Table 1 Overview of the Stratified Blended Approach
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 | |||
| Â | 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. |