Tracking Physical Activity for Chronic Pain Management Among Older Adults in Detroit

Study Overview
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Brief Summary
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Wearable, commercially-available physical activity monitors are being increasingly incorporated into chronic pain self-management interventions as a tool to help patients set goals and to tailor intervention content based on patient progress. Yet older adults from resource-challenged communities may face significant barriers to using these monitors and reporting activity data. Our pilot study will focus on wearable monitor use among older adults in Detroit with chronic musculoskeletal pain, testing the feasibility and validity of various technology-based strategies for reporting daily step count data. The study will also assess whether six weeks of monitor use is associated with improvements in functioning, relative to a control group.

Official Title
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Promoting Physical Activity for Chronic Pain Management Among Older Adults in Detroit: Comparing Technology-Based Strategies

Conditions
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Chronic Pain

Intervention / Treatment
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* Behavioral: STEPS Intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age > 60 years Ambulatory with or without assistive device Community living Have a SMS-capable cell phone Internet access (via smartphone, in-home or elsewhere); Self-reported chronic musculoskeletal pain (pain in muscles or joints for > 3 months) >4 (0-10 scale) average pain level over last week >1 day/previous 30 when pain made it difficult to do usual activities Ability to travel to study location in Detroit for a one-time session Exclusion criteria: Serious acute illness or hospitalization in last month Planned surgery in next month Severe cognitive impairment

Ages Eligible for Study
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Minimum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: STEPS Intervention Group<br>Participants will receive a wearable physical activity monitor and will be asked to report their daily step count in 3 different ways (2 weeks each of SMS text messages, Interactive Voice Response calls (IVR), automatic upload) during the 6-week study period. | Behavioral: STEPS Intervention<br>* Participants in the STEPS (Seniors Tracking Exercise for Pain Self-management) intervention will receive a commercially-available, wearable physical activity monitor. They will be asked to wear this monitor during waking hours for 6 weeks, reporting their daily step count every evening. The way in which participants report steps will change every 2 weeks. For the first 4 weeks of the study, participants will report via Interactive Voice Response (IVR) calls for 2 weeks and SMS text messages for 2 weeks. For the final two week period, research staff will help participants to set up the monitor to automatically send daily step counts to STEPS project staff. This can be done through a smartphone, tablet, or computer.<br>|
| No Intervention: STEPS Control Group<br>Participants in this group will not receive a wearable physical activity monitor and will not be asked to report their step count. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Pain Interference | The Patient-Reported Outcomes Measurement Information System (PROMIS-29) Pain Interference 4-item subscale, where a higher score indicates more pain interference. Items ask how much pain in the last 7 days has interfered with daily activities such as household chores and social activities (1=not at all to 5=very much). Raw scores are converted to T-scores (normed such that a score of 50 is the population mean and 10 T-score points=1 standard deviation). The possible range is 42 to 76, with a higher score representing worse outcome. | Baseline, eight weeks | 
| Adherence to Step Count Reporting - SMS | Proportion of days that step count was successfully provided/possible reporting days for SMS | Two weeks | 
| Adherence to Step Count Reporting - IVR | Proportion of days that step count was successfully provided/possible reporting days for IVR. | two weeks | 
| Adherence to Step Count Reporting - Sync | Proportion of days that step count was successfully provided/possible reporting days for syncing with app | two weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Physical Functioning | The Physical Functioning 4-item subscale of the Patient-Reported Outcomes Measurement Information System (PROMIS)-29 Adult Profile. Items ask how much difficulty participant has in doing daily activities such as household chores, using stairs, and walking 15 minutes (1=without any difficulty to 5=unable to do); raw total scale scores range from 4 (high functioning) to 20 (low functioning). When converted to T-scores (normed such that a score of 50 is the population mean and 10 T-score points=1 standard deviation), the possible range is 23 to 57, with a higher score representing worse outcome. | Baseline, eight weeks | 
| Change in Social Participation | Ability to Participate in Social Roles and Activities, a 4-item subscale from PROMIS-20 rating the amount of trouble (1=not at all to 5=very much) in participating in social roles such as family activities, leisure activities, and work. Raw total scale scores range from 4 (high functioning) to 20 (low functioning). When converted to T-scores (normed such that a score of 50 is the population mean and 10 T-score points=1 standard deviation), the possible range is 29 to 64, with a higher score representing worse outcome. | Baseline, eight weeks | 
| Validity of Manually-reported Step Count Data - SMS | Correlation of manually-reported SMS data with automatically uploaded data - percentage of days that counts are within 50 steps of each other | Two weeks | 
| Validity of Manually Reported Step Count Data - IVR | Correlation of manually-reported SMS data with automatically uploaded data - percentage of days that counts are within 50 steps of each other | Two weeks |