Table 2 Overview of the Stratified Blended Physiotherapy approach, developed in phase 1 of this study

Step 1. Stratification

Content and intensity of treatment

Is to be matched to the patient’s risk of persistent disabling pain (low, medium or high, assessed with the Keele STarT MSK Tool)

Mode of treatment delivery

Is to be matched to the patient’s suitability for blended care (yes or no, assessed with the Dutch Blended Physiotherapy Checklist by the physiotherapist)

Step 2. Matched treatment options (described per risk profile)

Low risk

Medium risk

High risk

Physiotherapy sessions (either face-to-face or video consults)

Aim

Improvement of pain and disability

Intensity of physiotherapy

3–4 sessions (over 3 weeks)

6–9 sessions (over 12 weeks)

8–12 sessions (over 12 weeks)

Content

Reassurance, provide information on neck/shoulder complaints, possible causes, self-management options and the importance of adequate physical activity/exercise behavior

Similar to low risk with the optional addition: provide passive or active joint mobilization techniques, in combination with functional exercise therapy

Similar to medium risk with the optional addition: address patient’s specific physical and psychosocial obstacles to recovery, using a combination of physical and psychological approaches, including pain education

Integration of e-Exercise or paper-based workbook

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

In the final session: 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 environment; e-Exercise app or paper-based workbook

Information module

3 weekly varying information themes, including assignments to stimulate patient self-reflection

12 weekly varying information themes, including assignments to stimulate patient 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 differs per risk subgroup and working status

Exercise module

3–4 personalized exercises to fit the patient’s specific functional status

Physical activity module

Not applicable

The patient chooses one physical activity and sets a goal to maintain or enhance the level of that physical activity. Optionally, 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.