Feasibility, acceptability and usability of InControl web-platform intervention for older adults with chronic musculoskeletal pain: A mixed-methods pilot study protocol

Oliveira and colleagues have published a protocol for a mixed-methods pilot study that will assess the feasibility, acceptability and usability of InControl, a web-based intervention combining exercise and pain science education for adults aged 60 or older with chronic musculoskeletal pain. The paper reports planned methods; no participant data or intervention results have been generated or analyzed.

The study will use a randomized, two-arm, parallel-group design comparing usual care with the InControl intervention. Researchers plan to recruit 34 participants through the Local Health Unit of the Aveiro Region, with 17 assigned to each group. The sample was selected for a pilot study rather than determined through a statistical power calculation and includes an anticipated attrition rate of 25%, leaving an estimated 12 participants per group to complete the study.

Eligible participants must be at least 60 years old, have musculoskeletal pain persisting for more than three months and occurring at least weekly, be able to use a computer or tablet, and have an average pain intensity score of at least 3 on the Numerical Pain Scale during the preceding week. People unable to read, those whose pain is associated with serious conditions, and those with acute, unstable or decompensated conditions that could prevent safe exercise will be excluded. The study also uses the American College of Sports Medicine’s Preparticipation Health Screening algorithm.

Cluster randomization will be used, with a physical therapist serving as the allocation unit. Therapists will be assigned in a 1:1 ratio to usual care or InControl, and all participants assigned to a therapist will receive that therapist’s intervention. An independent researcher will generate the computer sequence and conceal allocation until the first participant’s baseline assessment is complete. Outcome assessors will be blinded, although participants and physical therapists cannot be blinded because the intervention includes exercise and education. Six clusters are anticipated, with each therapist managing six or seven participants.

The InControl arm will receive an eight-week program comprising four in-person group sessions in weeks 1, 3, 5 and 7 and 20 remote sessions delivered through the platform. Remote sessions will include a functional-goal task, pain science education and physical exercise. Participants are expected to view educational material and complete quizzes for about 20 minutes and exercise for approximately 30 minutes on alternate days. A tailored program will include mobility and strengthening exercises, with intensity prescribed at light to moderate levels on the Modified Borg Scale. Adverse events, including falls, will be recorded.

Usability will be measured after eight weeks with the validated Portuguese System Usability Scale. Acceptability and appropriateness will be assessed through a structured questionnaire and individual semi-structured interview addressing experiences, perceived benefits and difficulties, barriers, platform usability, suggested improvements and overall satisfaction. Adherence is defined as completing at least 75% of scheduled sessions. Platform use, session frequency and duration, exercise completion and attendance at in-person sessions will be recorded, while two researchers will independently assess intervention fidelity using a sample of recorded sessions.

Feasibility indicators will include inclusion, refusal, exclusion, dropout and retention rates, as well as recruitment, adherence and the time required to administer the assessment battery. Prespecified thresholds will determine whether the protocol can proceed to a full randomized controlled trial, needs amendment or is not feasible without major restructuring. Secondary measures cover pain severity and interference, physical performance and activity, catastrophizing, kinesiophobia, depressive symptoms, perceived change, adverse symptoms, sarcopenia risk, sociodemographic and clinical characteristics, quality of life and cognitive function.

Quantitative data will be analyzed with descriptive statistics, including means and standard deviations for continuous variables and frequencies and percentages for ordinal or nominal variables. Missing data will be documented and reported. Because the pilot has a small sample and an exploratory purpose, the researchers do not plan subgroup or sensitivity analyses. Interviews will be transcribed and independently read by three researchers before coding, thematic grouping and comparison of the resulting categories and themes. No interim analyses or independent data monitoring committee are planned.

The protocol identifies several limitations: participants and therapists cannot be blinded, the small sample may limit generalizability, and differences in digital literacy could affect engagement and adherence. Requiring computer or tablet use may also exclude some older adults and limit the representativeness of the population. Recruitment was scheduled for September through November 2026, with data collection expected to conclude by January 2027. The study is registered as NCT07774416, and de-identified participant data, study materials, statistical code and a data dictionary are to be made available after publication of the main results.

Subject of Research: Protocol for an eight-week pilot study of the InControl digital pain-management platform in older adults

Article Title: Feasibility, acceptability and usability of InControl web-platform intervention for older adults with chronic musculoskeletal pain: A mixed-methods pilot study protocol

Article References: Oliveira, D., Rocha, N. P., & Silva, A. G. (2026). Feasibility, acceptability and usability of InControl web-platform intervention for older adults with chronic musculoskeletal pain: A mixed-methods pilot study protocol. PLOS One, 21(10), e0360321. https://doi.org/10.1371/journal.pone.0360321

Image Credits: AI Generated

DOI: 10.1371/journal.pone.0360321

Keywords: InControl platform, chronic musculoskeletal pain, older adults, digital health, feasibility study, usability, acceptability, exercise, pain science education, mixed-methods protocol, Feasibility, InControl