{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:53:21Z","timestamp":1792000401814,"version":"4.4.0"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"InControl project","award":["COMPETE2030-FEDER-00781500;2023.17304.ICDT;https:\/\/doi.org\/10.54499\/2023.17304.ICDT"],"award-info":[{"award-number":["COMPETE2030-FEDER-00781500;2023.17304.ICDT;https:\/\/doi.org\/10.54499\/2023.17304.ICDT"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic musculoskeletal pain is highly prevalent among older adults and is associated with disability, reduced physical activity, and decreased quality of life. Digital health interventions can improve access to care and support pain self-management. InControl is a user-centered web-based platform that combines exercise and pain science education. The aim of this pilot study is to assess the usability and acceptability of the InControl platform and the feasibility of the research methods. This will help inform methodological improvements in the design of a future randomized controlled trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A randomized, parallel-group, mixed-methods pilot study will be conducted with two groups: usual care group and the InControl intervention. Thirty-four participants aged 60 years or older with chronic musculoskeletal pain will be recruited at the Local Health Unit of Aveiro Region. The InControl intervention will last 8 weeks and will combine in-person sessions with remote interventions. Feasibility will be assessed using indicators of recruitment, retention, adherence, refusal, and dropout rates. Usability will be measured using the System Usability Scale, while acceptability and appropriateness will be assessed through a questionnaire and semi-structured interviews. Secondary outcomes will include pain, physical function, psychological factors, quality of life, and cognitive function. Data will be analyzed using descriptive statistics and qualitative thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The findings will inform the design of a future large-scale randomized controlled trial and contribute to the development of more effective digital interventions tailored to the needs of older adults with chronic musculoskeletal pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      This study is registered on clinicaltrials.gov, NCT07774416 (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT07774416?tab=study\" xlink:type=\"simple\">https:\/\/clinicaltrials.gov\/study\/NCT07774416?tab=study<\/jats:ext-link>\n                      ), August 18, 2026.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0360321","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:27:07Z","timestamp":1791998827000},"page":"e0360321","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Feasibility, acceptability and usability of InControl web-platform intervention for older adults with chronic musculoskeletal pain: A mixed-methods pilot study protocol"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6650-4748","authenticated-orcid":true,"given":"David","family":"Oliveira","sequence":"first","affiliation":[{"name":"University of Aveiro","place":["Aveiro, Portugal"],"department":["School of Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3801-7249","authenticated-orcid":true,"given":"Nelson P.","family":"Rocha","sequence":"additional","affiliation":[{"name":"Institute of Electronics and Informatics Engineering of Aveiro (IEETA), University of Aveiro","place":["Aveiro, Portugal"],"department":["Department of Medical Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anabela G.","family":"Silva","sequence":"additional","affiliation":[{"name":"University of Aveiro","place":["Aveiro, Portugal"],"department":["RISE-HEALTH, School of Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"key":"pone.0360321.ref001","doi-asserted-by":"crossref","DOI":"10.18356\/9789210019682","volume-title":"World Social Report 2023: Leaving No One Behind in an Ageing World","author":"United Nations Department of Economic and Social Affairs","year":"2023"},{"key":"pone.0360321.ref002","unstructured":"Instituto Nacional de Estat\u00edstica. Proje\u00e7\u00f5es de Popula\u00e7\u00e3o Residente em Portugal. 2025. https:\/\/www.ine.pt\/xportal\/xmain?xpid=INE&xpgid=ine_destaques&DESTAQUESdest_boui=707257343&DESTAQUESmodo=2"},{"key":"pone.0360321.ref003","doi-asserted-by":"crossref","first-page":"111233","DOI":"10.1016\/j.jpsychores.2023.111233","article-title":"Increasing pain prevalence and intensity among middle-aged and older adults: Evidence from the German Ageing Survey","volume":"168","author":"M Wettstein","year":"2023","journal-title":"J Psychosom Res"},{"key":"pone.0360321.ref004","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/j.pnpbp.2019.04.006","article-title":"The silent epidemic of chronic pain in older adults","volume":"93","author":"AF Domenichiello","year":"2019","journal-title":"Prog Neuropsychopharmacol Biol Psychiatry"},{"issue":"4","key":"pone.0360321.ref005","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1093\/pm\/pny112","article-title":"Association between objectively measured physical activity and the number of chronic musculoskeletal pain sites in community-dwelling older adults","volume":"20","author":"S Murata","year":"2019","journal-title":"Pain Med"},{"issue":"5","key":"pone.0360321.ref006","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1016\/j.mcna.2020.05.002","article-title":"Musculoskeletal pain in older adults","volume":"104","author":"TP Welsh","year":"2020","journal-title":"Medical Clinics of North America"},{"issue":"1","key":"pone.0360321.ref007","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1186\/s12877-024-04669-z","article-title":"Determinants of health-related quality of life in older people with chronic musculoskeletal pain: A cross-sectional study","volume":"24","author":"HP-Y Fong","year":"2024","journal-title":"BMC Geriatr"},{"issue":"10289","key":"pone.0360321.ref008","doi-asserted-by":"crossref","first-page":"2082","DOI":"10.1016\/S0140-6736(21)00393-7","article-title":"Chronic pain: An update on burden, best practices, and new advances","volume":"397","author":"SP Cohen","year":"2021","journal-title":"Lancet"},{"key":"pone.0360321.ref009","doi-asserted-by":"crossref","first-page":"1657014","DOI":"10.3389\/fpain.2025.1657014","article-title":"Effectiveness of digital pain management for older adults with musculoskeletal pain: Systematic review with meta-analysis","volume":"6","author":"AG Silva","year":"2025","journal-title":"Front Pain Res (Lausanne)"},{"issue":"9","key":"pone.0360321.ref010","doi-asserted-by":"crossref","DOI":"10.2196\/37869","article-title":"Digital health interventions for musculoskeletal pain conditions: Systematic review and meta-analysis of randomized controlled trials","volume":"24","author":"PP Valentijn","year":"2022","journal-title":"J Med Internet Res"},{"issue":"1","key":"pone.0360321.ref011","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1177\/2049463720976155","article-title":"Evidence-based clinical practice guidelines on the management of pain in older people - A summary report","volume":"16","author":"P Schofield","year":"2022","journal-title":"Br J Pain"},{"key":"pone.0360321.ref012","article-title":"Management of chronic pain in older adults","volume":"350","author":"MC Reid","year":"2015","journal-title":"BMJ"},{"issue":"4","key":"pone.0360321.ref013","doi-asserted-by":"crossref","DOI":"10.1016\/j.cnur.2017.08.001","article-title":"Pain management in older adults","volume":"52","author":"AL Horgas","year":"2017","journal-title":"Nurs Clin North Am"},{"issue":"1","key":"pone.0360321.ref014","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1519\/JPT.0000000000000279","article-title":"Multimodal interventions including rehabilitation exercise for older adults with chronic musculoskeletal pain: A systematic review and meta-analyses of randomized controlled trials","volume":"45","author":"A Kechichian","year":"2022","journal-title":"J Geriatr Phys Ther"},{"key":"pone.0360321.ref015","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1016\/j.apmr.2019.12.016","article-title":"Chronic pain self-management support with pain science education and exercise (COMMENCE) for people with chronic pain and multiple comorbidities: A randomized controlled trial","volume":"101","author":"J Miller","year":"2020","journal-title":"Archives of Physical Medicine and Rehabilitation"},{"key":"pone.0360321.ref016","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.jphys.2025.03.003","article-title":"Group-based exercise reduces pain and disability and improves other outcomes in older people with chronic non-specific low back pain: The ESCAPE randomised trial","volume":"71","author":"HJ Silva","year":"2025","journal-title":"Journal of Physiotherapy"},{"key":"pone.0360321.ref017","doi-asserted-by":"crossref","DOI":"10.1519\/JPT.0000000000000374","article-title":"Effects of resistance training on pain control and physical function in older adults with low back pain: A systematic review with meta-analysis","volume":"46","author":"I Syroyid","year":"2023","journal-title":"Journal of Geriatric Physical Therapy"},{"issue":"12","key":"pone.0360321.ref018","doi-asserted-by":"crossref","first-page":"3072","DOI":"10.1016\/j.pec.2021.04.017","article-title":"What do community-dwelling older adults with chronic pain value in a program of combined pain neuroscience education plus exercise?","volume":"104","author":"E Heleno","year":"2021","journal-title":"Patient Educ Couns"},{"issue":"1","key":"pone.0360321.ref019","doi-asserted-by":"crossref","DOI":"10.1097\/j.pain.0000000000002308","article-title":"Short-term impact of combining pain neuroscience education with exercise for chronic musculoskeletal pain: A systematic review and meta-analysis","volume":"163","author":"B Siddall","year":"2022","journal-title":"Pain"},{"issue":"1","key":"pone.0360321.ref020","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1111\/jgs.18125","article-title":"Impact of persistent pain on function, cognition, and well-being of older adults","volume":"71","author":"CS Ritchie","year":"2023","journal-title":"J Am Geriatr Soc"},{"issue":"10491","key":"pone.0360321.ref021","article-title":"SPIRIT 2025 statement: Updated guideline for protocols of randomised trials","volume":"405","author":"A-W Chan","year":"2025","journal-title":"Lancet"},{"issue":"1","key":"pone.0360321.ref022","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1097\/j.pain.0000000000001389","article-title":"The IASP classification of chronic pain for ICD-11: Chronic secondary musculoskeletal pain","volume":"160","author":"S Perrot","year":"2019","journal-title":"Pain"},{"key":"pone.0360321.ref023","first-page":"345","article-title":"Estudos de adapta\u00e7\u00e3o do Montreal Cognitive Assessment (MoCA) para a popula\u00e7\u00e3o portuguesa","volume":"9","author":"S Freitas","year":"2010","journal-title":"Avalia\u00e7\u00e3o Psicol\u00f3gica"},{"issue":"4","key":"pone.0360321.ref024","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1080\/23279095.2023.2252949","article-title":"Montreal cognitive assessment (MoCA): An update normative study for the Portuguese population","volume":"32","author":"J Gon\u00e7alves","year":"2025","journal-title":"Appl Neuropsychol Adult"},{"issue":"11","key":"pone.0360321.ref025","doi-asserted-by":"crossref","first-page":"2473","DOI":"10.1249\/MSS.0000000000000664","article-title":"Updating ACSM\u2019s recommendations for exercise preparticipation health screening","volume":"47","author":"D Riebe","year":"2015","journal-title":"Med Sci Sports Exerc"},{"key":"pone.0360321.ref026","article-title":"CONSORT 2010 statement: Extension to randomised pilot and feasibility trials","author":"SM Eldridge","year":"2016","journal-title":"BMJ"},{"issue":"4","key":"pone.0360321.ref027","doi-asserted-by":"crossref","DOI":"10.1093\/ptj\/pzag029","article-title":"Toward a shared framework for therapeutic pain education: A Delphi-based international consensus","volume":"106","author":"S Di-Bonaventura","year":"2026","journal-title":"Phys Ther"},{"key":"pone.0360321.ref028","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1016\/j.jpain.2015.05.005","article-title":"Fifteen years of explaining pain: The past, present, and future","volume":"16","author":"GL Moseley","year":"2015","journal-title":"The Journal of Pain"},{"issue":"3","key":"pone.0360321.ref029","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1080\/15360288.2024.2424853","article-title":"Pain neuroscience education: Teaching people about pain","volume":"38","author":"A Louw","year":"2024","journal-title":"J Pain Palliat Care Pharmacother"},{"issue":"6","key":"pone.0360321.ref030","first-page":"771","article-title":"A practice guide for physical therapists prescribing physical exercise for older adults","volume":"32","author":"FM Baptista","year":"2024","journal-title":"J Aging Phys Act"},{"key":"pone.0360321.ref031","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.procs.2015.09.273","article-title":"European Portuguese validation of the system usability scale (SUS)","volume":"67","author":"AI Martins","year":"2015","journal-title":"Procedia Computer Science"},{"key":"pone.0360321.ref032","doi-asserted-by":"crossref","first-page":"111610","DOI":"10.1016\/j.jclinepi.2024.111610","article-title":"The influence of intervention fidelity on treatment effect estimates in clinical trials of complex interventions: A metaepidemiological study","volume":"177","author":"A P\u00e1ez","year":"2025","journal-title":"J Clin Epidemiol"},{"key":"pone.0360321.ref033","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.jclinepi.2021.06.029","article-title":"Pilot and feasibility studies for pragmatic trials have unique considerations and areas of uncertainty","volume":"138","author":"CL Chan","year":"2021","journal-title":"J Clin Epidemiol"},{"key":"pone.0360321.ref034","doi-asserted-by":"crossref","DOI":"10.1097\/PR9.0000000000000830","article-title":"A pain science education and walking program to increase physical activity in people with symptomatic knee osteoarthritis: A feasibility study","volume":"5","author":"TR Stanton","year":"2020","journal-title":"PR9"},{"issue":"11","key":"pone.0360321.ref035","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2024-090523","article-title":"Exploring whether home-based neuromodulation can boost the analgesic effects of exercise in people with knee osteoarthritis: Protocol for a double-blinded, pilot randomised controlled trial","volume":"14","author":"KR McNally","year":"2024","journal-title":"BMJ Open"},{"key":"pone.0360321.ref036","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.pain.2004.09.012","article-title":"Core outcome measures for chronic pain clinical trials: IMMPACT recommendations","volume":"113","author":"RH Dworkin","year":"2005","journal-title":"Pain"},{"key":"pone.0360321.ref037","doi-asserted-by":"crossref","first-page":"104409","DOI":"10.1016\/j.ijnurstu.2022.104409","article-title":"Contribution of pain to subsequent cognitive decline or dementia: A systematic review and meta-analysis of cohort studies","volume":"138","author":"H Yuan","year":"2023","journal-title":"Int J Nurs Stud"},{"issue":"10","key":"pone.0360321.ref038","doi-asserted-by":"crossref","first-page":"2236","DOI":"10.1097\/j.pain.0000000000001932","article-title":"Persistent pain and cognitive decline in older adults: A systematic review and meta-analysis from longitudinal studies","volume":"161","author":"GPCG de Aguiar","year":"2020","journal-title":"Pain"},{"issue":"1","key":"pone.0360321.ref039","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1097\/MLR.0000000000001664","article-title":"Guidelines for designing and evaluating feasibility pilot studies","volume":"60","author":"JA Teresi","year":"2022","journal-title":"Med Care"},{"key":"pone.0360321.ref040","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2022-074256","article-title":"Practical thematic analysis: A guide for multidisciplinary health services research teams engaging in qualitative analysis","volume":"381","author":"CH Saunders","year":"2023","journal-title":"BMJ"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0360321","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:27:13Z","timestamp":1791998833000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0360321"}},"subtitle":[],"editor":[{"given":"Alejandro","family":"Torrado Pacheco","sequence":"first","affiliation":[{"name":"PLOS: Public Library of Science","place":["UNITED STATES OF AMERICA"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,10,14]]},"references-count":40,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,14]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0360321","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,14]]}}}