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3Background: 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.
ARTIKEL
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.
ARTIKEL
Background: Patient education, home-based exercise therapy, and advice on returning to normal activities are established physiotherapeutic treatment options for patients with nonspecific low back pain (LBP). However, the effectiveness of physiotherapy interventions on health-related outcomes largely depends on patient self-management and adherence to exercise and physical activity recommendations. e-Exercise LBP is a recently developed stratified blended care intervention comprising a smartphone app integrated with face-to-face physiotherapy treatment. Following the promising effects of web-based applications on patients’ self-management skills and adherence to exercise and physical activity recommendations, it is hypothesized that e-Exercise LBP will improve patients’ physical functioning. Objective: This study aims to investigate the short-term (3 months) effectiveness of stratified blended physiotherapy (e-Exercise LBP) on physical functioning in comparison with face-to-face physiotherapy in patients with nonspecific LBP. Methods: The study design was a multicenter cluster randomized controlled trial with intention-to-treat analysis. Patients with nonspecific LBP aged ≥18 years were asked to participate in the study. The patients were treated with either stratified blended physiotherapy or face-to-face physiotherapy. Both interventions were conducted according to the Dutch physiotherapy guidelines for nonspecific LBP. Blended physiotherapy was stratified according to the patients’ risk of developing persistent LBP using the Keele STarT Back Screening Tool. The primary outcome was physical functioning (Oswestry Disability Index, range 0-100). Secondary outcomes included pain intensity, fear-avoidance beliefs, and self-reported adherence. Measurements were taken at baseline and at the 3-month follow-up. Results: Both the stratified blended physiotherapy group (104/208, 50%) and the face-to-face physiotherapy group (104/208, 50%) had improved clinically relevant and statistically significant physical functioning; however, there was no statistically significant or clinically relevant between-group difference (mean difference −1.96, 95% CI −4.47 to 0.55). For the secondary outcomes, stratified blended physiotherapy showed statistically significant between-group differences in fear-avoidance beliefs and self-reported adherence. In patients with a high risk of developing persistent LBP (13/208, 6.3%), stratified blended physiotherapy showed statistically significant between-group differences in physical functioning (mean difference −16.39, 95% CI −27.98 to −4.79) and several secondary outcomes. Conclusions: The stratified blended physiotherapy intervention e-Exercise LBP is not more effective than face-to-face physiotherapy in patients with nonspecific LBP in improving physical functioning in the short term. For both stratified blended physiotherapy and face-to-face physiotherapy, within-group improvements were clinically relevant. To be able to decide whether e-Exercise LBP should be implemented in daily physiotherapy practice, future research should focus on the long-term cost-effectiveness and determine which patients benefit most from stratified blended physiotherapy.
ARTIKEL
In mental healthcare, blended care (online combined with face to face treatment) is presented as a mundane practice. Most mental health care organizations have ‘opened’ their electronic patient records for patients, as well as provided for online treatment interventions like psycho-education and cognitive behavioral therapy, so patients can work on their issues at home. This presentation of blended care in mental health care fits organizational and governmental policies, as online treatment is expected to help solving the problems of labor shortage in care and fit the self-managing patient. When zooming in though, we found how care professionals have to deal with all kinds of practical or fundamental issues on blended treatment. Some care professionals deal with hindrances hands on like “apps for texting are not supposed to be used for safety reasons, but they are quick and easy and hold all kinds of opportunities for contact with patients”. At the same time, there are care professionals that do not know how to adjust their routines and find it difficult to make use of online modules in a good way. In our ethnographic research, we add image to text and discuss with care professionals and patients what we observe and encounter in different ways. In this way, we articulate patients’ and care professionals’ knowledge and experience with blended care, and aim to help them solve their hindrances.
CONFERENTIEBIJDRAGE
Background Regular physiotherapy with a physiotherapist experienced in the field is not feasible for many patients with haemophilia. We, therefore, developed a blended physiotherapy intervention for persons with haemophilic arthropathy (HA) (e-Exercise HA), integrating face-to-face physiotherapy with a smartphone application. Aim The aim of the study was to determine proof of concept of e- Exercise HA and to evaluate feasibility. Methods Proof of concept was evaluated by a single-case multiple baseline design. Physical activity (PA) was measured with an accelerometer during a baseline, intervention and post-intervention phase and analysed using visual inspection and a single case randomisation test. Changes in limitations in activities (Haemophilia Activities List [HAL]) and a General Perceived Effect (GPE) were evaluated between baseline (T0), post-intervention (T1) and 3 months post-intervention (T2) using Wilcoxson signed rank test. Feasibility was evaluated by the number of adverse events, attended sessions and open-ended questions. Results Nine patients with HA (90% severe, median age 57.5 (quartiles 50.5–63.3) and median HJHS 32 (quartiles 22–36)) were included. PA increased in two patients. HAL increased mean 15 (SD 9) points (p = .001) at T1, and decrease to mean +8 points (SD 7) (p = .012) at T2 compared to T0. At T1 and T2 8/9 participants scored a GPE > 3. Median 5 (range 4–7) face-to-face sessions were attended and a median 8 out of 12 information modules were viewed. No intervention-related bleeds were reported. Conclusion A blended physiotherapy intervention is feasible for persons with HA and the first indication of the effectiveness of the intervention in decreasing limitations in activities was observed.
ARTIKEL
From the article: "This paper describes the process of introducing blended learning in a CS educational program. The methodology that has been used as well as the motivation for the choices made are given. The rst results compared with results from previous courses that used a more classical teaching approach are given. These results show that the new methodology proves to be promising and successful. The successes of the new program as well as the problems encountered are discussed with their possible solution."
CONFERENTIEBIJDRAGE
The main objective of this dissertation is to examine, both theoretically and empirically, the specific requirements of a blended learning instructional model aimed at facilitating higher education adult-learners into online interaction. Three objectives were formulated: Objective 1: to investigate adult-learners’ perceived satisfaction in relation to blended learning and the factors that foster their interaction with the ‘added’ online mode; and a thorough understanding of adult-learners’ educational needs and learning characteristics derived from theory. Objective 2: to understand the factors of social presence and convergence, and how these can be ingrained into design principles that foster online interaction. Objective 3: to explore the specifics of an instructional model for the design of a blended learning environment for adult-learners in higher education, both theoretically and empirically, and how said principles can be actualised in a validated model.
PROEFSCHRIFT
aphasia, speech apraxia, blended careDeze aanvraag is onderdeel van een structureel samenwerkingsverband van het UMCG Centrum voor Revalidatie met de Hanzehogeschool, afdeling Logopedie en de RUG, afdeling Taalwetenschappen, University College of Groningen en Universitair Ziekenhuis Gent. Het project heeft ten doel het verbeteren van de kwaliteit van de logopedische behandeling van spraak- en taalstoornissen na hersenletsel. Hierbij staat telkens het verbinden van theoretische inzichten uit de literatuur met klinisch opgedane inzichten voorop.
Increasing flexibilisation and personalisation of education creates challenges in terms of students’ social connectedness with each other, with the programme and with lecturers. For this reason, a team of researchers and professors from four universities of applied sciences in the Netherlands carried out research into how a sense of community can be created in learning communities. On the basis of a literature review and design-oriented research, we conducted experiments aimed at fostering social connectedness in eight learning communities. These learning communities were in the domains of Nursing, Healthcare and Welfare Teacher Training, Management in Care, Teacher Training, and Nutrition and Dietetics (part-time, full-time and dual programme variants). The above research resulted in this Social connectedness in Online and Blended Learning Communities guide, which consists of two parts. Part one outlines the seven design principles (focused on content, attitude and preconditions) which lecturers can work with in their role as facilitator. The lecturer can apply these design principles to promote social connectedness in online and blended learning communities, including when flexible student paths are involved. These design principles are supported by practical IT tools and working methods and are widely applicable. The design principles involved are: A. Getting to know each other B. Trust and cooperation
C. Shared and common goals D. Willingness to participate E. Programme and instruction strategies F. Sharing information and knowledge G. Resources and preconditions. Part 2 consists of a methodological justification and substantiation of the research underpinning the guide as well as a description of the results and ends with a conclusion, discussion and recommendations for further research.
The experiments showed that learning communities that were newly established or had changed in composition after some time mainly opted for design principles A. Getting to know each other and B. Trust and cooperation. Learning communities that had been active for a longer period chose mainly C. Shared and common goals. Further longitudinal and other research is needed to determine to what extent the design principles and the role of the facilitators can be applied in other domains (such as technology, economics, etc.).
BOEK
eHealth education should be integrated into vocational training and continuous professional development programmes. In this opinion article, we aim to support organisers of Continuing Professional Development (CPD) and teachers delivering medical vocational training by providing recommendations for eHealth education. First, we describe what is required to help primary care professionals and trainees learn about eHealth. Second, we elaborate on how eHealth education might be provided
ARTIKEL
