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.
