JMIR Publications

ABSTRACT

Background:

Chronic musculoskeletal pain is prevalent and disabling among older adults from underserved communities. Psychosocial pain management is more effective than pharmacological treatment in older adults. However, underserved community clinics often lack psychosocial treatments, in part because of a lack of trained providers. Shared medical appointments, in which patients undergo a brief medical evaluation, monitoring, counseling, and group support, are an efficacious and cost-effective method for chronic disease management in underserved clinics, reducing the need for specialized providers. However, shared medical visits are often ineffective for chronic pain, possibly due to lack of inclusion of skills most relevant for older adults (e.g., pacing to increase engagement in daily activities).

Objective:

To describe the protocol for the development and initial pilot effectiveness testing of the GetActive+ mind-body activity intervention for older adults with chronic musculoskeletal pain. GetActive+ was adapted from GetActive, an evidence-based intervention that improved pain outcomes among mostly affluent white adults. We aim to establish the initial feasibility, acceptability, fidelity, and effectiveness of GetActive+ when delivered as part of shared medical appointments in a community clinic.

Methods:

We conducted qualitative focus groups and individual interviews with providers (N=25) and English-speaking older adults (55+; N=18) with chronic musculoskeletal pain to understand the pain experience in this population, perceptions of intervention content, and barriers and facilitators to intervention participation and implementation in this setting. Qualitative interviews with Spanish-speaking older adults are in progress and will inform a future open pilot of the intervention in Spanish. We are now conducting an open pilot with exit interviews in English. (N=30 individuals total). Primary outcomes are feasibility (≥ 75% of patients approached agree to participate), acceptability (≥ 75% of patients enrolled will complete 8/10 sessions; qualitative), and fidelity (≥ 75% of session components delivered as intended; 20% rated). Secondary outcomes assessed physical function – self-reported, performance-based (6-minute walk test), and objective (step-count) - and emotional function (depression and anxiety). Other assessments include putative mechanisms (e.g., mindfulness, pain catastrophizing, coping, kinesiophobia, and social support).

Results:

We completed the qualitative phase with providers and English-speaking patients, and results are being analyzed using a hybrid inductive-deductive approach. We conducted rapid data analysis of this data to develop GetActive+ prior to the ongoing open pilot in English, including increasing readability and clarity of language, reducing the number of skills taught to encourage time for individual check-ins and group participation, and increasing experiential exercises for skill uptake.

Conclusions:

We provide a blueprint for the refinement of a mind-body activity intervention for the needs of older adults with chronic pain in underserved community clinics and for incorporation within shared medical visits. It will inform a future, fully-powered effectiveness-implementation trial of GetActive+ to help address the chronic pain epidemic among older adults. Clinical Trial: NCT05782231