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Table 1 Overview of the Stratified Blended Approach

From: Stratified care integrated with eHealth versus usual primary care physiotherapy in patients with neck and/or shoulder complaints: protocol for a cluster randomized controlled trial

Phase 1: Stratification
Content and intensity of treatment will be matched to the patient’s risk of persistent disabling pain (low, medium or high, assessed with the Keele STarT MSK Tool) Mode of care delivery will be matched to the patient’s suitability for blended care (yes or no, assessed with the Dutch Blended Physiotherapy Checklist)
Phase 2: Matched treatment per risk profile
  Low risk Medium risk High risk
Physiotherapy sessions (either face-to-face or video consults)
Aim Improvement of a patient’s pain and disability
Intensity 3–4 sessions (3 weeks) 6–9 sessions (12 weeks) 8–12 sessions (12 weeks)
Content Reassurance, provide information on neck/shoulder complaints, personal etiology, self-management options and the importance of adequate physical activity/exercise behavior Similar to low risk and additionally: consider to provide passive or active joint mobilization techniques, in combination with functional exercise therapy Similar to medium risk and additionally: consider to address patient’s specific physical and psychosocial obstacles to recovery, using a combination of physical and psychological approaches, including pain education
Integration Motivate to read information modules and do home-based exercises independently Per session evaluation of progress with e-Exercise app or paper-based workbook to optimize physiotherapy treatment
Evaluation A final session to evaluate the progress and give recommendations to prevent recurrent episodes of neck/shoulder complaints and maintain or improve the physical activity level
Patient’s home setting: e-Exercise app or paper-based workbook
Information module 3 weekly varying information themes, including assignments to stimulate self-reflection 12 weekly varying information themes, including assignments to stimulate self-reflection, about the etiology of neck/shoulder complaints, physical activity, patient experiences, pain management, and psychosocial factors related to neck/shoulder complaints. The information and order of the information provided will differ per risk profile and working status
Exercise module 3–4 personalized exercises to fit the patient’s specific functional status.
Physical activity module Recommendations The patient chooses one physical activity and sets a goal to maintain or enhance the level of that physical activity. A graded activity functionality can be activated. The patient chooses one physical activity and sets a goal to enhance the level of that physical activity, by using a graded activity functionality.