Background Providing individualized care based on the context and preferences of the patient is important. Knowledge on both prognostic risk stratification and blended eHealth care in musculoskeletal conditions is increasing and seems promising. Stratification can be used to match patients to the most optimal content and intensity of treatment as well as mode of treatment delivery (i.e. face-to-face or blended with eHealth). However, research on the integration of stratified and blended eHealth care with corresponding matched treatment options for patients with neck and/or shoulder complaints is lacking. Methods This study was a mixed methods study comprising the development of matched treatment options, followed by an evaluation of the feasibility of the developed Stratified Blended Physiotherapy approach. In the first phase, three focus groups with physiotherapists and physiotherapy experts were conducted. The second phase investigated the feasibility (i.e. satisfaction, usability and experiences) of the Stratified Blended Physiotherapy approach for both physiotherapists and patients in a multicenter single-arm convergent parallel mixed methods feasibility study. Results In the first phase, matched treatment options were developed for six patient subgroups. Recommendations for content and intensity of physiotherapy were matched to the patient’s risk of persistent disabling pain (using the Keele STarT MSK Tool: low/medium/high risk). In addition, selection of mode of treatment delivery was matched to the patient’s suitability for blended care (using the Dutch Blended Physiotherapy Checklist: yes/no). A paperbased workbook and e-Exercise app modules were developed as two different mode of treatment delivery options, to support physiotherapists. Feasibility was evaluated in the second phase. Physiotherapists and patients were mildly satisfied with the new approach. Usability of the physiotherapist dashboard to set up the e-Exercise app was considered ‘OK’ by physiotherapists. Patients considered the e-Exercise app to be of ‘best imaginable’ usability. The paper-based workbook was not used. Conclusion Results of the focus groups led to the development of matched treatment options. Results of the feasibility study showed experiences with integrating stratified and blended eHealth care and have informed amendments to the Stratified Blended Physiotherapy approach for patients with neck and/or shoulder complaints ready to use within a future cluster randomized trial.
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Background: Neck and shoulder complaints are common in primary care physiotherapy. These patients experience pain and disability, resulting in high societal costs due to, for example, healthcare use and work absence. Content and intensity of physiotherapy care can be matched to a patient’s risk of persistent disabling pain. Mode of care delivery can be matched to the patient’s suitability for blended care (integrating eHealth with physiotherapy sessions). It is hypothesized that combining these two approaches to stratified care (referred to from this point as Stratified Blended Approach) will improve the effectiveness and cost-effectiveness of physiotherapy for patients with neck and/or shoulder complaints compared to usual physiotherapy. Methods: This paper presents the protocol of a multicenter, pragmatic, two-arm, parallel-group, cluster randomized controlled trial. A total of 92 physiotherapists will be recruited from Dutch primary care physiotherapy practices. Physiotherapy practices will be randomized to the Stratified Blended Approach arm or usual physiotherapy arm by a computer-generated random sequence table using SPSS (1:1 allocation). Number of physiotherapists (1 or > 1) will be used as a stratification variable. A total of 238 adults consulting with neck and/or shoulder complaints will be recruited to the trial by the physiotherapy practices. In the Stratified Blended Approach arm, physiotherapists will match I) the content and intensity of physiotherapy care to the patient’s risk of persistent disabling pain, categorized as low, medium or high (using the Keele STarT MSK Tool) and II) the mode of care delivery to the patient’s suitability and willingness to receive blended care. The control arm will receive physiotherapy as usual. Neither physiotherapists nor patients in the control arm will be informed about the Stratified Blended Approach arm. The primary outcome is region-specific pain and disability (combined score of Shoulder Pain and Disability Index & Neck Pain and Disability Scale) over 9 months. Effectiveness will be compared using linear mixed models. An economic evaluation will be performed from the societal and healthcare perspective. Discussion: The trial will be the first to provide evidence on the effectiveness and cost-effectiveness of the Stratified Blended Approach compared with usual physiotherapy in patients with neck and/or shoulder complaints.
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This paper reports on the effects of an e-cycling incentive program in the province of North-Brabant, The Netherlands, in which commuters could earn monetary incentives when using their e-bike. The study used a longitudinal design allowing to observe behaviour change and mode shifts. The program appeared to be highly effective in stimulating e-bike use, as one month after the start of the program, the share of commute trips made by e-bike increased from 0% to 68%, with an increase up to 73% after half a year of participating. The environmental, congestion and health benefits of this shift are however mixed. Half of the e-bike trips substitute car trips, with positive effects on environment, congestion and health. The other half substitutes conventional cycling trips, implying fever health benefits. Our analyses further suggest that distance is an important factor for adopting e-cycling, where e-bike has a larger acceptable distance than a conventional bike. Nevertheless, we observed that the likelihood to use the e-bike decreased as commuting distance increased. Multivariate analyses suggest that a shift to e-cycling is affected by age, gender, physical condition, car ownership and household composition. Our study did find support for the hypothesis that having a strong car-commuting habit decreases the probability of mode shift to a new mode alternative. In contrast, multimodality may increase the likelihood of e-bike use as a result of openness to other travel options and a more deliberate mode choice. Lastly, dissatisfaction with the current travel mode positively influences mode shift towards the e-bike. Our results imply that stimulating e-cycling may be a promising way of stimulating physical activity, but that it will be most effective if targeted at specific groups who are not currently engaging in active travel.
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Polycotton textiles are fabrics made from cotton and polyester. It is used in many textile applications such as sporting cloths, nursery uniforms and bed sheets. As cotton and polyester are quite different in their polymer nature, polycotton textiles are hard to recycle and therefore mostly incinerated. Incineration of discarded polycotton, and substitution by virgin polycotton, create a significant environmental impact. However, textile manufacturers and brand owners will become obliged to apply recycled content in clothing from 2023 onwards. Therefore, the development of more sustainable recycling alternatives for the separation and purification of polycotton into its monomers and cellulose is vital. In a recently approved GoChem project, it has been shown that cotton can be separated from polyester successfully, using a chemical recycling process. The generated solution is a mixture of suspended and partially decolorized cotton (cellulose) and a liquid fraction produced from the depolymerization of the polyester (monomers). A necessary further step of this work is the investigation of possible separation methods to recover the cotton and purify the obtained polyester monomers into polymer-grade pure products suitable for repolymerization. Repolymerize is a new consortium, composed of the first project members, plus a separation and purification process group, to investigate efficient and high yield purification steps to recover these products. The project will focus on possible steps to separate the suspended fraction (cotton) and further recover of high purity ethylene glycol from the rest fraction (polyester depolymerization solution). The main objective is to create essential knowledge so the private partners can evaluate whether such process is technologically and economically feasible.
