Background: Self-management support is considered an important component in the physiotherapeutic treatment of people with chronic low back pain. The stratified blended physiotherapy intervention e-Exercise Low Back Pain is an example of a self-management intervention. More insight may contribute to improving blended interventions to stimulate self-management after treatment and thus hopefully prevent chronicity and/or relapses in patients with chronic low back pain. Objectives: The aim of this study was to gain an in-depth understanding of the self-management behaviour after a physiotherapist guided blended self-management intervention in people with chronic low back pain. Design: A qualitative study with semi-structured interviews nested within a randomized controlled trial on the (cost-)effectiveness of e-Exercise Low Back Pain was conducted. Method: Thematic analysis was used to analyse the transcriptions. A hybrid process of both deductive and inductive approaches was used. Results: After 12 interviews, data saturation was reached. Analysis of the data yielded six themes related to self-management behaviour: illness beliefs, coping, cognitions, social support and resource utilization, physiotherapeutic involvement and motivation. Conclusions: In our study the majority of the participants seemed to show adequate self-management behaviour when experiencing low back pain. Most participants first try to gain control over their low back pain themselves when experiencing a relapse before contacting the physiotherapist. Participants struggle in continuing health behaviour in pain free periods between relapses of low back pain. Physiotherapists are recommended to encourage long-term behaviour change. Additionally, better facilitation by the physiotherapist or additional functionalities in the app to stimulate social support might have a useful contribution.
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OBJECTIVE: To provide an overview of available strategies and tools that support physiotherapists to recognise patients with LHL and to adapt the physiotherapeutic communication during the diagnostic phase.METHODS: PubMed, Embase, CINAHL and PsycINFO were searched for publications appearing between 2000 and June 2024. Additional grey literature was searched up till October 2022. Studies were included if they described strategies and tools aimed at supporting communication with patients with Limited Health Literacy in physiotherapy. Exclusion criteria focusing on general health literacy prevalence, behavioural interventions, or basic communication training.RESULTS: Out of the 9960 unique studies identified by our literature searches, 314 full-text studies were assessed and 98 met the inclusion criteria. The data on strategies and tools were extracted into the following six categories: verbal communication (n = 3), written communication (n = 34), digital device (n = 9), questionnaire (n=19), interpreter (n = 22), and other media (n = 2). Within these categories, tools and strategies were further classified based on the communication aims. Some tools and strategies were uncategorisable.CONCLUSION: While various strategies and tools exist for recognising patients with limited Health Literacy, they are often generic and not tailored to the physiotherapeutic context. This scoping review identifies a gab in physiotherapeutic approaches, particularly on those that go beyond information provision.PRACTICE IMPLICATIONS: To improve communication in physiotherapy practice, there is a need for the development of tailored strategies and tools that reflect the specific dynamic of the physiotherapeutic process. We recommend engaging in design-based research that involves both patient and physiotherapist to co-create tools and strategies. In the meantime, physiotherapists are advised to use general communication strategies and tools and refer to our resources to select tools that best align with their specific goals.
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Background: Patient participation in goal setting is important to deliver client-centered care. In daily practice, however, patient involvement in goal setting is not optimal. Patient-specific instruments, such as the Patient Specific Complaints (PSC) instrument, can support the goal-setting process because patients can identify and rate their own problems. The aim of this study is to explore patients’ experiences with the feasibility of the PSC, in the physiotherapy goal setting. Method: We performed a qualitative study. Data were collected by observations of physiotherapy sessions (n=23) and through interviews with patients (n=23) with chronic conditions in physiotherapy practices. Data were analyzed using directed content analysis. Results: The PSC was used at different moments and in different ways. Two feasibility themes were analyzed. First was the perceived ambiguity with the process of administration: patients perceived a broad range of experiences, such as emotional and supportive, as well as feeling a type of uncomfortableness. The second was the perceived usefulness: patients found the PSC useful for themselves – to increase awareness and motivation and to inform the physiotherapist – as well as being useful for the physiotherapist – to determine appropriate treatment for their personal needs. Some patients did not perceive any usefulness and were not aware of any relation with their treatment. Patients with a more positive attitude toward questionnaires, patients with an active role, and health-literate patients appreciated the PSC and felt facilitated by it. Patients who lacked these attributes did not fully understand the PSC’s process or purpose and let the physiotherapist take the lead. Conclusion: The PSC is a feasible tool to support patient participation in the physiotherapy goal setting. However, in the daily use of the PSC, patients are not always fully involved and informed. Patients reported varied experiences related to their personal attributes and modes of administration. This means that the PSC cannot be used in the same way in every patient. It is perfectly suited to use in a dialogue manner, which makes it very suitable to improve goal setting within client-centered care.
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In this pilot study, we investigated the feasibility of a home-based, remotely guided exercise intervention for patients with gliomas. The six-month intervention included three home-based exercise sessions per week at 60%–85% of maximum heart rate. Participants wore heart rate monitors connected to an online platform to record activities that were monitored weekly by the physiotherapist.
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Background: We developed an Internet-based physical activity (PA) support program (IPAS), which is embedded in a patient portal. We evaluated the effectiveness and costs of IPAS alone (online only) or IPAS combined with physiotherapist telephone counselling (blended care), compared to a control group. Methods: Breast or prostate cancer survivors, 3–36 months after completing primary treatment, were randomized to 6-months access to online only, blended care, or a control group. At baseline and 6-month post-baseline, minutes of moderate-to-vigorous PA (MVPA) were measured by accelerometers. Secondary outcomes were self-reported PA, fatigue, mood, health-related quality of life, attitude toward PA, and costs. (Generalized) linear models were used to compare the outcomes between groups. Results: We recruited 137 survivors (participation rate 11%). We did not observe any significant between-group differences in MVPA or secondary outcomes. Adherence was rather low and satisfaction scores were low to moderate, with better scores for blended care. Costs for both interventions were low. Conclusions: Recruitment to the study was challenging and the interventions were less efficacious than anticipated, which led to lessons learned for future trials. Suggestions for future research are as follows: improved accessibility of the support program, increased frequency of support, and use of activity trackers.
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Aim: The aim of this study was to describe the experience with commercially available activity trackers embedded in the physiotherapy treatment of patients with a chronic disease. Methods: In a qualitative study, 29 participants with a chronic disease participated. They wore an activity tracker for two to eight weeks. Data were collected using 23 interviews and discussion with 6 participants. A framework analysis was used to analyze the data. Results: The framework analysis resulted in seven categories: purchase, instruction, characteristics, correct functioning, sharing data, privacy, use, and interest in feedback. The standard goal of the activity trackers was experienced as too high, however the tracker still motivated them to be more active. Participants would have liked more guidance from their physiotherapists because they experienced the trackers as complex. Participants experienced some technical failures, are willing to share data with their physiotherapist and, want to spend a maximum of e50,-. Conclusion: The developed framework gives insight into all important concepts from the experiences reported by patients with a chronic disease and can be used to guide further research and practice. Patients with a chronic disease were positive regarding activity trackers in general. When embedded in physiotherapy, more attention should be paid to the integration in treatment.
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Aim: The aim of this study was to describe the experience with commercially available activity trackers embedded in the physiotherapy treatment of patients with a chronic disease. Methods: In a qualitative study, 29 participants with a chronic disease participated. They wore an activity tracker for two to eight weeks. Data were collected using 23 interviews and discussion with 6 participants. A framework analysis was used to analyze the data. Results: The framework analysis resulted in seven categories: purchase, instruction, characteristics, correct functioning, sharing data, privacy, use, and interest in feedback. The standard goal of the activity trackers was experienced as too high, however the tracker still motivated them to be more active. Participants would have liked more guidance from their physiotherapists because they experienced the trackers as complex. Participants experienced some technical failures, are willing to share data with their physiotherapist and, want to spend a maximum of €50,-. Conclusion: The developed framework gives insight into all important concepts from the experiences reported by patients with a chronic disease and can be used to guide further research and practice. Patients with a chronic disease were positive regarding activity trackers in general. When embedded in physiotherapy, more attention should be paid to the integration in treatment.
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The aim of this study was to investigate if physiotherapists had knowledge and skills in applying Bobath-based therapy (BB), also referred to as Neurodevelopmental Treatment, in the care of stroke patients and if they generally used the therapy in daily practice. This is because of the important emphasis placed on documenting the extent of the therapy given to the client groups compared in outcome studies measuring the efficacy of therapeutic interventions. The study took place as an intervention check for a large outcome study measuring the effects of BB therapy. BB therapy had been implemented on six wards, whereas six other wards did not use this approach. The physiotherapists (n /38) knowledge and skills in making decisions about applying the BB principles in all wards was measured in two steps. In step 1, the physiotherapists received a questionnaire focusing on their physiotherapy strategy, and Bobath education. In step 2, they received a case vignette describing a stroke patient and questions concerning the content of the physiotherapy provided to this patient. An expert panel judged the therapists responses to the questions of both steps. Of the physiotherapists working in the BB wards, 14 (74%) therapists generally used BB principles, whereas four (21%) therapists did not (one was uncertain). Of the physiotherapists working in the non-BB wards (n /19), three (16%) did use BB therapy whereas 10 (52%) therapists did not use the therapy (six responses were missing). The study showed that within the BB wards, the physiotherapists had followed sufficient BB education, as judged by a panel of experts, and demonstrated the knowledge and skills in applying the BB therapy, whereas in the other wards they did not. BB wards could therefore participate in the experimental group of the study measuring the effects of the Bobath therapy, and the non-BB wards could serve as proper control wards.
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To evaluate the construct validity and the inter-rater reliability of the Dutch Activity Measure for Post- Acute Care “6-clicks” Basic Mobility short form measuring the patient’s mobility in Dutch hospital care. First, the “6-clicks” was translated by using a forward-backward translation protocol. Next, 64 patients were assessed by the physiotherapist to determine the validity while being admitted to the Internal Medicine wards of a university medical center. Six hypotheses were tested regarding the construct “mobility” which showed that: Better “6-clicks” scores were related to less restrictive pre-admission living situations (p¼0.011), less restrictive discharge locations (p¼0.001), more independence in activities of daily living (p¼0.001) and less physiotherapy visits (p<0.001). A correlation was found between the “6-clicks” and length of stay (r¼0.408, p¼0.001), but not between the “6-clicks” and age (r¼0.180, p¼0.528). To determine the inter-rater reliability, an additional 50 patients were assessed by pairs of physiotherapists who independently scored the patients. Intraclass Correlation Coefficients of 0.920 (95%CI: 0.828–0.964) were found. The Kappa Coefficients for the individual items ranged from 0.649 (walking stairs) to 0.841 (sit-to-stand). The Dutch “6-clicks” shows a good construct validity and moderate-toexcellent inter-rater reliability when used to assess the mobility of hospitalized patients.
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Background: Joint bleeds are the hallmark of hemophilia, leading to a painful arthritic condition called as hemophilic arthropathy (HA). Exercise programs are frequently used to improve the physical functioning in persons with HA. As hemophilia is a rare disease, there are not many physiotherapists who are experienced in the field of hemophilia, and regular physiotherapy sessions with an experienced physiotherapist in the field of hemophilia are not feasible for persons with HA. Blended care is an innovative intervention that can support persons with HA at home to perform the advised physical activities and exercises and provide self-management information. Objective: The aim of this study was to develop a blended physiotherapy intervention for persons with HA. Methods: The blended physiotherapy intervention, namely, e-Exercise HA was developed by cocreation with physiotherapists, persons with HA, software developers, and researchers. The content of e-Exercise HA was compiled using the first 3 steps of the Center for eHealth Research roadmap model (ie, contextual inquiry, value specification, and design), including people with experience in the development of previous blended physiotherapy interventions, a literature search, and focus groups. Results: A 12-week blended intervention was developed, integrating face-to-face physiotherapy sessions with a web-based app. The intervention consists of information modules for persons with HA and information modules for physiotherapists, a graded activity program using a self-chosen activity, and personalized video-supported exercises. The information modules consist of text blocks, videos, and reflective questions. The patients can receive pop-ups as reminders and give feedback on the performance of the prescribed activities. Conclusions: In this study, we developed a blended physiotherapy intervention for persons with HA, which consists of information modules, a graded activity program, and personalized video-supported exercises.
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