---
title: "InControl web platform pilot assessing usability and feasibility in older adults with chronic musc"
id: "plos-one-13-feasibility-acceptability-and-usability-of-incontrol-web-platform-intervention"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-13-feasibility-acceptability-and-usability-of-incontrol-web-platform-intervention"
content_type: "clinical_feed_article"
specialty: "General"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360321"
published_at: "2026-10-14T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# InControl web platform pilot assessing usability and feasibility in older adults with chronic musc
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-13-feasibility-acceptability-and-usability-of-incontrol-web-platform-intervention
- **Specialty:** [General](https://medichelpline.com/clinical-feed/general.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360321)
- **Published At:** 2026-10-14T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- The pilot evaluates the **InControl** web-based program combining exercise and pain science education for older adults with **chronic musculoskeletal pain**. - Design: randomized, two-arm, parallel-group, mixed-methods pilot with quantitative and qualitative components; 34 participants (17 per arm) are planned. - Recruitment occurs via primary healthcare centers and community outreach at the Local Health Unit of Aveiro Region; written informed consent required. - Inclusion criteria include age ≥60, pain >3 months at least weekly, ability to use a computer/tablet, average pain ≥3 on the Numerical Pain Scale, and absence of cognitive impairment per MoCA using age/education-adjusted cutoffs. - Exclusions include inability to read, pain from serious pathology, or acute/unstable medical conditions that prevent safe exercise; screening follows the ACSM Preparticipation Health Screening algorithm. - Randomization is cluster-level (physical therapist as unit); allocation concealed by an independent researcher; assessor blinded to group assignment. - Intervention: 8 weeks combining 4 in-person group sessions and ~20 remote sessions; remote content includes functional goal tasks, education, and tailored exercise (30–40 minutes/session). - Feasibility metrics: inclusion, refusal, exclusion, dropout and retention rates. Usability measured with the Portuguese **System Usability Scale**; acceptability via structured questionnaire and semi-structured interviews. - Secondary outcomes to be recorded: pain, physical function, psychological factors, quality of life, and cognitive function. - Data analysis will use descriptive statistics and thematic qualitative analysis. The protocol was registered (NCT07774416) and ethics-approved; no datasets were generated yet as this is a protocol.
## Clinical Analysis & Structured Key Points
Feasibility, acceptability and usability of InControl web-platform intervention for older adults with chronic musculoskeletal pain: A mixed-methods pilot study protocol | PLOS One Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click here . Article Authors Metrics Comments Media Coverage Reader Comments Figures Figures Abstract Background 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. Methods 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. Discussion 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. Trial registration This study is registered on clinicaltrials.gov, NCT07774416 ( https://clinicaltrials.gov/study/NCT07774416?tab=study ), August 18, 2026. Citation: Oliveira D, Rocha NP, Silva AG (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 Editor: Alejandro Torrado Pacheco, PLOS: Public Library of Science, UNITED STATES OF AMERICA Received: September 14, 2026; Accepted: September 18, 2026; Published: October 14, 2026 Copyright: © 2026 Oliveira et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: No datasets were generated or analyzed during this study. All relevant data will be made available upon study completion. Funding: This is the protocol for a pilot study being conducted as part of the InControl project — User-centered development and cost-effectiveness evaluation of a digital pain management program for older adults, COMPETE2030-FEDER-00781500;2023.17304.ICDT; https://doi.org/10.54499/2023.17304.ICDT . The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Introduction Increased life expectancy is a current trend worldwide [ 1 ]. The population aged 65 and older is expected to grow from 761 million in 2021 to 1.6 billion in 2050 [ 1 ]. A similar trend is observed in Portugal, reflecting a substantial increase in the aging index [ 2 ]. Chronic pain affects more than 50% of older adults, and it is also showing a tendency to increase over time [ 3 ]. Chronic musculoskeletal pain is associated with increased disability [ 4 ], reduced physical activity [ 5 ], higher rates of depression [ 3 ], and sleep problems [ 6 ]. It also negatively affects social and psychological well-being [ 4 ] and quality of life [ 7 ]. Pain represents one of the major challenges in healthcare, being one of the main reasons for seeking medical attention and contributing to substantial healthcare costs [ 4 , 8 ]. The prevalence of chronic conditions and multimorbidity in this population intensifies the burden on healthcare systems, challenging their capacity to respond on time [ 4 ]. To address these challenges, digital health interventions show potential to expand access to high-quality pain treatment [ 9 ], and to mitigate barriers such as distance and mobility limitations, which often restrict older adults’ access to in-person care [ 9 , 10 ]. The management of chronic musculoskeletal pain is demanding due to its multifactorial nature [ 6 ]. Exercise and pain science education are internationally recommended interventions for the management of chronic pain [ 11 – 15 ]. Existing studies [ 14 , 16 , 17 ] have demonstrated that exercise improves pain and physical function. On the other hand, pain science education changes beliefs related to chronic pain, promotes self-management and self-efficacy [ 18 ] and increases adherence to exercise [ 19 ]. However, evidence regarding the effectiveness and implementation of digital interventions for chronic musculoskeletal pain in older adults is conflicting [ 9 ]. A recent systematic review and meta-analysis found small, low to very low certainty effects on pain intensity and disability [ 9 ]. Moreover, many studies focus on only a single condition or a specific site of pain [ 9 ], although most older adults experience pain in more than one location [ 20 ], which limits the generalizability of the results to older adults with chronic musculoskeletal pain. Furthermore, research focuses primarily on effectiveness [ 9 ] rather than feasibility, acceptability, and usability. The intervention contents within the InControl web-based platform were co-created with healthcare professionals and older adults who have lived experience of chronic musculoskeletal pain. InControl integrates exercise and pain science education tailored to this population. The platform’s goal is to deliver a technology-mediated intervention that helps reduce pain and mitigate its negative impact on older adults with chronic musculoskeletal pain. Because digital literacy, engagement, and adherence may be challenging in this population, a pilot study is required before evaluation in a large-scale randomized controlled trial. In this pilot study, the acceptability and usability, as well as the feasibility of the research procedures, will be evaluated in a real-world setting. The pilot study aims to: i) assess the usability and acceptability of the InControl platform among older adults with chronic musculoskeletal pain; ii) determine the feasibility of using the proposed technological solution (InControl) over an 8-week period in a real-world setting, and iii) inform the methodological design of a randomized controlled trial to evaluate the cost-effectiveness of InControl. Methods Study design This is a randomized, two-arm, parallel-group pilot study using mixed methods, including both quantitative and qualitative approaches. It includes feasibility, acceptability and usability components, conducted within an exploratory framework that follows the Standard Protocol Items Recommendations for the International Trials guidelines [ 21 ] ( S1 File ). This study received approval from the Ethics Committee of the Egas Moniz Health Alliance Clinical Academic Center, No. 21-CE-ICVS/CAC-EMHA/08.06.2026. Participants Inclusion criteria. To be eligible the participants must: i) be 60 years of age or older; ii) have chronic musculoskeletal pain, defined as pain that persists for more than three months and is located in the muscles, bones, joints, or tendons [ 22 ] at least once a week; iii) be able to use a computer and/or a tablet; iv) have a score of 3 or higher on the Numerical Pain Scale for average pain intensity over the past week; and v) show no cognitive impairment, as determined by the Montreal Cognitive Assessment (MoCA) (validated and with normative data for the Portuguese population) [ 23 , 24 ] and be available to participate in the study. The MoCA cutoff scores for the absence of cognitive impairment to be considered are adjusted for the participants’ age and educational level [primary school (1–4 years), middle school (5–9 years), high school (10–12 years), and college (>12 years)], with 1.5 standard deviations [ 24 ]: i) Ages 60–69: elementary school – 17 points, middle school – 21 points, high school and college – 22 points; ii) Ages 70–79: elementary school – 15 points, middle school – 18 points, high school – 20 points, and college – 22 points; iii) Over 80 years old: elementary school – 12 points, middle school – 22 points, high school – 17 points, and college – 19 points. Exclusion criteria. Participants will be excluded if they meet any of the following criteria: i) inability to read; ii) pain associated with serious conditions (e.g., tumors, fractures); iii) any acute, unstable, or decompensated medical conditions that prevent safe physical exercise. Examples include cardiovascular diseases (recent acute myocardial infarction, unstable angina, uncontrolled cardiac arrhythmias, severe symptomatic aortic stenosis, symptomatic or unstable heart failure, acute myocarditis or pericarditis, acute aortic dissection, active endocarditis, uncontrolled hypertension), respiratory conditions (acute pulmonary embolism, pulmonary infarction, chronic obstructive pulmonary disease, uncontrolled asthma, or recent respiratory exacerbations), metabolic conditions (uncontrolled diabetes mellitus), neurological conditions (stroke, traumatic brain injury, Parkinson’s disease), or acute systemic infection. In addition, participants will be screened according to the American College of Sports Medicine’s Preparticipation Health Screening algorithm [ 25 ]. Recruitment and consent. Participants for this study will be recruited through the primary healthcare centers of the Local Health Unit of Aveiro Region (ULSRA), which includes hospitals and primary healthcare centers, and from the community. Information will be disseminated to health professionals at the ULSRA. In addition, posters will be displayed in strategic locations, such as health centers, community settings, and institutions that organize activities for older adults, as well as through digital and print media. The promotional materials will provide detailed information about the study and eligibility criteria and will instruct individuals to contact the research team to express their willingness to participate. All participants will receive verbal and written information about the study and will be required to provide written informed consent prior to participation. Sample size. Since this is a pilot study ( S2 and S3 Files ), the sample size was not determined statistically [ 26 ]. A total of 34 participants will be recruited and divided into two groups (n = 17 per group: intervention and control). This sample size accounts for an anticipated attrition rate of 25%, allowing for an estimated 12 participants per group to complete the study. Randomization and group assignment. The intervention will be delivered by members of the research team and physiotherapists from primary healthcare centers of the ULSRA. Randomization will be performed at a cluster level, with the physical therapist serving as the unit of allocation. Physical therapists will be randomly assigned in a 1:1 ratio to either the usual care or the InControl intervention arms. This approach aims to minimize contamination between groups caused by the physical therapist and the exchange of information among participants from different groups. An independent researcher, not involved in participant recruitment or assessment, will generate a computer-generated sequence (simple randomization). Allocation will be concealed by this researcher until after the baseline assessment of the first participant is completed. Assessments will be conducted by a blinded assessor trained by the principal investigator. After randomization, all participants assigned to that physical therapist will receive the intervention designated for that cluster. Due to the nature of the intervention (exercise and education), it is not possible to blind participants and physical therapists to the intervention. The assessor will be blinded to the allocation of physical therapists and participants to the group throughout the trial. Unblinding of the outcome assessor is not anticipated, however, in the event of a severe adverse event requiring safety review, unblinding will be documented and reported. Since this is a feasibility study, six clusters are estimated, with each physical therapist managing between six and seven participants. Intervention Each participant will be assigned to one of two groups (usual care or the InControl intervention). Usual care. This refers to the treatment that participants would normally receive in routine care (e.g., medication, physical therapy, or any other form of treatment). At the end of the treatment period, participants will report all treatments received during the intervention period. InControl intervention. Following the initial assessment at Week 0, participants will be introduced to the InControl platform with the assistance of a researcher to ensure familiarity and deliver technical support. The intervention will last 8 weeks and will combine 4 in-person group sessions (in Weeks 1, 3, 5, and 7) with 20 remote sessions delivered via the InControl platform. Remote sessions will be conducted two or three times per week, at a time to be determined by the participant and on non-consecutive days. Adverse events occurring during the intervention period (e.g., falls) will be systematically recorded. The study provides insurance coverage for accidents that occur during or as a result of the intervention. Minor adverse events related to exercise will be recorded and managed by the physical therapists. The in-person sessions will focus on platform support, documentation and resolution of technical or practical issues, reinforcement of pain science education content, adaptation and progression of exercises, assessment of functional goals and monitoring of adverse events. These sessions are designed to support adherence and enhance participants’ confidence in performing the intervention. Sessions will last approximately 60 minutes and will be conducted either at the School of Health Sciences of the University of Aveiro or at other facilities within the ULSRA, depending on the physical therapist responsible for delivery. The remote sessions include three main components: (i) completion of a functional goal-related task, (ii) pain science education and (iii) physical exercise. Each week, participants will complete the visualization of educational content and corresponding quizzes for about 20 minutes and exercise for approximately 30 minutes, on alternate days. The functional goal is to support self-management strategies and improve or restore an individually selected activity of daily living. The selected activity will be one that the participant considers important but is currently limited in performing due to pain. Functional goals will be carried out outside the InControl platform, through either i) pacing—a self-management strategy in which participants learn to balance time spent active with time spent resting — or ii) graded exposure to movement/activity [ 27 ]. For example, a participant may set as their functional goal regaining the ability to prepare a full meal while standing. Initially, the participant can alternate five minutes of activity with five minutes of rest (pacing) or gradually increase the standing time during meal preparation with progressive increases over time. Pain science education aims to improve participants’ understanding of pain as a biopsychosocial experience rather than a direct indicator of tissue damage, enabling pain reconceptualization, facilitating fear reduction and increase adherence to exercise [ 28 , 29 ]. Educational content includes topics such as the nature of chronic pain, the role of the nervous system and its sensitization, factors that modulate pain (e.g., emotions, sleep), factors that contribute to the maintenance of pain, the distinction between pain and injury, and pain self-management strategies. Content will be delivered through standardized videos, audio, and text developed in collaboration with clinicians and older adults with chronic pain. Participants will view two videos per week during the first four weeks, with optional review thereafter. Knowledge acquisition is reinforced through quizzes following each video. Each participant will receive a tailored exercise program adapted to their abilities over the course of 8 weeks. This program will be repeated for two weeks and may be modified during in-person sessions or upon the participant’s request when clinically appropriate. Participants may contact the physical therapist for guidance, share difficulties or to report symptom changes. Exercise prescription will be personalized, involving both progression and regression in the difficulty/level of the exercises, as well as changes in exercise modalities (mobility, balance, strengthening, or stretching), in order to ensure the participant’s safety, well-being, and symptom tolerance. Exercise intensity should be light (3–4) to moderate (5–6), as measured by the Modified Borg Scale, which is used to assess subjective perception of exertion [ 25 , 30 ]. Each exercise session will last between 30 and 40 minutes and will include a warm-up (5 minutes), main exercise component (15–30 minutes), and cool-down (5 minutes). Each session must include mobility and strengthening exercises and may incorporate other components as needed. Assessment instruments and procedures Primary outcomes. To assess feasibility, the following indicators will be calculated: i) Inclusion rate: the ratio between the number of participants enrolled in the study and the total number of individuals contacted; ii) Refusal rate: ratio between the number of individuals who refused to participate in the study and the number of individuals contacted; iii) Exclusion rate: ratio between the number of individuals excluded due to not meeting the inclusion criteria and the total number of individuals contacted; iv) Dropout rate: ratio between the number of participants who discontinue the study and the number of participants who completed the baseline assessment; v) Retention rate: ratio between the number of participants who completed the final assessment relative to those assessed at baseline. Usability will be assessed at the end of the 8-week intervention using the validated Portuguese version of the System Usability Scale [ 31 ] referring to the InControl platform. Acceptability of both study procedures and intervention will be assessed through a structured questionnaire ( S4 and S5 Files ) and a semi-structured interview ( S6 and S7 Files ). The questionnaire will include 10 statements to be rated on a 5-point Likert scale (1 = “strongly disagree” and 5 = “strongly agree”). The semi-structured interview will be conducted individually in a quiet setting using a predefined interview guide. The guide includes open-ended questions addressing participants’ experiences of the study procedures and intervention, including information received before the study, waiting time, perceived benefits and difficulties, barriers to adherence in daily life
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