A Multimodal Interventions for Managing Chronic Pain in Older Adults: A Randomized Controlled Trial in Primary Health Care Settings.

Authors

  • Daniele Bueno Godinho Ribeiro Universidade Federal de Tocantins, Faculty of Physical Education, Miracema, TO, Brazil.
  • Paulo Roberto Viana Gentil Federal University of Goiás. Faculty of Physical Education and Dance, Goiânia, GO, Brazil. 3 Univ
  • Paulo Andre Rodrigues de Sousa Universidade de Brasília
  • Gerson Cipriano Junior Department of Physiotherapy, University of Brasília, Brasília, DF, Brazil
  • Ana Clara Godinho Ribeiro Godinho Ribeiro Lutheran University Center of Palmas, Faculty of Psychology, Palmas, TO, Brazil.
  • Thales Rezende de Souza Department of Physiotherapy, University of Brasília, Brasília, DF, Brazil
  • Rodrigo Luiz Carregaro Universidade de Brasília, Rehabilitation Sciences Program, Brasilia, DF, Brazil.
  • Elaine Cristina Leite Pereira Department of Physiotherapy, University of Brasília, Brasília, DF, Brazil
  • Wagner Rodrigues Martins Department of Physiotherapy, University of Brasília, Brasília, DF, Brazil

DOI:

https://doi.org/10.70860_abef20253344

Abstract

Chronic musculoskeletal pain (CMSP) is a prevalent condition among older adults, which can significantly reduce functional capacity and quality of life. Multimodal interventions (MIs), combining aerobic, resistance, and balance exercises, are promising but understudied in primary healthcare settings. Objective: To evaluate the effectiveness of a 12-week MI program in reducing pain intensity and improving functional outcomes in older adults with CMSP. Methods: A randomized controlled trial was conducted with 113 participants (mean age: 68.5 ± 5.3 years), randomly assigned to an experimental group (EG, n=57) or control group (CG, n=56). Pain intensity (Numeric Rating Scale), functional capacity (6-minute walk test; 6MWT), and lower-limb strength (30-second sit-to-stand test; 30 s-CST) were assessed at baseline and post-intervention. Data were analyzed using repeated-measures ANOVA, with effect sizes calculated for clinical relevance. Results: Pain intensity decreased by 2.53 points (95% CI: 2.34–2.72) in the EG, surpassing the MCID threshold of 1–2 points (p<0.0001). Functional capacity improved by 23.87 meters (95% CI: 5.27–42.47) in the 6MWT, exceeding the MCID range of 14–30 meters (p<0.0001). Lower-limb strength increased by 0.89 repetitions (95% CI: 0.15–1.26) in the 30 s-CST, representing meaningful progress despite falling short of the MCID threshold of 2 repetitions. Effect sizes were moderate to large for all outcomes. Conclusion: The multimodal intervention significantly reduced pain and enhanced functional capacity, demonstrating its clinical impact and practical utility for managing CMSP. Further research should assess the long-term impacts of MIs and explore implementation in diverse settings. 

Author Biographies

Daniele Bueno Godinho Ribeiro, Universidade Federal de Tocantins, Faculty of Physical Education, Miracema, TO, Brazil.

PhD in Physical Education from the University of Brasília - UnB, research line: Physical Exercise and Rehabilitation for Special Populations. Master in Physical Education from the Federal University of Triângulo Mineiro - UFTM - MG. Graduated in Physical Education from the UnirG University Center (2008), Postgraduate Lato Sensu in Special Groups and Exercise Physiology from the Oswaldo Aranha Foundation / Volta Redonda University Center - RJ - UNIFOA (2009). Member of the CBCE (Brazilian College of Sports Sciences, State Secretariat of Tocantins). Researcher at the Center for Studies and Research in Body Practices (NEPPraC). Coordinator of the Extension and Research Project Active Life - UFT. Coordinator of the Research Project Street Running: A Systematic Review of this phenomenon. Tenured Professor of the Physical Education course at the Federal University of Tocantins - UFT.

Paulo Roberto Viana Gentil, Federal University of Goiás. Faculty of Physical Education and Dance, Goiânia, GO, Brazil. 3 Univ

Possessed a degree in Physical Education from the University of Brasília (2000), a master's degree in Physical Education from the Catholic University of Brasília (2006) and a PhD in Health Sciences from the University of Brasília (2010). He is currently a professor at the Faculty of Physical Education and Dance of the Federal University of Goiás. We mainly focus on the following topics: strength training, muscular strength, body composition and chronic-degenerative diseases.

Gerson Cipriano Junior, Department of Physiotherapy, University of Brasília, Brasília, DF, Brazil

ACADEMIC TRAINING: Post-Doctorate in Physical Therapy from the University of Miami (USA) (2018/19 - PVE/CAPES); from the University of Miami (2017 - FAPDF); and from the University of New Mexico (2013 - CNPq). PhD in Health Sciences (Cardiovascular Surgery) from UNIFESP (2007). Master's in Health Sciences (Cardiology) (2004). MBA in Management from BBS/Richmond (2003). Specialization in Physical Therapy in Pulmonology from UNIFESP (2001). Bachelor's degree in Physical Therapy from the University of West Paulista (1999). ADVANCED TRAINING: Training in Cardiopulmonary Testing (CHEST - USA, 2019; CareFusion/ACSM - USA, 2009); GRADE Guideline Development (U.S. GRADE Network - USA, 2019); Cardiovascular Rehabilitation (ESC - Switzerland, 2013); Basic and Advanced Systematic Review (Brazilian Cochrane Centre - Brazil, 2015). ACADEMIC AND RESEARCH ACTIVITY: Associate Professor of the Physiotherapy Course at the University of Brasília (UnB). Advisor in the Postgraduate Programs in Health Sciences and Technologies (UnB - Area 45) and PPGMHR (Unievangélica - Area 21). Leader of the Cardiorespiratory Rehabilitation Research Group (GPRC/CNPq) since 2009. Coordinator of the In-Person and Remote Cardiorespiratory Rehabilitation projects (PRECAP_ON and PRECAP_OFF, 2014-present) and the Post-COVID-19 Rehabilitation Program (COVIDIMT, 2020-2022). ACADEMIC MANAGEMENT: Coordinator of Research and Innovation at the FCE/UnB Campus (2023). He coordinated the Graduate Programs in Health Sciences and Technologies (PPGCTS) at UnB (2014 to 2016), coordinated all Stricto Sensu Graduate Programs at UnB with the Dean's Office of Graduate Studies at UnB (2018), led the first APCN for the creation of the PPG in Rehabilitation Sciences (2016). He served as a member of the Research Ethics Committee (2017-2018; 2022-2023) and was vice-coordinator and coordinator of the Physiotherapy Course at UnB (2011-2012) and at Ibirapuera University (2006-2007). PARTNERSHIPS AND FUNDING: Has established international collaborations with the University of Miami (USA), Ottawa University (Canada), Hasselt University (Belgium), among others. Coordinates 5 funded projects and has coordinated 14 projects through various funding agencies, including international ones. SUPERVISIONS: Currently supervises 2 postdoctoral students, 5 doctoral students, 1 master's student, 3 scientific initiation fellows, and 1 final project. Has completed 6 postdoctoral supervisions, 11 doctoral programs, 15 master's programs, and 31 scientific initiation programs. Several graduates hold academic positions in higher education institutions, including 4 at federal universities, 10 completed sandwich doctoral programs abroad, and 2 have dual degrees. SCIENTIFIC PRODUCTION: Author of 212 indexed articles, 23 book chapters, 1 patent, and 3 registered software programs. He was Associate Editor of PLOS ONE and General Editor of Scientific Documents at ASSOBRAFIR, co-authoring the first International Guidelines in Cardiovascular, Respiratory and Intensive Care Physiotherapy of ASSOBRAFIR. ORCID (0000-0001-6323-7003) Web of Science (K-6317-2014), Scopus (57226103372). H-Index: Web of Science (17), Scopus (20). CONSULTANCY: Ad Hoc Consultant for CAPES, CNPq, FAPDF and PIBIC/PIBIT/UnB, in addition to national and international journals. Member of the Brazilian Association for Research and Postgraduate Studies in Physiotherapy (ABRAPG-Ft, 2018-2022), ASSOBRAFIR and European Society of Cardiology. He was a CNPq PQ-2 scholarship holder (2021-2024). AWARDS and TITLES: I received 30 academic and scientific awards and titles, 4 of which were international, including recognition as a Fellow of the European Society of Cardiology (FESC) and the Presidency of the Largest International Symposium of Physiotherapy Specialties (SIFR/Assobrafir), in 2024.

Ana Clara Godinho Ribeiro Godinho Ribeiro, Lutheran University Center of Palmas, Faculty of Psychology, Palmas, TO, Brazil.

Graduation Lutheran University Center of Palmas, Faculty of Psychology, Palmas, TO, Brazil.

Thales Rezende de Souza, Department of Physiotherapy, University of Brasília, Brasília, DF, Brazil

Associate Professor in the Department of Physiotherapy, professor and current coordinator of the Postgraduate Program in Rehabilitation Sciences (CAPES 6) at the Federal University of Minas Gerais (UFMG). Coordinator of the Movement Analysis Laboratory (LAM) of the School of Physical Education, Physiotherapy and Occupational Therapy. Coordinator of the service provision (extension) project "Analysis of Movement and Human Functionality", developed at LAM. He was area coordinator (emphasis on Orthopedics) of the Specialization in Physiotherapy at UFMG from 2014 to 2017. He graduated in Physiotherapy (2005), specialized in Orthopedics and Sports (2006), master (2008) and PhD (2012) in Rehabilitation Sciences, from UFMG. He did a postdoctoral fellowship at the Free University of Amsterdam, in the Netherlands (2019). He was Associate Editor of the Brazilian Journal of Physical Therapy from 2022 to 2024. He has experience in the area of ​​Physiotherapy, with an emphasis on orthopedics and clinical biomechanics, working mainly on the following topics: Human Movement, Locomotion, Joint Stability, Sports Injuries, Biomechanical Insoles.

Rodrigo Luiz Carregaro, Universidade de Brasília, Rehabilitation Sciences Program, Brasilia, DF, Brazil.

Graduated in Physiotherapy at the Universidade Estadual de Londrina (UEL) in 2003. Master in Physiotherapy at the Universidade Federal de São Carlos (UFSCar) in 2007. Doutorado in Sciences da Saúde at the Universidade de Brasília (UnB). Pós-doutorado de Vrije Universiteit Amsterdam no Departamento de Ciências da Saúde - Seção de Avaliação de Tecnologias em Saúde. Especialista em Economia e Gestão em Saúde: Ênfase em Avaliação de Tecnologias em Saúde at UNICAMP; e em Avaliação de Tecnologias em Saúde (MBA/HAOC). Desenvolveu tutorial activities and monografia orientation of Alunos of Specialization course in Basic Education in Family Health (FIOCRUZ/CERRADO-PANTANAL), no period from 2011 to 2012. Faith docente of course of Fisioterapia da Universidade Federal de Mato Grosso do Sul (UFMS) between 2009 and 2012, wave of development activities, small and extensive. Member of the Scientific and Scientific Committee of the UFMS for several years from 2011 to 2012. Coordinator of the Post-Graduation and Rehabilitation Program (PPG-CR/UnB) between 2015 and 2017. Currently a professor of the Curriculum Association Fisioterapia da Universidade de Brasília (UnB), Campus UnB Ceilândia. Permanent Doctorate of Programa de Pós-Graduação em Ciências da Reabilitação (PPGCR/UnB) e Ciências e Tecnologias em Saúde (PPGCTS/UnB) no Campus UnB Ceilândia. Currently, you are interested in passing through ATS, especially economically supported by non-transmissive chronic conditions, mainly for lower back and musculoskeletal dysfunctions; there is no room for intervention by me in physical exercises and therapeutic treatments in Fisioterapia; system reviews of interventions in the saúde; Please note that you are interested in the basis of the evidence.

Elaine Cristina Leite Pereira, Department of Physiotherapy, University of Brasília, Brasília, DF, Brazil

physiotherapist from the Federal University of São Carlos (1997), PhD in Cellular and Structural Biology in Anatomy from the State University of Campinas (2005) and Master in Cellular and Structural Biology in Anatomy from the State University of Campinas (2000). Specialist in Distance Education Training. She is currently Associate Professor at the Faculty of Health Sciences and Technologies (FCTS) of the Ceilândia campus of the University of Brasília (UnB). Accredited in the Stricto Sensu Postgraduate Program in Rehabilitation Sciences (PPGCR) of FCTS/UnB. Evaluator for the National Higher Education Assessment System - BASis. She is a reviewer for the journals Frontiers in Physiology, Clinics, Oxidants and Antioxidants in Medical Science and the Brazilian Journal of Science and Movement. Member of the editorial board of the Brazilian Journal of Physical Therapy. She develops research in the area of ​​Skeletal Muscle Plasticity. He has academic experience in the area of ​​morphology, public health, biomechanics, kinesiotherapy, and manual therapies.

Wagner Rodrigues Martins, Department of Physiotherapy, University of Brasília, Brasília, DF, Brazil

I graduated in physical therapy from the Faculty of Rehabilitation of the Association of Solidarity with Exceptional Children (FASCE) in Rio de Janeiro (graduated in 2002). I obtained my specialist certification in Functional Traumatology and Orthopedics from the University of Brasília (UnB) in 2005, my Master's degree in Health Sciences in 2008, and my Doctorate in Health Sciences in 2013, both from the Graduate Program in Health Sciences at UnB. I completed a postdoctoral internship with funding from the CNPQ (National Council for Scientific and Technological Development) in the Rehabilitation Sciences Program at the Federal University of Minas Gerais (2018-2019). I am currently an Associate Professor at UnB in the Physical Therapy Program (Faculdade de Ceilândia - FCE). I also work as a permanent professor in the graduate programs in Physical Education (PPGEF) and Rehabilitation Sciences (PPGCR). In addition to teaching and research, I mentor extension students in a Continuous Action Extension Project (PEAC) in the community of Ceilândia, Federal District. I am a member of the Brazilian Association of Research and Postgraduate Studies in Physiotherapy (ABRAPG-FT).

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Published

2025-12-31

How to Cite

Bueno Godinho Ribeiro, D., Viana Gentil, P. R., Rodrigues de Sousa, P. A., Cipriano Junior, G., Godinho Ribeiro, A. C. G. R., Rezende de Souza, T., … Rodrigues Martins, W. (2025). A Multimodal Interventions for Managing Chronic Pain in Older Adults: A Randomized Controlled Trial in Primary Health Care Settings . Brazilian Archives of Physical Education, 8, 32–44. https://doi.org/10.70860_abef20253344

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Vol. 8 (2025): Brazilian Archives of Physical Education

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