PMID- 37999947 OWN - NLM STAT- MEDLINE DCOM- 20231127 LR - 20240110 IS - 1438-8871 (Electronic) IS - 1439-4456 (Print) IS - 1438-8871 (Linking) VI - 25 DP - 2023 Nov 24 TI - Effectiveness and Cost-Effectiveness of a Stratified Blended Physiotherapy Intervention Compared With Face-to-Face Physiotherapy in Patients With Nonspecific Low Back Pain: Cluster Randomized Controlled Trial. PG - e43034 LID - 10.2196/43034 [doi] LID - e43034 AB - BACKGROUND: Nonspecific low back pain (LBP) is a leading contributor to disability worldwide, and its socioeconomic burden is substantial. Self-management support is an important recommendation in clinical guidelines for the physiotherapy treatment of patients with LBP and may support cost-effective management. However, providing adequate individually tailored self-management support is difficult. The integration of web-based applications into face-to-face care (ie, blended care) seems promising to optimize tailored treatment and enhance patients' self-management and, consequently, may reduce LBP-related costs. OBJECTIVE: We aimed to evaluate the long-term effectiveness and cost-effectiveness of stratified blended physiotherapy (e-Exercise LBP) compared with face-to-face physiotherapy in patients with nonspecific LBP. METHODS: An economic evaluation was conducted alongside a prospective, multicenter, cluster randomized controlled trial in primary care physiotherapy. Patients with nonspecific LBP were treated with either stratified blended physiotherapy (e-Exercise LBP) (n=104) or face-to-face physiotherapy (n=104). The content of both interventions was based on the Dutch physiotherapy guidelines for nonspecific LBP. Blended physiotherapy was stratified according to the patients' risk of developing persistent LBP using the STarT Back Screening Tool. The primary clinical outcome was physical functioning (Oswestry Disability Index version 2.1a). For the economic evaluation, quality-adjusted life years (QALYs; EQ-5D-5L) and physical functioning were the primary outcomes. Secondary clinical outcomes included fear avoidance beliefs and self-reported adherence. Costs were measured from societal and health care perspectives using self-report questionnaires. Effectiveness was estimated using linear mixed models. Seemingly unrelated regression analyses were conducted to estimate total cost and effect differences for the economic evaluation. RESULTS: Neither clinically relevant nor statistically substantial differences were found between stratified blended physiotherapy and face-to-face physiotherapy regarding physical functioning (mean difference [MD] -1.1, 95% CI -3.9 to 1.7) and QALYs (MD 0.026, 95% CI -0.020 to 0.072) over 12 months. Regarding the secondary outcomes, fear avoidance beliefs showed a statistically significant improvement in favor of stratified blended physiotherapy (MD -4.3, 95% CI -7.3 to -1.3). Societal and health care costs were higher for stratified blended physiotherapy than for face-to-face physiotherapy, but the differences were not statistically significant (societal: euro972 [US $1027], 95% CI -euro1090 to euro3264 [US -$1151 to $3448]; health care: euro73 [US $77], 95% CI -euro59 to euro225 [US -$62 to $238]). Among the disaggregated cost categories, only unpaid productivity costs were significantly higher for stratified blended physiotherapy. From both perspectives, a considerable amount of money must be paid per additional QALY or 1-point improvement in physical functioning to reach a relatively low to moderate probability (ie, 0.23-0.81) of stratified blended physiotherapy being cost-effective compared with face-to-face physiotherapy. CONCLUSIONS: The stratified blended physiotherapy intervention e-Exercise LBP is neither more effective for improving physical functioning nor more cost-effective from societal or health care perspectives compared with face-to-face physiotherapy for patients with nonspecific LBP. TRIAL REGISTRATION: ISRCTN 94074203; https://www.isrctn.com/ISRCTN94074203. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12891-020-3174-z. CI - (c)Tjarco Koppenaal, Johanna M van Dongen, Corelien JJ Kloek, Remco M Arensman, Cindy Veenhof, Martijn F Pisters, Raymond WJG Ostelo. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 24.11.2023. FAU - Koppenaal, Tjarco AU - Koppenaal T AUID- ORCID: 0000-0002-5319-4588 AD - Research Group Empowering Healthy Behaviour, Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, Netherlands. AD - Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, Netherlands. AD - Physical Therapy Research, Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, Netherlands. FAU - van Dongen, Johanna M AU - van Dongen JM AUID- ORCID: 0000-0002-1606-8742 AD - Department of Health Sciences, Faculty of Science, VU University Amsterdam, Amsterdam Public Health research institute, Amsterdam, Netherlands. AD - Department of Health Sciences, Faculty of Science, VU University Amsterdam, Amsterdam Movement Sciences research institute Amsterdam, Amsterdam, Netherlands. FAU - Kloek, Corelien Jj AU - Kloek CJ AUID- ORCID: 0000-0002-7426-7141 AD - Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, Netherlands. AD - Research Group Innovation of Human Movement Care, Research Center Healthy and Sustainable Living, HU University of Applied Sciences, Utrecht, Netherlands. FAU - Arensman, Remco M AU - Arensman RM AUID- ORCID: 0000-0002-9462-963X AD - Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, Netherlands. AD - Physical Therapy Research, Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, Netherlands. FAU - Veenhof, Cindy AU - Veenhof C AUID- ORCID: 0000-0003-0970-2896 AD - Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, Netherlands. AD - Physical Therapy Research, Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, Netherlands. AD - Research Group Innovation of Human Movement Care, Research Center Healthy and Sustainable Living, HU University of Applied Sciences, Utrecht, Netherlands. FAU - Pisters, Martijn F AU - Pisters MF AUID- ORCID: 0000-0002-2875-1709 AD - Research Group Empowering Healthy Behaviour, Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, Netherlands. AD - Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, Netherlands. AD - Physical Therapy Research, Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, Netherlands. FAU - Ostelo, Raymond Wjg AU - Ostelo RW AUID- ORCID: 0000-0001-7679-7210 AD - Department of Health Sciences, Faculty of Science, VU University Amsterdam, Amsterdam Movement Sciences research institute Amsterdam, Amsterdam, Netherlands. AD - Department of Epidemiology and Data Science, Amsterdam University Medical Centre, Location Vrije Universiteit, Amsterdam, Netherlands. LA - eng PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20231124 PL - Canada TA - J Med Internet Res JT - Journal of medical Internet research JID - 100959882 SB - IM MH - Humans MH - Cost-Benefit Analysis MH - *Low Back Pain/therapy MH - Prospective Studies MH - Physical Therapy Modalities MH - Delivery of Health Care PMC - PMC10709796 OTO - NOTNLM OT - blended care OT - eHealth OT - economic evaluation OT - mobile phone OT - nonspecific low back pain OT - physiotherapy COIS- Conflicts of Interest: None declared. EDAT- 2023/11/24 12:43 MHDA- 2023/11/27 12:41 PMCR- 2023/11/24 CRDT- 2023/11/24 11:54 PHST- 2022/09/28 00:00 [received] PHST- 2023/10/24 00:00 [accepted] PHST- 2023/07/06 00:00 [revised] PHST- 2023/11/27 12:41 [medline] PHST- 2023/11/24 12:43 [pubmed] PHST- 2023/11/24 11:54 [entrez] PHST- 2023/11/24 00:00 [pmc-release] AID - v25i1e43034 [pii] AID - 10.2196/43034 [doi] PST - epublish SO - J Med Internet Res. 2023 Nov 24;25:e43034. doi: 10.2196/43034.