Impact of Home Exercise Delivery on Compliance & Outcomes for Musculoskeletal Pain

Patients seeking care for their chronic low back or knee pain will be recruited to
participate in a trial investigating the value of different exercise and education
prescription strategies as well as strategies to determine the influence of various exercise
reminder strategies. On day 1 of enrollment, patients will be randomized and instructed in
two different types and amounts of exercises, as well as two types of delivery strategies.
The ability to recall and perform these exercises will be assessed 20 minutes after
completion of the instructional period (retention). In phase 2, patients will be randomized
to receive different reminder strategies (none, email, text, and/or video) and their
compliance assessed over a 1 month period (compliance). Self-reported compliance over the
first month, and health care utilization outcomes will be analyzed for the 1 year following
completion of the 1 month period, in all groups.

Inclusion Criteria:

1. The primary complaint of low back pain or knee pain and is not actively seeking care
for their contralateral knee.

2. The current episode for the injury is 6 weeks or greater

3. A home exercise program is appropriate as part of the management plan for their injury
on the first day

4. Between the age of 18 and 65 years.

5. Own and utilize a smart phone

6. Read and speak English well enough to interact with the smart phone-based tool.

7. Able and willing to come in for follow-up at 1-month.

Exclusion Criteria:

1. History of prior surgery to the lower extremities or spine

2. Already receiving or have received treatment for this episode of pain within the past
6 months.

3. Medical "red flags" of a potentially serious condition including cauda equina
syndrome, major or rapidly progressing neurological deficit, fracture, malignancy,
joint infection, or systemic disease

4. If participating with low back pain, known current pregnancy or history of pregnancy
in the last 6 months

5. Exiting military health system in the next 2 months, pending litigation, or pending a
medical separation board.