Managing Pain and Cognitions in Older Adults With Mild Cognitive Impairment or Memory Related Problems and Chronic Pain

Study Overview
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Brief Summary
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We aim to conduct a pilot randomized controlled trial comparing 2 symptom management programs for older adults with self-reported memory problems and chronic pain, Active Brains 1 and Active Brains 2. We will assess how each program may help in improving coping with pain and coping with cognitive functioning. We will explore feasibility, acceptability, and credibility and within group changes in physical, emotional and cognitive functioning.

Detailed Description
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We aim to conduct a pilot randomized controlled trial comparing 2 symptom management programs for older adults with self-reported memory problems and chronic pain: Active Brains 1 Active Brains 2. We will assess how each program may help in improving coping with pain and coping with cognitive functioning. We will explore feasibility, acceptability, and credibility and within group changes in physical, emotional and cognitive functioning. Each group meets for 8 90 minute sessions over a secure video platform. Each group has 5-8 participants. Participants receive a treatment manual. There are 2 assessment points: baseline, and post program. Assessments involve questionnaires, a walk test, and objective step count with ActiGraphs for 1 week.

Official Title
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Active Brains: Managing Pain and Cognitions in Older Adults With Mild Cognitive Impairment (MCI) or Memory Related Problems (MRP) and Chronic Pain

Conditions
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Chronic Pain, Mild Cognitive Impairment, Older Adults, Physical Activity

Intervention / Treatment
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* Behavioral: Active Brains 1
* Behavioral: Active Brains 2


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male and female patients, age 60 years or older Have nonmalignant chronic pain for more than 3 months Has MCI or subjective memory related problems Able to perform a 6-minute walk test at an accelerated pace Owns a smartphone with Bluetooth 4.0 Willingness and ability to participate in the Active Brains intervention and to comply with the requirements of the study protocol (including weekly sessions and Fitbit use) Free of concurrent psychotropic or pain medication for at least 2 weeks prior to initiation of treatment, OR stable on current psychotropic or pain medication for a minimum of 6 weeks and willing to maintain a stable dose Cleared by a medical doctor for study participation Leads a sedentary lifestyle Exclusion Criteria: Diagnosed with medical illness expected to worsen in the next 6 months Serious mental illness or instability for which hospitalization may be likely in the next 6 months Current suicidal ideation reported on self-report Lifetime history of schizophrenia, bipolar disorder, or other psychotic disorder, or substance dependence Current substance use disorder, within the past 6 months Practice of yoga/meditation, or other mind-body techniques that elicit the relaxation response, once per week for 45 minutes or more within the last 3 months or less Regular use of Fitbit in the last 3 months Engagement in regular intensive physical exercise for >30 minute daily Unable to walk without use of assistance (e.g., wheelchair, walker)

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: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Active Brains<br>Active Brains uses a multimodal approach to introduce and reinforce new skills, including didactics, in-session activities, discussions, and weekly practice assignments (homework). The Active Brains sessions reflect a purposeful integration of the three treatment approaches (relaxation methods, stress appraisal & coping, and growth enhancement). The format is an 8-week program with weekly meetings and a focus on relaxation response strategies, cognitive behavioral training, positive psychology and mind-body interactions. Active Brains 1 uses a digital monitoring device (i.e., Fitbit) for recording of physical activity. | Behavioral: Active Brains 1<br>* Active Brains uses a multimodal approach to introduce and reinforce new skills, including didactics, in-session activities, discussions, and weekly practice assignments (homework). The Active Brains sessions reflect a purposeful integration of the three treatment approaches (relaxation methods, stress appraisal & coping, and growth enhancement). The format is an 8-week program with weekly meetings and a focus on relaxation response strategies, cognitive behavioral training, positive psychology and mind-body interactions. Active Brains 1 uses a digital monitoring device (i.e., Fitbit) for recording of physical activity.<br>Behavioral: Active Brains 2<br>* This active comparison condition controls for the effect of time spent, group member support/feedback, and interventionist support/feedback. The original HEP was adapted to provide population-specific information on chronic pain and MCI/MRP symptoms. Participants also receive lifestyle education consistent from public health recommendations and standards for health promotion (e.g., Sleep, Nutrition, Healthy Weight, and Medical appointments). The HEP program consists on 8 group sessions (each session is 90 minutes) that occur concurrently with the active intervention condition. The HEP is conducted in the same format as Active Brains-Fitbit but are not taught the mind-body, walking, or cognitive-behavioral skills. HEP participants are encouraged to set lifestyle goals instead of quota-based walking goals aided by the Fitbit as in the Active Brains-Fitbit condition.<br>|
| Placebo Comparator: Active Brains 2<br>This active comparison condition controls for the effect of time spent, group member support/feedback, and interventionist support/feedback. The original HEP was adapted to provide population-specific information on chronic pain and MCI/MRP symptoms. Participants also receive lifestyle education consistent from public health recommendations and standards for health promotion (e.g., Sleep, Nutrition, Healthy Weight, and Medical appointments). The HEP program consists on 8 group sessions (each session is 90 minutes) that occur concurrently with the active intervention condition. The HEP is conducted in the same format as Active Brains-Fitbit but are not taught the mind-body, walking, or cognitive-behavioral skills. HEP participants are encouraged to set lifestyle goals instead of quota-based walking goals aided by the Fitbit as in the Active Brains-Fitbit condition. | Behavioral: Active Brains 1<br>* Active Brains uses a multimodal approach to introduce and reinforce new skills, including didactics, in-session activities, discussions, and weekly practice assignments (homework). The Active Brains sessions reflect a purposeful integration of the three treatment approaches (relaxation methods, stress appraisal & coping, and growth enhancement). The format is an 8-week program with weekly meetings and a focus on relaxation response strategies, cognitive behavioral training, positive psychology and mind-body interactions. Active Brains 1 uses a digital monitoring device (i.e., Fitbit) for recording of physical activity.<br>Behavioral: Active Brains 2<br>* This active comparison condition controls for the effect of time spent, group member support/feedback, and interventionist support/feedback. The original HEP was adapted to provide population-specific information on chronic pain and MCI/MRP symptoms. Participants also receive lifestyle education consistent from public health recommendations and standards for health promotion (e.g., Sleep, Nutrition, Healthy Weight, and Medical appointments). The HEP program consists on 8 group sessions (each session is 90 minutes) that occur concurrently with the active intervention condition. The HEP is conducted in the same format as Active Brains-Fitbit but are not taught the mind-body, walking, or cognitive-behavioral skills. HEP participants are encouraged to set lifestyle goals instead of quota-based walking goals aided by the Fitbit as in the Active Brains-Fitbit condition.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Client Satisfaction Questionnaire 3-Item (CSQ-3): Number of Participants With Scores Above and Below Scale Midpoint | Items are summed to generate a total score; scores range from 3 to 12, with higher values indicating higher satisfaction | 8 Weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of Participants With Valid Digital Monitoring Device Wear | The proportion of patients with valid ActiGraph (digital monitoring device) wear for greater than or equal to 6 days (7+ hr/day) at baseline and 5 days at post test | 0 Weeks, 8 Weeks | 
| Proportion of Participants With Valid Adherence to Homework | Proportion of participants completing at least 5 out of 7 days of homework assigned throughout the study | 0 Weeks, 8 Weeks | 
| Rate of Interventionist's Delivering the Programs by Following the Established Session Topics and Skills | Percentage of audio recordings, progress notes, and checklists that were completed with 100% of content delivered for each session | 0 Weeks, 8 Weeks | 
| Percentage of Missing or Low Reliability Measures (Feasibility of Quantitative Measures) | Percentage of questionnaires that were entirely missing in >25% of participants and/or had an internal reliability below .70 | 0 Weeks, 8 Weeks | 
| Proportion of Participants Using Rescue (Non-Narcotic) Analgesics | Single-item question on demographics form indicating whether participant used rescue (non-narcotic) analgesics at baseline | 0 Weeks | 
| Proportion of Participants Using Narcotic Analgesics | Single-item question on demographics form indicating whether participant used narcotic analgesics at baseline | 0 Weeks | 
| Credibility and Expectancy Questionnaire (CEQ): Number of Participants With Scores Above and Below Scale Midpoint | Number of participants rating expectations and believed credibility for the program above and below the scale midpoint, with higher ratings indicating more belief that the program is logical and will help with the intended outcome | 0 Weeks | 
| Montreal Cognitive Assessment (MoCA) | Assesses several cognitive domains and detection of mild cognitive impairment (MCI), with scores ranging from 0-30 and lower scores indicating greater cognitive decline | 0 Weeks, 8 Weeks | 
| Godin Leisure-Time Exercise Questionnaire | Rate of participant's leisure time and physical activity levels by indicating how many days per week are spent doing the activity for more than 15 minutes. Scores range from 0-119, with higher scores indicating greater levels of activity. | 0 Weeks, 8 Weeks | 
| Measure of Current Status (MOCS-A) | Rate of a participant's self-reported perceived stress self-management skills, with items ranging from 0-4 and a total score ranging from 0-52, and higher scores reflecting more usage of stress self-management skills | 0 Weeks, 8 Weeks | 
| The Measurement of Everyday Cognition (eCog) | Rate of participant's cognitively mediated functional abilities, with items ranging from 1-5. Total scores are an average of the items (range = 1-5), with higher scores indicating greater cognitive decline. | 0 Weeks, 8 Weeks | 
| Numerical Rating Scale | Rate of a participant's pain at rest and with activity using a Likert scale with 0 being no pain and 10 being the worst possible pain | 0 Weeks, 8 Weeks | 
| The Cognitive and Affective Mindfulness Scale - Revised (CAMS-R) | Rate of a participant's broad conceptualization of mindfulness, items range from 1-4 and scores range from 12-48, with higher values reflecting higher levels of mindfulness | 0 Weeks, 8 Weeks | 
| WHO Disability Assessment Schedule 2.0 | Rate of a participant's health and disability, with items ranging from 0-4, total scores ranging from 0-100, and higher scores reflecting greater disability | 0 Weeks, 8 Weeks | 
| The Gratitude Questionnaire (GQ-6) | Rate of a participant's proneness to experience gratitude in daily life, with items ranging from 1-7, total scores ranging from 6-24, and a higher score indicating greater amount of gratitude | 0 Weeks, 8 Weeks | 
| PROMIS Physical Function | Rate of a participant's capability rather than performance of physical activities, with items ranging from 1-4, and total scores ranging from 8-40, with a higher score reflecting greater physical function | 0 Weeks, 8 Weeks | 
| PROMIS Emotional Support | Rate of a participant's perceived feelings of being cared and values for as an individual, with items ranging from 1-5. Items are normed to T-scores (mean = 50, standard deviation = 10), with higher T-scores indicating higher perceived social support. | 0 Weeks, 8 Weeks | 
| T-Score for PROMIS Depression | Rate of a participant's depressive symptoms, with items ranging from 1-5. Items are normed to T-scores (mean = 50, standard deviation = 10), with higher T-scores indicating higher depression. | 0 Weeks, 8 Weeks | 
| T-Score for PROMIS Anxiety | Rate of a participant's fear, anxious, hyper arousal, and somatic symptoms pertaining to arousal. Items are normed to T-scores (mean = 50, standard deviation = 10), with higher T-scores indicating higher anxiety. | 0 Weeks, 8 Weeks | 
| Pain Catastrophizing Scale (PCS) | Rate of a participant's pain experience, with items ranging from 0-4, and total scores ranging from 0-52, with higher scores indicating higher levels of pain catastrophizing | 0 Weeks, 8 Weeks | 
| UCLA Loneliness Scale | Rate of a participant's feelings of loneliness and social isolation and items range from 0-3, with a higher score reflecting greater feelings of loneliness, with total scores ranging from 0-24 | 0 Weeks, 8 Weeks | 
| Pain Self Efficacy Questionnaire (PSEQ) | Rate of a participant's confidence to do various activities despite their pain, with items ranging from 0-6, and a higher score showing greater levels of confidence with pain self-efficacy, with total scores ranging from 0-60 | 0 Weeks, 8 Weeks | 
| Tampa Kinesiophobia Scale | Rate of a participant's fear of movement, with items ranging from 1-4, and a total scores ranging from 17-68, and higher scores indicating higher levels of fear of movement | 0 Weeks, 8 Weeks | 
| Chronic Pain Acceptance Questionnaire | Rate of a participant's acceptance of chronic pain, with scores ranging from 0-6, with the total score ranging from 0-48, and higher scores indicating higher levels of acceptance of chronic pain | 0 Weeks, 8 Weeks | 
| Self-Compassion Scale (SCS) | Rate of a participant's amount of self-compassion, with items ranging from 1-5, and total scores ranging from 12-60 and higher scores indicating higher levels of self-compassion | 0 Weeks, 8 Weeks | 
| ActiGraph Average Steps | Participants wore a ActiGraph accelerometer around their waist for 8 days to measure their daily average step count. | 0 weeks, 8 weeks | 
| Six-Minute Walk Test (6MWT) | The Six-Minute Walk Test (6MWT) measures the distances participants can walk at an accelerated pace in meters over a 6-minute span. | 0 weeks, 8 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Chronic Pain, Mild Cognitive Impairment, Older Adults, Physical Activity, Memory Related Problems