323: Dual-task training for older adults with chronic musculoskeletal pain and frailty: a pilot RCT

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 musculoskeletal pain (CMP) significantly affects the ageing population, compromising physical activity, psychological well-being, cognitive function, and exacerbating frailty.(1) There is a strong association between pain severity and frailty,(2) with a high prevalence of chronic pain in frail older adults.(3)

While exercise can improve physical functions and reduce pain, cognitive impairment—often comorbid with CMP(4,5) and frailty(6)—remains largely unaddressed. This pilot randomised controlled trial (RCT) aims to investigate the effects of dual-task training (DTT), a potentially effective strategy that combines physical and cognitive training, in improving frailty and other health-related outcomes in frail older adults with CMP.

Methods: This was a two-armed, parallel pilot RCT (NCT07035327) involving 38 community-dwelling older adults with CMP and frailty. Participants were randomly assigned to the intervention group, receiving DTT that combined resistance and cognitive training, or the control group, receiving resistance exercises only. Both groups participated in supervised sessions twice weekly for 10 weeks. Primary outcomes included feasibility (targeting a 70% recruitment rate and compliance [≥80% participation in the programme]), acceptability (satisfaction measured at programme completion), and changes in frailty levels before and after the programme. Secondary outcomes included changes in cognitive function, pain level, and health-related quality of life (HRQoL).

Results: Of the 201 individuals screened, 69 were eligible and 38 participants (Median [IQR] age: 67 years [63-72]; 34 female) were successfully recruited (recruitment rate: 55.1%). Among participants, 82.4% in the intervention group (n=17) and 84.2% in the control group (n=19) achieved ≥80% participation in the 10-week programme. Notably, 94.1% of DTT participants (n=17) expressed satisfaction with the programme. Both groups demonstrated significant improvements in frailty levels after interventions (all p<0.05), and the improvements were similar between groups (all p>0.05). No significant effects associated with DTT were observed on cognitive functions, pain intensity, or HRQoL (all p>0.05).

Conclusions: The DTT programme was well accepted by older adults with CMP and frailty, demonstrating satisfactory compliance and a high satisfaction rate. Exploratory findings suggested that DTT may lead to improvements in frailty. However, further investigation with a larger trial is necessary to evaluate the effectiveness of DTT. This should include strategies to enhance recruitment, refinement of eligibility criteria, and modification of outcomes to be more sensitive to changes resulting from the interventions.

References: 1. Blyth FM, Noguchi N. Chronic musculoskeletal pain and its impact on older people. Best Pract Res Clin Rheumatol. 2017;31(2):160-168.
2. Chaplin WJ, McWilliams DF, Millar BS, Gladman JRF, Walsh DA. The bidirectional relationship between chronic joint pain and frailty: data from the Investigating Musculoskeletal Health and Wellbeing cohort. BMC Geriatr. 2023;23(1):273.
3. Otones Reyes P, Garcia Perea E, Pedraz Marcos A. Chronic pain and frailty in community-dwelling older adults: A systematic review. Pain Manag Nurs. 2019;20(4):309-315.
4. Alcon C, Bergman E, Humphrey J, Patel RM, Wang-Price S. The relationship between pain catastrophizing and cognitive function in chronic musculoskeletal pain: A scoping review. Pain Res Manag. 2023;2023:5851450.
5. Chen J, Wang X, Xu Z. The relationship between chronic pain and cognitive impairment in the elderly: A review of current evidence. J Pain Res. 2023;16:2309-2319.
6. Macuco CR, Batistoni SS, Lopes A, et al. Mini-Mental State Examination performance in frail, pre-frail, and non-frail community dwelling older adults in Ermelino Matarazzo, São Paulo, Brazil. Int Psychogeriatr. 2012;24(11):1725-1731.

Presenting Author: Derek King Wai YAU
Submitting Author: Derek King Wai YAU

Senior Author: Derek King Wai YAU

IASP 2026 Global Year theme of Neuropathic Pain: No

• Tin Yeung LEUNG: BSc - The Hong Kong Polytechnic University
• Chun Hin LEE: BSc - The Hong Kong Polytechnic University
• Hui Lok LIU: BSc - The Hong Kong Polytechnic University
• Daphne MA: BSc - The Hong Kong Polytechnic University
• Chun Wing NG: BSc - The Hong Kong Polytechnic University
• Xiaohan ZHOU: MSc, BA - The Hong Kong Polytechnic University