The purpose of this research study is to study four treatments for chronic low-back pain to learn whether or not certain treatments work better for people with certain characteristics.The study's main goal is to find a way to match treatments to low-back pain patients based on their characteristics and how they responded to treatments they have used before.

This study is a multi-site, sequential, multiple assignment randomized trial (SMART) designed to meet the primary objective of estimating an algorithm for optimally assigning evidence-based interventions for chronic low-back pain. The trial is based on an individual patient's phenotypic markers and response to treatment. Interventions being evaluated in this trial are: (1) acceptance and commitment therapy (ACT), (2) duloxetine, (3) enhanced self-care (ESC), and (4) evidence-based exercise and manual therapy (EBEM).

Research shows that exercising at home can improve arm and hand movement after a stroke. Unfortunately, it can be hard to exercise enough to make a difference in arm and hand movement after stroke. In this study, we will try to determine things that make it easy or hard to exercise the arm and hand after a stroke. In this study, we will recruit stroke survivors who are in therapy for arm and hand rehabilitation. First, we will administer surveys and questionnaires to get stroke survivors' perspectives on their self-confidence, mood, sleep, and more. Then, we will ask them to track their baseline upper extremity activity for approximately 3 days. At a 2nd visit, we will instruct participants in a home exercise program and ask them to complete the home exercise program daily for 7 days. Then, stroke survivors will meet with a researcher to talk about their experience doing home exercise and why they think it was easy or hard to do.