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

January 16, 2020 updated by: Dan Rhon

The Impact of Home Exercise Program Delivery Type on Exercise Compliance and Clinical Outcomes for Musculoskeletal Pain

Patients seeking care for chronic low back or knee pain will be recruited for enrollment, and randomized within two phases (retention and compliance). Patients will consent to a 2-step study design, with independent randomization for each. The initial step will assess retention based on 4 different exercise prescription strategies. This will be assessed short-term, and then the 2nd step will consist of a second independent randomization to receive different reminder strategies to determine their influence on exercise compliance at home.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

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.

Study Type

Interventional

Enrollment (Actual)

116

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Texas
      • San Antonio, Texas, United States, 78219
        • Brooke Army Medical Center

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 65 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

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.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Exercise Amount
Phase 1: 2 or 4 exercises.
Other: Number of Exercises
Subjects will receive either 2 or 4 exercises to evaluate the short-term recall and performance.
Other: Type of Instruction
The type of instruction in phase 1 will be compared: Instruction by providing a handout only vs being instructed by a provider and practiced by the patient with provider feedback.
Active Comparator: Type of instruction
Phase 1: Handout on paper versus handout and visual demonstration/performance.
Other: Number of Exercises
Subjects will receive either 2 or 4 exercises to evaluate the short-term recall and performance.
Other: Type of Instruction
The type of instruction in phase 1 will be compared: Instruction by providing a handout only vs being instructed by a provider and practiced by the patient with provider feedback.
Active Comparator: Delivery Type
Phase 2: Handout vs electronic delivery
Other: Delivery Type
In phase 2 subjects will be provided 4 exercises using only a handout vs delivered to them electronically with the addition of a video.
Other: Mobile Reminder
A text-message based mobile reminder tool will be utilized to engage with subjects via texting on a daily basis to provide reminders and encouragement to perform their home exercises.
Experimental: Reminder Type
Phase 2: Mobile reminders vs no mobile reminders
Other: Delivery Type
In phase 2 subjects will be provided 4 exercises using only a handout vs delivered to them electronically with the addition of a video.
Other: Mobile Reminder
A text-message based mobile reminder tool will be utilized to engage with subjects via texting on a daily basis to provide reminders and encouragement to perform their home exercises.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Performance Assessment Tool
Time Frame: 1-month
A locally developed tool designed to meet the needs of assessing both exercise retention and compliance. It will capture the subject's ability to recall the name of an exercise, the prescribed sets and repetitions, and the ability to perform an exercise using a 4-point ordinal scale
1-month
Compliance
Time Frame: 1-month
Subjects will be asked to submit self-reported daily compliance logs.
1-month

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Patient Reported Outcomes Measurement Information Systems (PROMIS) 57 (v2.0)
Time Frame: 1-month
The PROMIS 57-item short form efficiently assesses several outcomes important to patients with chronic low back and knee pain including pain intensity and interference, sleep disturbance, anxiety, depression, fatigue, and social role participation using items developed with rigorous methodology and patient input.
1-month
Patient Acceptable Symptom State (PASS)
Time Frame: 1-month
the PASS as a global, dichotomized single-item score indicating if patients are satisfied with the current state of their symptoms.
1-month
Self-perception on Physical Health and Ability to Return to Work or Full Duty
Time Frame: 1-month
This survey consists of a total of 9 questions, 5 of them modified from the Short Form-36. It asks questions related to the subject's perception of their physical health. The first 5 questions are related to the subject's perception of ability to return to work or full duty, the need for additional healthcare for their current condition, and function at the level that they feel is expected of them. The final 4 questions ask about their perception of general physical health.
1-month

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Dan Rhon

Investigators

  • Principal Investigator: Daniel Rhon, DSc, Brooke Army Medical Center

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 12, 2018

Primary Completion (Actual)

June 30, 2019

Study Completion (Actual)

November 30, 2019

Study Registration Dates

First Submitted

February 7, 2018

First Submitted That Met QC Criteria

March 19, 2018

First Posted (Actual)

March 20, 2018

Study Record Updates

Last Update Posted (Actual)

January 18, 2020

Last Update Submitted That Met QC Criteria

January 16, 2020

Last Verified

January 1, 2020

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • C.2017.093d

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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