Preliminary Use and Outcome Data of a Digital Home Exercise Program for Back, Hip, and Knee Pain: Retrospective Observational Study With a Time Series and Matched Analysis

Background: Musculoskeletal conditions are among the main contributors to the global burden of disease. International
guidelines consider patient education and movement exercises as the preferred therapeutic option for unspecific and degenerative
musculoskeletal conditions. Innovative and decentralized therapeutic means are required to provide access to and availability of
such care to meet the increasing therapeutic demand for this spectrum of conditions.
Objective: This retrospective observational study of preliminary use and outcome data explores the clinical outcomes of Vivira
(hereafter referred to as “program”), a smartphone-based program for unspecific and degenerative pain in the back, hip, and knee
before it received regulatory approval for use in the German statutory health insurance system.
Methods: An incomplete matched block design was employed to assess pain score changes over the intended 12-week duration
of the program. Post hoc analyses were performed. In addition, a matched comparison of self-reported functional scores and
adherence rates is presented.
Results: A total of 2517 participants met the inclusion criteria and provided sufficient data to be included in the analyses.
Overall, initial self-reported pain scores decreased significantly from an average of 5.19 out of 10 (SD 1.96) to an average of
3.35 out of 10 (SD 2.38) after 12 weeks. Post hoc analyses indicate a particularly emphasized pain score reduction over the early
use phases. Additionally, participants with back pain showed significant improvements in strength and mobility scores, whereas
participants with hip or knee pain demonstrated significant improvements in their coordination scores. Across all pain areas and
pain durations, a high yet expected attrition rate could be observed.
Conclusions: This observational study provides the first insights into the clinical outcomes of an exercise program for unspecific
and degenerative back, hip, and knee pain. Furthermore, it demonstrates a potential secondary benefit of improved functionality
(ie, strength, mobility, coordination). However, as this study lacks confirmatory power, further research is required to substantiate
the clinical outcomes of the program assessed.
Trial Registration: German Clinical Trials Register DRKS00021785; https://drks.de/search/en/trial/DRKS00021785