299: Principles to Tailor Exercise Interventions for Chronic Knee Pain in Older Adults With Dementia.

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Non-pharmacological treatments, Physiotherapy (e.g. exercise, rehab), Pain in special populations (e.g. neonates, children, teens, elderly, neurodegenerative diseases)

Background and Aims: Chronic knee pain is prevalent among community-dwelling older adults, is associated with poor quality of life, and can be further complicated by cognitive impairment, including dementia.1 Physical activity is a recommended first-line treatment; however, existing programs often lack the unique cognitive, behavioral, and environmental considerations of this population, limiting engagement and feasibility.2,3 While clinicians often manage chronic pain in people living with dementia (PLWD), there remains a lack of structured, evidence-informed guidance for adapting physical activity interventions for this group.4,5 Accordingly, there is a need to define program principles to support the development of interventions tailored to individuals’ interests and preserved physical and cognitive abilities, while leveraging empirical knowledge and clinical expertise.6 The aim of this study is to identify key principles for a tailored physical activity program to manage knee pain in PLWD, informed by clinicians and individuals with lived experience (PLWD and care partners).

Methods: A qualitative study using semi-structured interviews and focus groups was conducted with interdisciplinary clinicians (n = 16; four focus groups), PLWD with mild dementia and chronic knee pain (n = 20; 10 dyads and 10 individual interviews), and care partners (n = 16; 10 dyads and six individual interviews). Interviews explored perceptions of physical activity in the context of chronic knee pain and dementia, including their intersection; determinants of participation; ideal interventionist characteristics and expertise; and considerations for program design and delivery. All sessions were recorded, transcribed verbatim, and analyzed using content analysis. Coding was conducted iteratively by multiple researchers, with discrepancies resolved through discussion. Identified themes were refined with empirical literature and behavioral intervention development framework (i.e., Intervention Mapping). Input from a community advisory board, including interdisciplinary clinicians and individuals with lived experience, contributed to interpretation and refinement of findings.

Results: Overarching themes included: Prioritizing mobility, function, pain coping, and safety and tailored approached and delivery. Refinement of the themes with empirical literature and advisory board yielded nine principles: (1) Person-centered assessment and care planning, including comprehensive biopsychosocial evaluation, functional goal setting, individualized design, and iterative reassessments; (2) Prioritizing functional mobility, with success defined by meaningful activity participation rather than pain reduction alone; (3) Delivering progressive physical activity dosing (≥150 minutes/week) across clinic and home programming; (4) Leveraging preferred and meaningful activities to enhance program engagement; (5) Calibrating delivery to cognitive ability using simplified cueing, demonstration, task adaptation, environmental consistency, and caregiver involvement; (6) Integrating behavioral strategies to support motivation, habit formation, and shared decision-making.; (7) Applying a multimodal, holistic approach combining physical, cognitive, and lifestyle interventions with supportive education; (8) Optimizing environments for safety and participation; and (9) Empowering PLWD and care partners through education, self-management strategies, and support.

Conclusions: This study identified nine key program principles to guide the development of tailored exercise programs for community-dwelling older adults with chronic knee pain and cognitive impairment, derived from stakeholder input and empirical literature. These findings align with the BioPsychoSocial-Environmental framework3 at the intersection of chronic pain, dementia, care practices, and expertise of a licensed physical therapist. The principles can be operationalized into intervention sessions to support delivery of and access to evidence-informed, person-centered care that integrates care partner involvement and behavioral strategies to enhance engagement and sustainability of physical activity. Such approaches may support not only pain and cognitive health, but also management of multimorbidity (e.g., cardiovascular disease, diabetes) and maintenance or improvement of functional ability.7 These principles provide a foundation for developing feasible, acceptable, and scalable nonpharmacological interventions for pain management in PLWD that should be evaluated in future research.

References: 1. Hunt LJ, Covinsky KE, Yaffe K, et al. Pain in Community-Dwelling Older Adults with Dementia: Results from the National Health and Aging Trends Study. J Am Geriatr Soc 2015;63(8):1503–11. DOI: 10.1111/jgs.13536.
2. American Geriatrics Society Panel on E, Osteoarthritis. Exercise prescription for older adults with osteoarthritis pain: consensus practice recommendations. A supplement to the AGS Clinical Practice Guidelines on the management of chronic pain in older adults. J Am Geriatr Soc 2001;49(6):808–23. DOI: 10.1046/j.1532-5415.2001.00496.x.
3. Na A, Bradt J, Gliebus GP, Fritz JA, Gitlin L. Exercise-Based Pain Interventions for People with Dementia Using a Biopsychosocial-Environmental (BPSE) Model. Curr Geriatr Rep 2025;14(1):23. DOI: 10.1007/s13670-025-00450-1.
4. Coronado RA, Albers HE, Allen JL, et al. Pain-Reducing Effects of Physical Therapist-Delivered Interventions: A Systematic Review of Randomized Trials Among Older Adults With Dementia. J Geriatr Phys Ther 2020;43(3):159–169. DOI: 10.1519/JPT.0000000000000235.
5. Na A, Sefcik JS, Gitlin LN. Nonpharmacological Pain Management for People With Dementia: A Scoping Review Mapping Research Gaps From a Pragmatic Lens. J Am Geriatr Soc 2025;73(7):2247–2261. DOI: 10.1111/jgs.19418.
6. Gitlin LN, Czaja SJ. Behavioral Intervention Research: Designing, Evaluating, and Implementing. New York, NY: Springer Publishing Company, 2016.
7. Lassell RKF, Pritchard K, Baehr LA, et al. New horizons in advancing lifestyle medicine for older adults utilizing a transdisciplinary approach: gaps and opportunities. Age Ageing 2025;54(6). DOI: 10.1093/ageing/afaf159.

Presenting Author: Annalisa Na
Submitting Author: Annalisa Na

Senior Author: Joke Bradt

IASP 2026 Global Year theme of Neuropathic Pain: No

• Annalisa Na: PT, DPT, PhD - Drexel University
• Laura N. Gitlin: PhD - Drexel University
• Julie Fritz: PT, PhD - University of Utah
• G. Peter Gliebus: MD - Marcus Neuroscience Institute
• Joke Bradt: PhD - Drexel University