The goal of this pilot study is to evaluate the feasibility of integrating neural mobilization techniques into a multimodal physical exercise program for older adults with chronic musculoskeletal pain. The main questions it aims to answer are: * What is the average time to assess secondary outcomes for each participant? * What proportion of participants adhered and/or withdrew from the study at the end of the intervention protocol? * Are there adverse events/effects associated with the intervention protocol? * What is the level of approval/satisfaction of the participants in relation to the assessment and intervention protocols? * What is the impact of the intervention protocol on participants´ pain, function, physical performance, somatosensory function, and nerve excursion (secondary outcomes)? Participants will be assessed at 3 different moments: initial assessment (T0), at the end of the intervention protocol (8 weeks) (T1) and 3 months after the end of the intervention protocol (T2). The intervention protocol will consist of a multimodal exercise program (with or without integration of neural mobilization techniques) to be carried out over a period of 8 weeks at a frequency of twice a week.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
30
The physical exercise program will consist of exercises from three different exercise modalities: aerobic training, balance exercises, and isometric exercises.
Neural mobilization techniques for the upper and lower quadrants will be actively performed by participants.
University of Aveiro
Aveiro, Portugal
Dropout and adherence rates
Proportion of participants who adhered and withdrew from the study at the end of the intervention protocol. "Adherence to treatment" will be considered if the participant attends at least 12 sessions (75% of the total scheduled sessions).
Time frame: T1: 8 weeks (post-intervention assessment); T2: 3 months post-intervention (follow-up assessment)
Adverse events and adverse effects
Proportion of participants that reported adverse events and adverse effects during the intervention protocol.
Time frame: T1: 8 weeks (post-intervention assessment); T2: 3 months post-intervention (follow-up assessment)
Practicality
The average time taken to assess secondary outcomes for each participant.
Time frame: T0: baseline assessment; T1: 8 weeks (post-intervention assessment); T2: 3 months post-intervention (follow-up assessment)
Acceptability
The degree to which participants approve of or are satisfied with the assessment and intervention protocols. Acceptability will be assessed qualitatively through focus groups, where a recorded interview (audio only) will be carried out by the study's main researcher, in order to assess the participants' perception of the study and the intervention protocol.
Time frame: T1: 8 weeks (post-intervention assessment)
Pain severity
Brief Pain Inventory (BPI)
Time frame: T0: baseline assessment; T1: 8 weeks (post-intervention assessment); T2: 3 months post-intervention (follow-up assessment)
Temporal characteristics of pain
World Health Organization (WHO) Classification - It is a categorical variable with three different possible response categories: * Episodic recurrent pain - recurrent pain attacks with pain-free intervals; * Continuous pain - pain is always present; * Continuous with pain attacks - recurrent pain flare-ups as exacerbations of ongoing underlying pain.
Time frame: T0: baseline assessment; T1: 8 weeks (post-intervention assessment); T2: 3 months post-intervention (follow-up assessment)
Neuropathic pain components
painDETECT questionnaire - The instrument consists of 4 sections related to: (1) pain intensity in the last 4 weeks; (2) the pain pattern; (3) regions of pain; and (4) presence of neuropathic descriptors. The total score is obtained by adding the scores of the last 3 sections and can vary from 1 to 38. Scores ≤ 12 = the neuropathic mechanism is very unlikely to be present (predominance of the nociceptive mechanism); Scores ≥ 19 = there is a high probability of a predominant neuropathic mechanism; Scores \> 12 and \< 19 = the presence of a mixed component.
Time frame: T0: baseline assessment; T1: 8 weeks (post-intervention assessment); T2: 3 months post-intervention (follow-up assessment)
Pain Catastrophizing
Pain Catastrophizing Scale (PCS) - The instrument has 13 items subdivided into three different subscales: helplessness (items 1, 2, 3, 4, 5, and 12); magnification (items 6, 7, and 13); and rumination (items 8, 9, 10, and 11). All subscales are evaluated on a 5-point Likert scale, from 0 (not at all) to 4 (all the time), where higher scores represent a greater level of catastrophizing.
Time frame: T0: baseline assessment; T1: 8 weeks (post-intervention assessment); T2: 3 months post-intervention (follow-up assessment)
Fear of Movement
Tampa Scale for Kinesiophobia - The instrument comprises 13 items rated on a 4-point Likert scale, as follows: (1) strongly disagree; (2) somewhat disagree; (3) somewhat agree; (4) strongly agree. The higher the score, the greater the fear perceived during the execution of the movement.
Time frame: T0: baseline assessment; T1: 8 weeks (post-intervention assessment); T2: 3 months post-intervention (follow-up assessment)
Symptoms of Central Sensitization
Central Sensitization Inventory (CSI)
Time frame: T0: baseline assessment; T1: 8 weeks (post-intervention assessment); T2: 3 months post-intervention (follow-up assessment)
Pressure Pain Threshold (Thenar region of the right hand; Right calcaneus; Region of greatest pain)
Algometer
Time frame: T0: baseline assessment; T1: 8 weeks (post-intervention assessment); T2: 3 months post-intervention (follow-up assessment)
Cold and Warm Perception Threshold ((Thenar region of the right hand; Right calcaneus; Region of greatest pain)
Q-sense
Time frame: T0: baseline assessment; T1: 8 weeks (post-intervention assessment); T2: 3 months post-intervention (follow-up assessment)
Lower Limb Strength
Five Times Sit to Stand Test
Time frame: T0: baseline assessment; T1: 8 weeks (post-intervention assessment); T2: 3 months post-intervention (follow-up assessment)
Grip Strength
Hand-held dynamometer
Time frame: T0: baseline assessment; T1: 8 weeks (post-intervention assessment); T2: 3 months post-intervention (follow-up assessment)
Agility and Dynamic Balance
Timed-Up-And-Go Test
Time frame: T0: baseline assessment; T1: 8 weeks (post-intervention assessment); T2: 3 months post-intervention (follow-up assessment)
Nerve excursion (median and tibial nerves)
Ultrasonography - The longitudinal and transverse excursion of the tibial and median nerves will be measured in millimeters using ultrasound images taken during the execution of a joint movement.
Time frame: T0: baseline assessment; T1: 8 weeks (post-intervention assessment); T2: 3 months post-intervention (follow-up assessment)
Range of Motion (ankle dorsiflexion and wrist extension)
Goniometer
Time frame: T0: baseline assessment; T1: 8 weeks (post-intervention assessment); T2: 3 months post-intervention (follow-up assessment)
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