A behavioral medicine intervention for community-dwelling older adults with chronic musculoskeletal pain: protocol for a randomized controlled trial

Abstract

Background

Chronic musculoskeletal pain is a major health problem among older adults, particularly those who live alone and/or those who are dependent on formal care. Chronic pain is associated with mobility problems, falls, fear of falling, catastrophizing thoughts, and a lower quality of life. Research shows that physical therapy interventions based on behavioral medicine approaches are beneficial for middle-aged adults with chronic pain. However, there appears to be no previous randomized controlled trials (RCTs) based on this theoretical framework that have examined the effect on older adults with chronic musculoskeletal pain who live alone at home and are dependent on formal care to manage their everyday lives. The aim of the planned study is to evaluate the effect of an individually tailored integrated physical therapy intervention based on a behavioral medicine approach compared with the effect of standard care.

Methods/design

The planned study is an RCT that will include one intervention and one control group involving a total of 150 adults aged ≥75 years with chronic musculoskeletal pain who live alone at home and are dependent on formal care to manage their everyday lives. The intervention will involve a 12-week home-based individually tailored intervention that will be designed to enhance the participants’ ability to perform everyday activities by improving physical function and reducing pain-related disability and beliefs. The control group will be given standard care, including general advice about physical activity. The participants will be assessed at baseline and at 3 and 6 months after baseline. The primary outcome will be pain-related disability and physical performance.

Discussion

The intervention, if effective, will have the potential to be the basis of the first evidence-based guidelines for physical therapists who work with older adults with chronic musculoskeletal pain.

Keywords:

• fall
• fear of falling
• independence
• physical activity
• self-efficacy
• quality of life

Acknowledgments

The authors thank Professor Are Pripp for help with the randomization plan and the calculation of the sample size for the study.

The study is funded by the Norwegian Physical Therapist Association. The funders have had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author contributions

SC conceived of the study. SC, ED, and AB participated in the design of the study. SC, together with a statistician, calculated the required sample size, and SC, ED, and AB developed the plan for the statistical analysis of the trial outcomes. SC will be responsible for the trial management, recruitment, and data collection. SC drafted the manuscript with contributions from all the other authors. All the authors have read and approved the final manuscript.

Disclosure

The authors report no conflicts of interest in this work.