Background & Aims

A blended intervention consisting of face-to-face physiotherapy and psychologically informed digital health (Back2Action) was developed to optimise the management of people with persistent spinal pain who also have psychosocial factors associated with the maintenance of persistent pain (1). To successfully implement this newly developed intervention, adherence to evidence-based practice is important. The intervention should not only be grounded in the best available scientific evidence but also in line with the needs and expectations of participants (2). By exploring participants’ experiences, insights are gained into the useful elements of the intervention and areas that may require attention. This study aimed to gain insights into how participants experienced this blended intervention.

Methods

An interpretative qualitative study using semi-structured interviews with a pre-defined topic list (3), was conducted alongside a randomised control trial evaluating the (cost-)effectiveness of Back2Action compared to usual care physiotherapy (1, 4). The study sample consisted of eleven people with at least six weeks of non-specific low back pain or neck pain who also experienced psychosocial factors, such as depressive symptoms, anxiety, or kinesiophobia, and received the blended intervention within the trial. All interviews were recorded, transcribed verbatim, and analysed independently by two researchers. Data were analysed using a thematic inductive approach. Meaningful parts of the transcript were independently labelle (open codes), which were compared until consensus was reached. Based on these open codes, a code tree with axial and selective codes was constructed. All codes were formed and analysed systematically in the software MAXQDA. Multiple peer debriefings were performed.

Results

The median (IQR) age of the eleven included patients was 28 years (25-44) and 55% were female. The analysis identified four themes: (1) Experiencing a better understanding of the relationship between own physical and mental health; (2) Importance of the physiotherapist’s active involvement in biopsychosocial blended care, which describes the crucial role of physiotherapists in supporting participants in this; (3) Appreciation of digital health, to better understand persistent pain and make meaningful lifestyle changes; and (4) Trials and triumphs, revealing gains such as better pain coping, but also challenges with implementation of changes into long-term routines.

Conclusions

Participants of the blended intervention experienced positive changes in thoughts and behaviours, which highlights the feasibility and acceptability of the blended intervention as a more holistic treatment within pain management. The differences in personal preferences for receiving psychologically informed digital health pose challenges to the implementation of blended biopsychosocial care in evidence-based practice.

References

1)Bijker L, de Wit L, Cuijpers P, Poolman E, Scholten-Peeters G, Coppieters MW. Back2Action: effectiveness of physiotherapy blended with eHealth consisting of pain education and behavioural activation versus physiotherapy alone-protocol for a pragmatic randomised clinical trial for people with subacute or persistent spinal pain. BMJ Open. 2022 Jan 7;12(1):e050808. doi: 10.1136/bmjopen-2021-050808. PMID: 34996786; PMCID: PMC8744098.

2)Kayser L, Kushniruk A, Osborne RH, Norgaard O, Turner P. Enhancing the Effectiveness of Consumer-Focused Health Information Technology Systems Through eHealth Literacy: A Framework for Understanding Users’ Needs. JMIR Hum Factors. 2015 May 20;2(1):e9. doi: 10.2196/humanfactors.3696. PMID: 27025228; PMCID: PMC4797661.

3)Dweck, C. S. (2006) Mindset: The new psychology of success. Random House.

4)Bier JD, Scholten-Peeters WGM, Staal JB, Pool J, van Tulder MW, Beekman E, Knoop J, Meerhoff G, Verhagen AP. Clinical Practice Guideline for Physical Therapy Assessment and Treatment in Patients With Nonspecific Neck Pain. Phys Ther. 2018 Mar 1;98(3):162-171. doi: 10.1093/ptj/pzx118. PMID: 29228289.

Presenting Author

Gwendolyne GM Scholten-Peeters

Poster Authors

Wendy Scholten-Peeters

PhD

Vrije universiteit Amsterdam

Lead Author

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Eva Poolman

Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, The Netherlands

Lead Author

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Lukas Vorstermans

HAN University of Applied Sciences, Nijmegen, The Netherlands

Lead Author

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Marianne Donker

Faculty of Beta Sciences, Vrije Universiteit Amsterdam, The Netherlands

Lead Author

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Lisette Bijker

Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, The Netherlands

Lead Author

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Michel Coppieters

Vrije Universiteit Amsterdam

Lead Author

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Pim Cuijpers

Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, The Netherlands

Lead Author

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Leonore de Wit

Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, The Netherlands

Lead Author

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Topics

  • Specific Pain Conditions/Pain in Specific Populations: Low Back Pain

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