeared to be feasible. However, various prerequisites and points of improvement were mentioned to improve physiotherapists’ training and the prototype.

KEYWORDS:

• Low back pain
• physical therapy modalities
• telemedicine
• feasibility

Ethics approval and consent to participate

The Medical Research Ethics Committee Utrecht declared that the e-Exercise LBP project is not covered by the Dutch Medical Research Involving Human Subjects Act (WMO), because patients were not subjected to actions and no rules of behavior were imposed on them. The main reason was that patients were not exposed to any new interventions, but existing and recommended interventions were offered in a new way. All patients signed informed consent to participate in the e-Exercise LBP study. All physiotherapists gave verbal consent to use their data anonymously.

Disclosure Statement

The authors report no conflict of interest.

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Additional information

Funding

This work was supported by the Scientific College Physical Therapy (WCF) of the Royal Dutch Society for Physical Therapy (KNGF).