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.
Challenges that surveys are facing are increasing data collection costs and declining budgets. During the past years, many surveys at Statistics Netherlands were redesigned to reduce costs and to increase or maintain response rates. From 2018 onwards, adaptive survey design has been applied in several social surveys to produce more accurate statistics within the same budget. In previous years, research has been done into the effect on quality and costs of reducing the use of interviewers in mixed-mode surveys starting with internet observation, followed by telephone or face-to-face observation of internet nonrespondents. Reducing follow-ups can be done in different ways. By using stratified selection of people eligible for follow-up, nonresponse bias may be reduced. The main decisions to be made are how to divide the population into strata and how to compute the allocation probabilities for face-to-face and telephone observation in the different strata. Currently, adaptive survey design is an option in redesigns of social surveys at Statistics Netherlands. In 2018 it has been implemented in the Health Survey and the Public Opinion Survey, in 2019 in the Life Style Monitor and the Leisure Omnibus, in 2021 in the Labour Force Survey, and in 2022 it is planned for the Social Coherence Survey. This paper elaborates on the development of the adaptive survey design for the Labour Force Survey. Attention is paid to the survey design, in particular the sampling design, the data collection constraints, the choice of the strata for the adaptive design, the calculation of follow-up fractions by mode of observation and stratum, the practical implementation of the adaptive design, and the six-month parallel design with corresponding response results.
“Municipal Youth Work taken over by Christians”. (Binnenlands Bestuur, 2009) This heading refers to the work of Youth for Christ in an Amsterdam neighbourhood. This organisation, successful in Youth Work nationwide, last year came out first in an open competition of the Amsterdam district De Baarsjes. Because of this they were commissioned to undertake all the youth work in this multicultural neighbourhood. The conditions were not to evangelise and not to limit recruitment of personnel inside their own circle but to recruit from outside the organisation as well. When they later appeared to have put a job advertisement only on their own website, this led to heated debates. Finally Youth for Christ acknowledged and rectified this mistake. This example is a concrete illustration of the actual and sometimes delicate relationships between philosophy of life and social work
