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Stratified care with LARS (Lage Rugpijn Support tool) for patients with chronic non-specific low back pain and physiotherapists in primary care. A participative development and feasibility study.


Fysiotherapie op maat: digitale keuzehulp LARS

Chronische lage rugpijn is wereldwijd een groot sociaal-maatschappelijk probleem waarbij diverse behandelvormen met wisselend succes worden ingezet.


Doel van deze studie is om samen met cliënten met chronische lage rugpijn, fysiotherapeuten, ICT-deskundigen en studenten de digitale keuzehulp LARS (LAge Rugpijn Support) te ontwikkelen.


Samen met gebruikers worden de visies en voorkeuren over de factoren die het behandelsucces beïnvloeden bepaald. Zo wordt in co-creatie bepaald hoe LARS eruit moet zien om de tool bruikbaar en toepasbaar te maken in de praktijk. 

Verwachte resultaten

LARS helpt bij het kiezen van de meest passende fysiotherapeutische behandeling door de voor- en nadelen van elke behandeling op een rij te zetten. Zo kan een cliënt zich goed voorbereiden op het gesprek bij de fysiotherapeut. In samenspraak wordt dan een behandeling gekoz


Lees hoe 2 innovaties voor betere behandeling van chronische lage rugpijn, dit digitale keuzehulpmiddel en oefeningen met Virtual Reality, elkaar kunnen versterken en leiden tot meer doelmatigheid.

> Interview met Karin Verkerk en Jesper Knoop


Jesper Knoop en Karin Verkerk


Samenvatting van de aanvraag

OBJECTIVES. To develop and establish the feasibility, usability of the technology and user acceptance of prototype LARS (=LAge Rugpijn Support tool). LARS is a web-based Treatment Shared decision making Tool for primary care physiotherapists (PTs) and patients with chronic nonspecific low back pain (CNSLBP). LARS is an eHealth tool to support informed shared decision making by offering treatment recommendations to PTs and patients, based on patient characteristics (stratified care). DESIGN. Participative co-design project involving patients and PTs. We use the evidence-based framework CeHRes (Centre for eHealth Research and Disease Management) as guideline. Part I: We address three of four iterative phases of the CeHRes Roadmap: 1) contextual inquiry, 2) value specification and 3) design. Part II, phase 4) operationalization, followed by an evaluation study. For each phase, research questions, tasks and methods are formulated. By means of co-design, a process of collective creativity and partnership is initiated with all potential users and stakeholders, who are actively involved across the entire development of LARS, ensuring the tool meets users’ needs and preferences. Immediate benefits of employing a co-design approach include: improved knowledge of users’ needs; immediate validation of concepts; more efficient shared decision making; identification of what works in the real world, and increased feasibility and effectiveness. Research activities to support LARS development prior to implementation include literature studies, focus groups, and iterative rounds of interviews. POPULATION. Patients with CNSLBP and PTs working in primary care take part in co-design groups with subsequent pilot-testing of LARS in 12 PT-practices with 50 patients in total. CNSLBP is established by the persistence of pain in the lower back and sometimes also in the leg, beyond 7 weeks to 3 months without specific pathology. OUTCOMES. Patient and PT reported outcomes of assessment of feasibility, usability and acceptance of LARS. RELEVANCE. Patients with CNSLBP often become frequent users of physiotherapy services in their attempt to find treatments that minimize the severity of their symptoms. Despite increasing numbers of randomized controlled trials that evaluate interventions for CNSLBP, treatment outcomes remain suboptimal. One explanation is that it is difficult for PTs to identify which patient will benefit most from which treatment. PTs often choose treatment modalities based on their expertise and experience, instead of on personalized stratified care principles. This project introduces stratified care and uses prediction models developed from three Dutch RCTs in primary care, and supports shared decision making regarding choice of treatment (=matched care). The treatment choices in our study (behaviour graded activity, workplace intervention, active physical therapy programs and usual care) have shown moderate effect. This project aims to contribute in the optimization of the shared decision making process for the best choice of treatment for a patient with CSNLBP. The combination of evidence-based decision support with patient preferences promises to substantially improve personalized care and effect of treatment. TIME SCHEDULE. The project lasts 30 months from and consists of two parts: Part I - Participatory co-design process (15 months) following the first 3 of 4 phases of the CeHRes Roadmap. The first step in the development of LARS (6 months) involves a thorough contextual inquiry, including stakeholder identification, stakeholder analysis, and description of the current situation in order to specify the added value of LARS. Then, we move to value specification (3 months) where the goals LARS should reach according to stakeholders will be determined. Co-design, literature studies, focus groups, and iterative rounds of interviews are used with an ongoing formative evaluation process. During the third phase, the blueprint of LARS is developed in co-design (6 months). Several prototypes of LARS are produced and usability tests are performed. Persuasive elements are added to guarantee that patients and PTs will actually start and keep using LARS. Part II - Process Evaluation (15 months). Phase 4 of the CeHRes Roadmap entails the operationalization of the actual introduction, adoption, and employment of LARS in PT primary practice. The cycle consists of enabling and reinforcing activities and mobilizing resources for training, education, and deployment of the LARS as a forthcoming eHealth technology in daily practice. An accepted business model will be developed to steer the adoption process. 12 PT-practices with 50 patients will take part in the evaluation of the outcomes feasibility, usability and acceptance. If successful, LARS will be disseminated nationally.


Looptijd: 85%
Looptijd: 85 %
Onderdeel van programma:
Gerelateerde subsidieronde:
Projectleider en penvoerder:
dr. A.L. van Staa
Verantwoordelijke organisatie:
Hogeschool Rotterdam

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