Evidence map›Paper›PMID 33546656›Full record

ArticleBMC musculoskeletal disorders2021

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.

Mark L van Tilburg, Corelien J J Kloek, Martijn F Pisters, J Bart Staal, Johanna M van Dongen, Marjolein de Weerd, Raymond W J G Ostelo, Nadine E Foster, Cindy Veenhof

Open access · goldAbstract readClinical Trial Protocol
In one paragraph

Article in BMC musculoskeletal disorders, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 2 pooled it
1.5field-weighted citation impact, top 20% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 2 syntheses or guidelines pooled it, 11 citations in OpenAlex.

  1. Selection and reporting of usual care comparators when designing primary care trials of complex health interventions: a systematic review.The British journal of general practice : the journal of the Royal College of General Practitioners · 2025
    Pooled it
  2. Telerehabilitation for neck pain.The Cochrane database of systematic reviews · 2025
    Pooled it
  3. Trial
  4. Article
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 5 institutions in 3 countries.

Mark L van TilburgExpertise Center Healthy Urban Living, Research Group Innovation of Human Movement Care, HU University of Applied Sciences Utrecht, Heidelberglaan 7, 3584, CS, Utrecht, the Netherlands. mark.vantilburg@hu.nl.ORCID http://orcid.org/0000-0002-3474-0950
Corelien J J KloekExpertise Center Healthy Urban Living, Research Group Innovation of Human Movement Care, HU University of Applied Sciences Utrecht, Heidelberglaan 7, 3584, CS, Utrecht, the Netherlands.
Martijn F PistersCenter for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, the Netherlands.
J Bart StaalMusculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands.
Johanna M van DongenDepartment of Health Sciences, Faculty of Science, VU University, Amsterdam Movement Sciences Research Institute, Amsterdam, the Netherlands.
Marjolein de WeerdExpertise Center Healthy Urban Living, Research Group Innovation of Human Movement Care, HU University of Applied Sciences Utrecht, Heidelberglaan 7, 3584, CS, Utrecht, the Netherlands.
Raymond W J G OsteloDepartment of Health Sciences, Faculty of Science, VU University, Amsterdam Movement Sciences Research Institute, Amsterdam, the Netherlands.
Nadine E FosterPrimary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK.
Cindy VeenhofExpertise Center Healthy Urban Living, Research Group Innovation of Human Movement Care, HU University of Applied Sciences Utrecht, Heidelberglaan 7, 3584, CS, Utrecht, the Netherlands.
University of Applied Sciences Utrecht · NLAmsterdam University Medical Centers · NLHAN University of Applied Sciences · NLThe University of Queensland · AUUtrecht University · NL

Funding

Scientific College Physiotherapy (WCF), part of the Royal Dutch Association for Physiotherapy (KNGF) Call 2017
6 · The paper itself

Abstract

backgroundNeck and shoulder complaints are common in primary care physiotherapy. These patients experience pain and disability, resulting in high societal costs due to, for example, healthcare use and work absence. Content and intensity of physiotherapy care can be matched to a patient's risk of persistent disabling pain. Mode of care delivery can be matched to the patient's suitability for blended care (integrating eHealth with physiotherapy sessions). It is hypothesized that combining these two approaches to stratified care (referred to from this point as Stratified Blended Approach) will improve the effectiveness and cost-effectiveness of physiotherapy for patients with neck and/or shoulder complaints compared to usual physiotherapy.

methodsThis paper presents the protocol of a multicenter, pragmatic, two-arm, parallel-group, cluster randomized controlled trial. A total of 92 physiotherapists will be recruited from Dutch primary care physiotherapy practices. Physiotherapy practices will be randomized to the Stratified Blended Approach arm or usual physiotherapy arm by a computer-generated random sequence table using SPSS (1:1 allocation). Number of physiotherapists (1 or > 1) will be used as a stratification variable. A total of 238 adults consulting with neck and/or shoulder complaints will be recruited to the trial by the physiotherapy practices. In the Stratified Blended Approach arm, physiotherapists will match I) the content and intensity of physiotherapy care to the patient's risk of persistent disabling pain, categorized as low, medium or high (using the Keele STarT MSK Tool) and II) the mode of care delivery to the patient's suitability and willingness to receive blended care. The control arm will receive physiotherapy as usual. Neither physiotherapists nor patients in the control arm will be informed about the Stratified Blended Approach arm. The primary outcome is region-specific pain and disability (combined score of Shoulder Pain and Disability Index & Neck Pain and Disability Scale) over 9 months. Effectiveness will be compared using linear mixed models. An economic evaluation will be performed from the societal and healthcare perspective. DISCUSSION: The trial will be the first to provide evidence on the effectiveness and cost-effectiveness of the Stratified Blended Approach compared with usual physiotherapy in patients with neck and/or shoulder complaints.

trial registrationNetherlands Trial Register: NL8249 . Officially registered since 27 December 2019. Date of first enrollment: 30 September 2020. Study status: ongoing, data collection.

Indexed as

ShoulderTelemedicineAdultCost-Benefit AnalysisHumansMulticenter Studies as TopicNetherlandsPhysical Therapy ModalitiesPragmatic Clinical Trials as TopicPrimary Health CareRandomized Controlled Trials as TopicBlended careeHealthMusculoskeletal disordersNeck painPhysiotherapyShoulder painStratified careTelemedicine

Identifiers

PMID33546656
PMCPMC7862842
OpenAlexW3128761726

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.