Background: Patient education, advice on returning to normal activities and (home-based) exercise therapy are established treatment options for patients with non-specific low back pain (LBP). However, the effectiveness of physiotherapy interventions on physical functioning and prevention of recurrent events largely depends on patient self-management, adherence to prescribed (home-based) exercises and recommended physical activity behaviour. Therefore we have developed e-Exercise LBP, a blended intervention in which a smartphone application is integrated within face-to-face care. E-Exercise LBP aims to improve patient self-management skills and adherence to exercise and physical activity recommendations and consequently improve the effectiveness of physiotherapy on patients’ physical functioning. The aim of this study is to investigate the short- (3 months) and long-term (12 and 24 months) effectiveness on physical functioning and cost-effectiveness of e-Exercise LBP in comparison to usual primary care physiotherapy in patients with LBP. Methods: This paper presents the protocol of a prospective, multicentre cluster randomized controlled trial. In total 208 patients with LBP pain were treated with either e-Exercise LBP or usual care physiotherapy. E-Exercise LBP is stratified based on the risk for developing persistent LBP. Physiotherapists are able to monitor and evaluate treatment progress between face-to-face sessions using patient input from the smartphone application in order to optimize physiotherapy care. The smartphone application contains video-supported self-management information, video-supported exercises and a goal-oriented physical activity module. The primary outcome is physical functioning at 12-months follow-up. Secondary outcomes include pain intensity, physical activity, adherence to prescribed (home-based) exercises and recommended physical activity behaviour, self-efficacy, patient activation and health-related quality of life. All measurements will be performed at baseline, 3, 12 and 24months after inclusion. An economic evaluation will be performed from the societal and the healthcare perspective and will assess cost-effectiveness of e-Exercise LBP compared to usual physiotherapy at 12 and 24months. Discussion: A multi-phase development and implementation process using the Center for eHealth Research Roadmap for the participatory development of eHealth was used for development and evaluation. The findings will provide evidence on the effectiveness of blended care for patients with LBP and help to enhance future implementation of blended physiotherapy.
BACKGROUND: Blended physiotherapy, in which physiotherapy sessions and an online application are integrated, might support patients in taking an active role in the management of their chronic condition and may reduce disease related costs. The aim of this study was to evaluate the cost-effectiveness of a blended physiotherapy intervention (e-Exercise) compared to usual physiotherapy in patients with osteoarthritis of hip and/or knee, from the societal as well as the healthcare perspective.METHODS: This economic evaluation was conducted alongside a 12-month cluster randomized controlled trial, in which 108 patients received e-Exercise, consisting of physiotherapy sessions and a web-application, and 99 patients received usual physiotherapy. Clinical outcome measures were quality-adjusted life years (QALYs) according to the EuroQol (EQ-5D-3 L), physical functioning (HOOS/KOOS) and physical activity (Actigraph Accelerometer). Costs were measured using self-reported questionnaires. Missing data were multiply imputed and bootstrapping was used to estimate statistical uncertainty.RESULTS: Intervention costs and medication costs were significantly lower in e-Exercise compared to usual physiotherapy. Total societal costs and total healthcare costs did not significantly differ between groups. No significant differences in effectiveness were found between groups. For physical functioning and physical activity, the maximum probability of e-Exercise being cost-effective compared to usual physiotherapy was moderate (< 0.82) from both perspectives. For QALYs, the probability of e-Exercise being cost-effective compared to usual physiotherapy was 0.68/0.84 at a willingness to pay of 10,000 Euro and 0.70/0.80 at a willingness to pay of 80,000 Euro per gained QALY, from respectively the societal and the healthcare perspective.CONCLUSIONS: E-Exercise itself was significantly cheaper compared to usual physiotherapy in patients with hip and/or knee osteoarthritis, but not cost-effective from the societal- as well as healthcare perspective. The decision between both interventions can be based on the preferences of the patient and the physiotherapist.TRIAL REGISTRATION: NTR4224 (25 October 2013).
Review in het kader van COST Action IS1106 Working group 3 In the review below, we summarize resent empirical research about practising offender supervision in The Netherlands on six theme’s: 1. The roles, characteristics, recruitment and training of key actors in the delivery of offender supervision. 2. Interactions and relationships between key actors in the delivery of offender supervision and other relevant professionals. 3. The delivery/practice/performance of offender supervision. 4. The role of tools and technologies in the delivery of OS. 5. The management, supervision and/or regulation of practitioners and their practice. 6. Reflections / contextual issues Ongoing research is discussed in the descriptions of the different theme’s. We conclude with a short reflection about research on practising supervision in the Netherlands. The review is limited to studies about adults. Studies on community sentences have not yet been addressed, we will do this in the next version.
Manual labour is an important cornerstone in manufacturing and considering human factors and ergonomics is a crucial field of action from both social and economic perspective. Diverse approaches are available in research and practice, ranging from guidelines, ergonomic assessment sheets over to digitally supported workplace design or hardware oriented support technologies like exoskeletons. However, in the end those technologies, methods and tools put the working task in focus and just aim to make manufacturing “less bad” with reducing ergonomic loads as much as possible. The proposed project “Human Centered Smart Factories: design for wellbeing for future manufacturing” wants to overcome this conventional paradigm and considers a more proactive and future oriented perspective. The underlying vision of the project is a workplace design for wellbeing that makes labor intensive manufacturing not just less bad but aims to provide positive contributions to physiological and mental health of workers. This shall be achieved through a human centered technology approach and utilizing advanced opportunities of smart industry technologies and methods within a cyber physical system setup. Finally, the goal is to develop smart, shape-changing workstations that self-adapt to the unique and personal, physical and cognitive needs of a worker. The workstations are responsive, they interact in real time, and promote dynamic activities and varying physical exertion through understanding the context of work. Consequently, the project follows a clear interdisciplinary approach and brings together disciplines like production engineering, human interaction design, creative design techniques and social impact assessment. Developments take place in an industrial scale test bed at the University of Twente but also within an industrial manufacturing factory. Through the human centered design of adaptive workplaces, the project contributes to a more inclusive and healthier society. This has also positive effects from both national (e.g. relieve of health system) as well as individual company perspective (e.g. less costs due to worker illness, higher motivation and productivity). Even more, the proposal offers new business opportunities through selling products and/or services related to the developed approach. To tap those potentials, an appropriate utilization of the results is a key concern . The involved manufacturing company van Raam will be the prototypical implementation partner and serve as critical proof of concept partner. Given their openness, connections and broad range of processes they are also an ideal role model for further manufacturing companies. ErgoS and Ergo Design are involved as methodological/technological partners that deal with industrial engineering and ergonomic design of workplace on a daily base. Thus, they are crucial to critically reflect wider applicability and innovativeness of the developed solutions. Both companies also serve as multiplicator while utilizing promising technologies and methods in their work. Universities and universities of applied sciences utilize results through scientific publications and as base for further research. They also ensure the transfer to education as an important leverage to inspire and train future engineers towards wellbeing design of workplaces.
It is essential to look for new forms of care, with an emphasis on Prevention, Relocation and Replacement (Health & Care Knowledge and Innovation Agenda 2020-2030). Especially when it comes to Alcohol Use Disorder (AUD). Globally, more than 5% of all illness and injury are attributable to AUD. Treatment is challenging; 47-75% of AUD patients who are clinically detoxified relapse within one year. Recovry aims to prevent an unhealthy lifestyle due to (alcohol) addiction by developing and testing a Virtual Reality (VR) self-prevention tool (relocating and replacing care treatment). Although research shows that VR is used successfully in health care and in the treatment of alcohol addiction, especially through the creation of presence, it has not been tested for effectiveness and implementation (as an adjuvant in a clinical post-detoxification phase of an AUD- therapy). The question of whether virtual-humans should be used in a VR treatment and whether 3600 recorded VR or computer generated (CG) VR should be selected before. The use of a virtual human in VR has expected advantages (more effect) but also disadvantages (more costs). The expected advantages and disadvantages of 360o VR (cheaper, faster, more personal) and CG VR (more flexible and interactive) also cause choice and implementation problems. Recovry is the first project in which a VR tool is (further) developed in which an AUD treatment can (and will) be tested for the effect and effectiveness of adding virtual humans in CG and 360o VR environments as part of preventive care for patients with an AUD. This project thus serves as a prelude to cooperation in the Netherlands around a more effective implementation of VR in the (self) care system and thus the active and independent integration of former AUD patients in society (“more people, less patients”).
