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Table 1 Description of the intervention group based on the TIDieR checklist and the TIDieR-Telehealth checklist

From: Non-inferiority of a hybrid outpatient rehabilitation: a randomized controlled trial (HIRE, DRKS00028770)

Brief name

Digital back school (hybrid rehabilitation)

Why

The back school aims to increase physical activity in everyday life, according to the health action process approach, and to change cognitive patterns towards pain that lead to pain chronicity, based on the fear-avoidance beliefs model [26]

What (materials)

All content of the back school is digitalized and accessible online, via app or web browser, using the Caspar application. Patients use their private electronic device to participate. A study assistant within each outpatient rehabilitation center gives oral and practical instructions on correct use of the Caspar application and hands out a booklet with further information on the program, including the individual login account of the patient. The multimedia content contains educative videos and videos on physical exercises. For interactive meetings, the electronic device must be equipped with a suitable camera. Furthermore, patients can communicate with a health care professional (HCP), in particular physiotherapists, individually through a chat box at any time during the week

What (procedures)

The back school consists of seven modules [23]: (1) fundamentals; (2) back health and physical activity; (3) body awareness and spine stabilization; (4) mental factors; (5) posture and movement sequences in everyday life and at work; (6) physical activity in everyday life Part 1; and (7) physical activity in everyday life Part 2

Who provided

Caspar Health is a private company that provides all features of the Caspar application. The Tele-Therapie Klinik Berlin is a telemedicine clinic and provides all HCPs that guide the interactive sessions in the intervention group online, including the chat. These HCPs are experienced and specialized in digital therapy. The Tele-Therapie Klinik Berlin plans, organizes, and schedules all the interactive meetings

How

The entire rehabilitation program is implemented online, using the Caspar application. Group interactive meetings are performed by an HCP via camera. Non-interactive parts of the modules are performed by each patient independently

Where

The patients participate in the intervention from home. The HCPs operate from the buildings of Tele-Therapie Klinik Berlin or from home

When and how much

The seven modules are completed within 3 weeks. Each module requires 45 min to complete. The patients can choose freely when to use the educational videos and the videos on physical exercises during the week. In addition, every week a 45-min live interactive meeting is conducted online via camera and a video conference tool. Interactive meetings are scheduled during the afternoon. The participants can choose from different time slots. In addition to the online back school, patients follow their individual 3-week rehabilitation program in the outpatient rehabilitation centers. Treatments in the rehabilitation programs follow the therapy standards developed by the Federal German Pension Insurance for the rehabilitation of chronic back pain [29]

Tailoring

No specific tailoring of the intervention to the patient is planned. Nevertheless, during the weekly interactive meeting and in the chat, patients can receive individual feedback from the physiotherapist and apply it accordingly (e.g., change a physical exercise if painful)

Modifications

Not applicable

How well

No strategies are implemented to maintain adherence to rehabilitation. However, it is registered if and how often the patients watched the videos and if patients joined the weekly interactive meetings. Therapy adherence is measured and assessed by the researchers at the University of Lübeck