PROJECT SUMMARY: Chronic musculoskeletal pain (pain > 3 months) is prevalent, costly, challenging to treat and a national priority area. Older adults have the highest rates of chronic pain, and these are expected to increase given the growth of the older adult population over the next three decades. Older adults from underserved communities (low SES, racial and ethnic minorities, immigrants) are at the highest risk for negative pain related health consequences such as lower physical and emotional function and morbidity and mortality. We lack evidence based non-pharmacological treatments to address chronic pain within community health clinics that serve this older adult patient population. GetActive is an evidence-based mind-body activity program that directly targets improvement in pain outcomes by combining cognitive behavioral and mindfulness skills with gradual increase in walking (preferred and safe activity for older adults) linked to valued activities. In direct response to RFA-NS- 22-002 we have partnered with the MGH-Revere HealthCare Center which serves >5,000 disadvantaged older adults, to optimize GetActive to bypass socioecological barriers and effectively engage this population into non-pharmacological pain management strategies. In the R61 phase, we will: 1) develop GetActive+ (optimized GetActive), 2) evaluate its feasibility and acceptability; and 3) refine and finalize training, program manual, measures, and procedures. In the R33 phase, we will conduct a randomized, hybrid type 1 effectiveness-implementation trial (N=200) to evaluate effectiveness and implementation of GetActive+ versus treatment as usual on the following outcomes: 1) self-reported physical function (primary), 2) performance based (6MWT) and objective (step count) physical function, emotional function, pain, social support, loneliness (secondary); and 3) feasibility, acceptability, fidelity and adoption at patient, provider and organization levels (implementation). Through this project we aim to solve the problem of lack of evidence based nonpharmacological treatments for older adults in underserved communities. GetActive+ delivered by clinic staff can be routinely incorporated into group visits (already available at MGH-Revere HealthCare Center and other similar community centers) which are billable, thus providing a sustained model of care for older adults with chronic pain from disadvantaged backgrounds. Because GetActive incorporates mind-body skills with activity (e.g., walking), there is potential for improvement in other outcomes (e.g., decreased risk for morbidity and mortality) over and above pain.

PROJECT NARRATIVE Up to 60% of older adults have at least some persistent pain which is associated with impaired physical and emotional function and increased risk for morbidity and mortality. Older adults from underserved communities (e.g., low SES, racial and ethnic minorities, immigrants) are at the highest risk for negative pain outcomes, yet we lack nonpharmacological treatments within community health centers that serve them. Using the socioecological frameworks, Aaron’s stage model and Proctor’s implementation model, we aim to culturally adapt GetActive, an evidence-based mind-body activity program for chronic pain, to incorporate the values, facilitators, resources, and language, for disadvantaged older adults with chronic pain and routine implementation in the community based clinical settings that serve them.