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Background: Stratified care has the potential to be efficient in addressing the physical and psychosocial components of low back pain (LBP) and optimise treatment outcomes essential in low-income countries. This study aimed to investigate the perceptions of physiotherapists and patients in Nigeria towards stratified care for the treatment of LBP, exploring barriers and enablers to implementation.
Methods: A qualitative design with semistructured individual telephone interviews for physiotherapists and patients with LBP comprising research evidence and information on stratified care was adopted. Preceding the interviews, patients completed the Subgroups for Targeted Treatment tool. The interviews were recorded, transcribed and analysed following grounded theory methodology.
Results: Twelve physiotherapists and 13 patients with LBP participated in the study (11 female, mean age 42.8 (SD 11.47) years). Seven key categories emerged: recognising the need for change, acceptance of innovation, resistance to change, adapting practice, patient’s learning journey, trusting the therapist and needing conviction. Physiotherapists perceived stratified care to be a familiar approach based on their background training. The prevalent treatment tradition and the patient expectations were seen as major barriers to implementation of stratified care by the physiotherapists. Patients see themselves as more informed than therapists realise, yet they need conviction through communication and education to cooperate with their therapist using this approach. Viable facilitators were also identified as patients’ trust in the physiotherapist and adaptations in terms of training and modification of the approach to enhance its use.
Conclusion: Key barriers identified are the patients’ treatment expectations and physiotherapists’ adherence to the tradition of practice. Physiotherapists might facilitate implementation of the stratified care by communication, hierarchical implementation and utilisation of patients’ trust. Possibilities to develop a consensus on key strategies to overcome barriers and on utilisation of facilitators should be tested in future research.
Zur Optimierung von Zulaufsatzkultur-Fermentationen von methylotrophen Organismen wird eine Online-Messmethode vorgestellt, mit der die Methanol-Konzentration im Medium während einer Fermentation durch ein Spülgaspervaporations-Prinzip bestimmt werden kann. Im Gegensatz zu anderen Analysemethoden bietet die Messmethode die Möglichkeit, die Substratkonzentration bei Prozessen mit Methanol als zentralem Substrat über eine Regelung auf einem definierten Wert zu halten. Es werden Schwierigkeiten, aber auch deren Überwindung bei der Adaption der Messmethode auf Fermentationsprozesse dargestellt.
The implementation of single-use technologies offers several major advantages, e.g. prevention of cross-contamination, especially when spore-forming microorganisms are present. This study investigated the application of a single-use bioreactor in batch fermentation of filamentous fungus Penicillium sp. (IBWF 040-09) from the Institute of Biotechnology and Drug Research (IBWF), which is capable of intracellular production of a protease inhibitor against parasitic proteases as a secondary metabolite. Several modifications to the SU bioreactor were suggested in this study to allow the fermentation in which the fungus forms pellets. Simultaneously, fermentations in conventional glass bioreactor were also conducted as reference. Although there are significant differences in the construction material and gassing system, the similarity of the two types of bioreactors in terms of fungal metabolic activity and the reproducibility of fermentations could be demonstrated using statistic methods. Under the selected cultivation conditions, growth rate, yield coefficient, substrate uptake rate, and formation of intracellular protease-inhibiting substance in the single-use bioreactor were similar to those in the glass bioreactor.
Purification of mRNA with oligo(dT)-functionalized magnetic particles involves a series of magnetic separations for buffer exchange and washing. Magnetic particles interact and agglomerate with each other when a magnetic field is applied, which can result in a decreased total surface area and thus a decreased yield of mRNA. In addition, agglomeration may also be caused by mRNA loading on the magnetic particles. Therefore, it is of interest how the individual steps of magnetic separation and subsequent redispersion in the buffers used affect the particle size distribution. The lysis/binding buffer is the most important buffer for the separation of mRNA from the multicomponent suspension of cell lysate. Therefore, monodisperse magnetic particles loaded with mRNA were dispersed in the lysis/binding buffer and in the reference system deionized water, and the particle size distributions were measured. A concentration-dependent agglomeration tendency was observed in deionized water. In contrast, no significant agglomeration was detected in the lysis/binding buffer. With regard to magnetic particle recycling, the influence of different storage and drying processes on particle size distribution was investigated. Agglomeration occurred in all process alternatives. For de-agglomeration, ultrasonic treatment was examined. It represents a suitable method for reproducible restoration of the original particle size distribution.
Laboratory protocols using magnetic beads have gained importance in the purification of mRNA for vaccines. Here, the produced mRNA hybridizes specifically to oligo(dT)-functionalized magnetic beads after cell lysis. The mRNA-loaded magnetic beads can be selectively separated using a magnet. Subsequently, impurities are removed by washing steps and the mRNA is eluted. Magnetic separation is utilized in each step, using different buffers such as the lysis/binding buffer. To reduce the time required for purification of larger amounts of mRNA vaccine for clinical trials, high-gradient magnetic separation (HGMS) is suitable. Thereby, magnetic beads are selectively retained in a flow-through separation chamber. To meet the requirements of biopharmaceutical production, a disposable HGMS separation chamber with a certified material (United States Pharmacopeia Class VI) was developed which can be manufactured using 3D printing. Due to the special design, the filter matrix itself is not in contact with the product. The separation chamber was tested with suspensions of oligo(dT)-functionalized Dynabeads MyOne loaded with synthetic mRNA. At a concentration of cB = 1.6–2.1 g·L–1 in lysis/binding buffer, these 1 μm magnetic particles are retained to more than 99.39% at volumetric flows of up to 150 mL·min–1 with the developed SU-HGMS separation chamber. When using the separation chamber with volumetric flow rates below 50 mL·min–1, the retained particle mass is even more than 99.99%.
Productive biofilms are gaining growing interest in research due to their potential of producing valuable compounds and bioactive substances such as antibiotics. This is supported by recent developments in biofilm photobioreactors that established the controlled phototrophic cultivation of algae and cyanobacteria. Cultivation of biofilms can be challenging due to the need of surfaces for biofilm adhesion. The total production of biomass, and thus production of e.g. bioactive substances, within the bioreactor volume highly depends on the available cultivation surface. To achieve an enlargement of surface area for biofilm photobioreactors, biocarriers can be implemented in the cultivation. Thereby, material properties and design of the biocarriers are important for initial biofilm formation and growth of cyanobacteria. In this study, special biocarriers were designed and additively manufactured to investigate different polymeric materials and surface designs regarding biofilm adhesion of the terrestrial cyanobacterium Nostoc flagelliforme (CCAP 1453/33). Properties of 3D-printed materials were characterized by determination of wettability, surface roughness, and density. To evaluate the influence of wettability on biofilm formation, material properties were specifically modified by gas-phase fluorination and biofilm formation was analyzed on biocarriers with basic and optimized geometry in shaking flask cultivation. We found that different polymeric materials revealed no significant differences in wettability and with identical surface design no significant effect on biomass adhesion was observed. However, materials treated with fluorination as well as optimized biocarrier design showed improved wettability and an increase in biomass adhesion per biocarrier surface.
The purpose of this article is to evaluate optimal expected utility risk measures (OEU) in a risk-constrained portfolio optimization context where the expected portfolio return is maximized. We compare the portfolio optimization with OEU constraint to a portfolio selection model using value at risk as constraint. The former is a coherent risk measure for utility functions with constant relative risk aversion and allows individual specifications to the investor’s risk attitude and time preference. In a case study with three indices, we investigate how these theoretical differences influence the performance of the portfolio selection strategies. A copula approach with univariate ARMA-GARCH models is used in a rolling forecast to simulate monthly future returns and calculate the derived measures for the optimization. The results of this study illustrate that both optimization strategies perform considerably better than an equally weighted portfolio and a buy and hold portfolio. Moreover, our results illustrate that portfolio optimization with OEU constraint experiences individualized effects, e.g., less risk-averse investors lose more portfolio value in the financial crises but outperform their more risk-averse counterparts in bull markets.
Hydrochar derived from Argan nut shell (ANS) was synthesized and applied to remove bisphenol A (BPA) and diuron. The results indicated that the hydrochar prepared at 200 °C (HTC@ANS-200) possessed a higher specific surface area (42 m2/g) than hydrochar (HTC@ANS-180) prepared at 180 °C (17 m2/g). The hydrochars exhibited spherical particles, which are rich in functional groups. The HTC@ANS-200 exhibited high adsorption efficiency, of about 92% of the BPA removal and 95% of diuron removal. The maximum Langmuir adsorption capacities of HTC@ANS-200 at room temperature were 1162.79 mg/for Bisphenol A and 833.33 mg/g for diuron (higher than most reported adsorbents). The adsorption process was spontaneous (− ΔG°) and exothermic (− ΔH°). Excellent reusability was reclaimed after five cycles, the removal efficiency showed a weak decrease of 4% for BPA and 1% for diuron. The analysis of Fourier transforms infrared spectrometry demonstrated that the aromatic C=C and OH played major roles in the adsorption mechanisms of BPA and diuron in this study. The high adsorption capacity was attributed to the beneficial porosity (The pore size of HTC@ANS-200 bigger than the size of BPA and diuron molecule) and surface functional groups. BPA and diuron adsorption occurred also via multiple adsorption mechanisms, including pore filling, π–π interactions, and hydrogen bonding interactions on HTC@ANS-200.
Modeling and executing knowledge-intensive processes (KiPs) are challenging with state-of-the-art approaches, and the specific demands of KiPs are the subject of ongoing research. In this context, little attention has been paid to the ontology-driven combination of data-centric and semantic business process modeling, which finds additional motivation by enabling the division of labor between humans and artificial intelligence. Such approaches have characteristics that could allow support for KiPs based on the inferencing capabilities of reasoners. We confirm this as we show that reasoners can infer the executability of tasks based on a currently researched ontology- and data-driven business process model (ODD-BP model). Further support for KiPs by the proposed inference mechanism results from its ability to infer the relevance of tasks, depending on the extent to which their execution would contribute to process progress. Besides these contributions along with the execution perspective (start-to-end direction), we will also show how our approach can help to reach specific process goals by inferring the relevance of process elements regarding their support to achieve such goals (end-to-start direction). The elements with the most valuable process progress can be identified in the intersection of both, the execution and goal perspective. This paper will introduce this new approach and verifies its practicability with an evaluation of a KiP in the field of emergency call centers.
A comprehensive overview is provided evaluating direct real-world CO2 emissions of both diesel and petrol cars newly registered in Europe between 1995 and 2015. Before 2011, European diesel cars emitted less CO2 per kilometre than petrol cars, but since then there is no appreciable difference in per-km CO2 emissions between diesel and petrol cars. Real-world CO2 emissions of diesel cars have not declined appreciably since 2001, while the CO2 emissions of petrol cars have been stagnant since 2012. When adding black carbon related CO2-equivalents, such as from diesel cars without particulate filters, diesel cars were discovered to have had much higher climate relevant emissions until the year 2001 when compared to petrol cars. From 2001 to 2015 CO2-equivalent emissions from new diesel cars and petrol cars were hardly distinguishable. Lifetime use phase CO2-equivalent emissions of all European passenger vehicles were modelled for 1995–2015 based on three scenarios: the historic case, another scenario freezing percentages of diesel cars at the low levels from the early 1990s (thus avoiding the observed “boom” in new diesel registrations), and an advanced mitigation scenario based on high proportions of petrol hybrid cars and cars burning gaseous fuels. The difference in CO2-equivalent emissions between the historical case and the scenario avoiding the diesel car boom is only 0.4%. The advanced mitigation scenario would have been able to achieve a 3.4% reduction in total CO2-equivalent emissions over the same time frame. The European diesel car boom appears to have been ineffective at reducing climate-warming emissions from the European transport sector.
Electric drive systems are increasingly used in automobiles. However, the combination of comfort, dynamics and safety requirements places high demands on the torque accuracy. The complex interplay of battery, inverter and electrical machine causes a lot of system uncertainties based on parameter fluctuations and measurement errors that influence the system performance. In this paper these influences on the closed loop torque control are analyzed and quantified using a variance based sensitivity analysis. The method enables to connect the variance of the torque accuracy with the parameter uncertainties causing this variance. Moreover, it quantifies the influences of the parameters independent of the complexity of the analyzed system. In addition, two methods to ensure convergence of the estimated variance based sensitivity measures are proposed. The results of the analysis are presented for 19 static working points of an battery electric drive system.
Passenger cars in Europe have become both heavier and more powerful over the past decades. This trend has increased vehicle utility but it might have also offset technical improvements in powertrain efficiency. Here, we analyze efficiency trade-offs and CO2 emissions for three popular compact cars in Germany. We find that mass, power, and front area of model variants has increased by 66%, 147%, and 22%, respectively between 1980 and 2018. In the same period, fuel consumption decreased 14% for gasoline models but it increased 9% for diesel models. However, if vehicle mass, power, and front area had remained at 1980 levels, technical efficiency improvements would have decreased the fuel consumption of gasoline and diesel models by 23% and 24%, respectively. The related efficiency trade-offs amount to 24 g CO2/km or 13% of the current fuel consumption for gasoline models and 40 g CO2/km or 25% of the current fuel consumption for diesel models. These findings suggest that about half of the technical efficiency improvements in gasoline models and all of the technical efficiency improvements in diesel models are offset through other vehicle attributes. By accounting for the observed efficiency trade-offs, climate policy could become more effective.
A local non-restrictive ramp metering strategy PRO is introduced. It is based on the stochasticity of capacity. The ramp metering algorithm shows innovative features:
• upstream time shifted measurements for anticipation
• measurements are actuated every second
• up to three vehicles per green are allowed
Details of the theory of this strategy are described in the first part. At freeway B27 three ramp meters with the PRO algorithm were installed. In the second part, based on extensive detailed traffic and accident data the effects on traffic flow and safety are described. The impact is positive regarding vehicle speed, queue duration and length as well as capacity and traffic safety. The improvements of speeds, travel times and capacities are statistically significant. The ramp metering systems are highly cost effective.
Online Learning algorithms and Indoor Positioning Systems are complex applications in the environment of cyber-physical systems. These distributed systems are created by networking intelligent machines and autonomous robots on the Internet of Things using embedded systems that enable the exchange of information at any time. This information is processed by Machine Learning algorithms to make decisions about current developments in production or to influence logistics processes for optimization purposes. In this article, we present and categorize the further development of the prototype of a novel Indoor Positioning System, which constantly adapts its knowledge to the conditions of its environment with the help of Online Learning. Here, we apply Online Learning algorithms in the field of sound-based indoor localization with low-cost hardware and demonstrate the improvement of the system over its predecessor and its adaptability for different applications in an experimental case study.
Stratified care for low back pain (LBP) has been shown to be clinically- and cost-effective in the UK, but its transferability to the German healthcare system is unknown. This study explores LBP patients’ perspectives regarding future implementation of stratified care, through in-depth interviews (n = 12). The STarT-Back-Tool was completed by participants prior to interviews. Interview data were analysed using Grounded Theory. The overarching theme identified from the data was ‘treatment-success’, with subthemes of ‘assessment and treatment planning’, ‘acceptance of the questionnaire’ and ‘contextual factors’. Patients identified the underlying cause of pain as being of great importance (whereas STarT-Back allocates treatment based on prognosis). The integration of the STarT-Back-Tool in consultations was considered helpful as long as it does not disrupt the therapeutic relationship, and was acceptable if tool results are handled confidentially. Results indicate that for patients to find STarT-Back acceptable, the shift from a focus on identifying a cause of pain and subsequent diagnosis, to prediction-orientated treatment planning, must be made clear. Patient ‘buy in’ is important for successful uptake of clinical interventions, and findings can help to inform future strategies for implementing STarT-Back in the Germany, as well as having potential implications for transferability to other similar healthcare systems.
Background: Electric vehicles have been identified as being a key technology in reducing future emissions and energy consumption in the mobility sector. The focus of this article is to review and assess the energy efficiency and the environmental impact of battery electric cars (BEV), which is the only technical alternative on the market available today to vehicles with internal combustion engine (ICEV). Electricity onboard a car can be provided either by a battery or a fuel cell (FCV). The technical structure of BEV is described, clarifying that it is relatively simple compared to ICEV. Following that, ICEV can be ‘e-converted’ by experienced personnel. Such an e-conversion project generated reality-close data reported here.
Results: Practicability of today's BEV is discussed, revealing that particularly small-size BEVs are useful. This article reports on an e-conversion of a used Smart. Measurements on this car, prior and after conversion, confirmed a fourfold energy efficiency advantage of BEV over ICEV, as supposed in literature. Preliminary energy efficiency data of FCV are reviewed being only slightly lower compared to BEV. However, well-to-wheel efficiency suffers from 47% to 63% energy loss during hydrogen production. With respect to energy efficiency, BEVs are found to represent the only alternative to ICEV. This, however, is only true if the electricity is provided by very efficient power plants or better by renewable energy production. Literature data on energy consumption and greenhouse gas (GHG) emission by ICEV compared to BEV suffer from a 25% underestimation of ICEV-standardized driving cycle numbers in relation to street conditions so far. Literature data available for BEV, on the other hand, were mostly modeled and based on relatively heavy BEV as well as driving conditions, which do not represent the most useful field of BEV operation. Literature data have been compared with measurements based on the converted Smart, revealing a distinct GHG emissions advantage due to the German electricity net conditions, which can be considerably extended by charging electricity from renewable sources. Life cycle carbon footprint of BEV is reviewed based on literature data with emphasis on lithium-ion batteries. Battery life cycle assessment (LCA) data available in literature, so far, vary significantly by a factor of up to 5.6 depending on LCA methodology approach, but also with respect to the battery chemistry. Carbon footprint over 100,000 km calculated for the converted 10-year-old Smart exhibits a possible reduction of over 80% in comparison to the Smart with internal combustion engine.
Conclusion: Findings of the article confirm that the electric car can serve as a suitable instrument towards a much more sustainable future in mobility. This is particularly true for small-size BEV, which is underrepresented in LCA literature data so far. While CO2-LCA of BEV seems to be relatively well known apart from the battery, life cycle impact of BEV in categories other than the global warming potential reveals a complex and still incomplete picture. Since technology of the electric car is of limited complexity with the exception of the battery, used cars can also be converted from combustion to electric. This way, it seems possible to reduce CO2-equivalent emissions by 80% (factor 5 efficiency improvement).
Background: As electric kick scooters, three-wheelers, and passenger cars enter the streets, efficiency trade-offs across vehicle types gain practical relevance for consumers and policy makers. Here, we compile a comprehensive dataset of 428 electric vehicles, including seven vehicle types and information on certified and real-world energy consumption. Regression analysis is applied to quantify trade-offs between energy consumption and other vehicle attributes.
Results: Certified and real-world energy consumption of electric vehicles increase by 60% and 40%, respectively, with each doubling of vehicle mass, but only by 5% with each doubling of rated motor power. These findings hold roughly also for passenger cars whose energy consumption tends to increase 0.6 ± 0.1 kWh/100 km with each 100 kg of vehicle mass. Battery capacity and vehicle mass are closely related. A 10 kWh increase in battery capacity increases the mass of electric cars by 15 kg, their drive range by 40–50 km, and their energy consumption by 0.7–1.0 kWh/100 km. Mass-produced state-of-the-art electric passenger cars are 2.1 ± 0.8 kWh/100 km more efficient than first-generation vehicles, produced at small scale.
Conclusion: Efficiency trade-offs in electric vehicles differ from those in conventional cars—the latter showing a strong dependency of fuel consumption on rated engine power. Mass-related efficiency trade-offs in electric vehicles are large and could be tapped by stimulating mode shift from passenger cars to light electric road vehicles. Electric passenger cars still offer potentials for further efficiency improvements. These could be exploited through a dedicated energy label with battery capacity as utility parameter.
Carbon footprinting of universities worldwide: Part I — objective comparison by standardized metrics
(2021)
Background: Universities, as innovation drivers in science and technology worldwide, should be leading the Great Transformation towards a carbon–neutral society and many have indeed picked up the challenge. However, only a small number of universities worldwide are collecting and publishing their carbon footprints, and some of them have defined zero emission targets. Unfortunately, there is limited consistency between the reported carbon footprints (CFs) because of different analysis methods, different impact measures, and different target definitions by the respective universities.
Results: Comprehensive CF data of 20 universities from around the globe were collected and analysed. Essential factors contributing to the university CF were identified. For the first time, CF data from universities were not only compared. The CF data were also evaluated, partly corrected, and augmented by missing contributions, to improve the consistency and comparability. The CF performance of each university in the respective year is thus homogenized, and measured by means of two metrics: CO2e emissions per capita and per m2 of constructed area. Both metrics vary by one order of magnitude across the different universities in this study. However, we identified ten universities reaching a per capita carbon footprint of lower than or close to 1.0 Mt (metric tons) CO2e/person and year (normalized by the number of people associated with the university), independent from the university’s size. In addition to the aforementioned two metrics, we suggested a new metric expressing the economic efficiency in terms of the CF per $ expenditures and year. We next aggregated the results for all three impact measures, arriving at an overall carbon performance for the respective universities, which we found to be independent of geographical latitude. Instead the per capita measure correlates with the national per capita CFs, and it reaches on average 23% of the national impacts per capita. The three top performing universities are located in Switzerland, Chile, and Germany.
Conclusion: The usual reporting of CO2 emissions is categorized into Scopes 1–3 following the GHG Protocol Corporate Accounting Standard which makes comparison across universities challenging. In this study, we attempted to standardize the CF metrics, allowing us to objectively compare the CF at several universities. From this study, we observed that, almost 30 years after the Earth Summit in Rio de Janeiro (1992), the results are still limited. Only one zero emission university was identified, and hence, the transformation should speed up globally.
Background: Stratified care is an up-to-date treatment approach suggested for patients with back pain in several guidelines. A comprehensively studied stratification instrument is the STarT Back Tool (SBT). It was developed to stratify patients with back pain into three subgroups, according to their risk of persistent disabling symptoms. The primary aim was to analyse the disability differences in patients with back pain 12 months after inclusion according to the subgroups determined at baseline using the German version of the SBT (STarT-G). Moreover, the potential to improve prognosis for disability by adding further predictor variables, an analysis for differences in pain intensity according to the STarT-Classification, and discriminative ability were investigated.
Methods: Data from the control group of a randomized controlled trial were analysed. Trial participants were members of a private medical insurance with a minimum age of 18 and indicated as having persistent back pain. Measurements were made for the risk of back pain chronification using the STarT-G, disability (as primary outcome) and back pain intensity with the Chronic Pain Grade Scale (CPGS), health-related quality of life with the SF-12, psychological distress with the Patient Health Questionnaire-4 (PHQ-4) and physical activity. Analysis of variance (ANOVA), multiple linear regression, and area under the curve (AUC) analysis were conducted.
Results: The mean age of the 294 participants was 53.5 (SD 8.7) years, and 38% were female. The ANOVA for disability and pain showed significant differences (p < 0.01) among the risk groups at 12 months. Post hoc Tukey tests revealed significant differences among all three risk groups for every comparison for both outcomes. AUC for STarT-G’s ability to discriminate reference standard ‘cases’ for chronic pain status at 12 months was 0.79. A prognostic model including the STarT-Classification, the variables global health, and disability at baseline explained 45% of the variance in disability at 12 months.
Conclusions: Disability differences in patients with back pain after a period of 12 months are in accordance with the subgroups determined using the STarT-G at baseline. Results should be confirmed in a study developed with the primary aim to investigate those differences.
Background: The STarT-Back-Approach (STarT: Subgroups for Targeted Treatment) was developed in the UK and has demonstrated clinical and cost effectiveness. Based on the results of a brief questionnaire, patients with low back pain are stratified into three treatment groups. Since the organisation of physiotherapy differs between Germany and the UK, the aim of this study is to explore German physiotherapists’ views and perceptions about implementing the STarT-Back-Approach.
Methods: Three two-hour think-tank workshops with physiotherapists were conducted. Focus groups, using a semi-structured interview guideline, followed a presentation of the STarT-Back-Approach, with discussions audio recorded, transcribed and qualitatively analysed using content analysis.
Results: Nineteen physiotherapists participated (15 female, mean age 41.2 (SD 8.6) years). Three main themes emerged, each with multiple subthemes: 1) the intervention (15 subthemes), 2) the healthcare context (26 subthemes) and 3) individual characteristics (8 subthemes). Therapists’ perceptions of the extent to which the STarT-Back intervention would require changes to their normal clinical practice varied considerably. They felt that within their current healthcare context, there were significant financial disincentives that would discourage German physiotherapists from providing the STarT-Back treatment pathways, such as the early discharge of low-risk patients with supported self-management materials. They also discussed the need for appropriate standardised graduate and post-graduate skills training for German physiotherapists to treat high-risk patients with a combined physical and psychological approach (e.g., communication skills).
Conclusions: Whilst many German physiotherapists are positive about the STarT-Back-Approach, there are a number of substantial barriers to implementing the matched treatment pathways in Germany. These include financial disincentives within the healthcare system to early discharge of low-risk patients. Therapists also highlighted the need for solutions in respect of scalable physiotherapy training to gain skills in combined physical and psychological approaches.