Effects of a videoconference-based therapeutic exercise intervention on the musculoskeletal pain of eldercare workers: protocol for the ReViEEW randomized controlled trial

Espine al. BMC Musculoskele al Diso de s (2023) 24:463
h ps://doi.o g/10.1186/s12891-023-06584-7
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BMC Musculoskele al
Diso de s
E ec s o a ideocon e ence-based
he apeu ic exe cise in e en ion
on hemusculoskele al pain o elde ca e
wo ke s: p o ocol o  heReViEEW andomized
con olled ial
Ande Espin1,2*, Jon I azus a1,2, I zia Sego ia Celaya3, Ál a o Mosque a Lajas4, Vanesa González‑Templado5 and
Ana Rod iguez‑La ad1,2
Abs ac
Backg ound P e alence o musculoskele al pain is high among elde ca e wo ke s, and he apeu ic exe cise has
shown o be e ec i e o i s managemen . Al hough ele ehabili a ion is an inc easingly used al e na i e o deli e ing
he apeu ic exe cise, no s udies ha e assessed synch onous g oup ele ehabili a ion in e en ions o he manage‑
men o musculoskele al diso de s. Thus, he aim o his a icle is o desc ibe he p o ocol o a andomized con olled
ial ha will assess he e ec s o a ideocon e ence‑based g oup he apeu ic exe cise in e en ion on he musculo‑
skele al pain o elde ca e wo ke s.
Me hods This mul icen e ial will andomly assign 130 elde ca e wo ke s o ei he a con ol o expe imen al g oup.
Pa icipan s in he con ol g oup will no ecei e any in e en ion, and pa icipan s in he expe imen al g oup will ake
pa in a 12‑week emo e supe ised ideocon e ence‑based in e en ion, consis ing o 2 weekly 45‑min g oup ses‑
sions. Each session will include 4 se s o 6 p og essi e esis ance exe cises o he lowe limbs, uppe limbs and unk,
pe o med wi h bodyweigh and elas ic bands a mode a e‑high in ensi y. Following he 12 weeks, pa icipan s in he
expe imen al g oup will be p o ided wi h ma e ial o au onomously ca y on he he apeu ic exe cises and ad ised
o con inue pe o ming 2 weekly sessions on hei own un il a 48‑week ollow‑up. Assessmen s will be pe o med
a baseline, 12 and 48 weeks. P ima y ou come will be a e age pain in ensi y in he low back du ing he las 7 days,
measu ed by he 0–10 Nume ical Ra ing Scale. Seconda y ou comes will include addi ional measu es o musculoskel‑
e al pain, psycho‑a ec i e s a e, wo k‑ ela ed a iables, and physical i ness.
Discussion This will be he i s ial, o ou knowledge, assessing whe he a emo e deli e y o a g oup he apeu ic
exe cise in e en ion ia ideocon e ence is e ec i e o educing he musculoskele al pain, imp o ing he psycho‑
a ec i e s a e and physical i ness, and enhancing he wo k‑ ela ed pa ame e s in elde ca e wo ke s. I success ul, his
s udy will p o ide inno a i e ools o implemen ing e ec i e, scalable and a o dable in e en ions o ackle mus‑
culoskele al diso de s in he wo kplace. I will also highligh he u ili y o eleheal h, and add ess he impo ance o
*Co espondence:
Ande Espin
ande [email p o ec ed]
Full lis o au ho in o ma ion is a ailable a he end o he a icle
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Espine al. BMC Musculoskele al Diso de s (2023) 24:463
he apeu ic exe cise o manage musculoskele al pain in a c i ical popula ion o he u u e o he aging socie ies as i
is he elde ca e wo ke s.
T ial egis a ion The s udy p o ocol was p ospec i ely egis e ed a ClinicalT ials.go ( egis a ion numbe :
NCT05050526) on Sep embe 20, 2021.
Keywo ds Clinical ial, S udy p o ocol, Tele‑ ehabili a ion, Resis ance exe cise, Musculoskele al diso de s, Pain,
Occupa ional heal h, Physical i ness, Men al heal h, Quali y o li e
In oduc ion
Elde ca e wo ke s a e quali ied p o essionals who p o-
ide assis ance o dependen elde ly people a ei he
home o long- e m acili ies [1]. Demog aphic p ojec-
ions o he coming decades sugges ha he demand o
elde ca e will a leas double by 2050 [2], which makes
hese p o essionals a co ne s one o acing he challenge
o aging. Taking ca e o people wi h mode a e o se e e
disabili y is a physically demanding ask, in ol ing li ing,
ans e ing and o he ca e ac i i ies ha migh lead o
an o e load o musculoskele al issues [3]. Se e al s ud-
ies ha e shown ha p e alence o pain is high among
elde ca e wo ke s [4, 5], wi h 88% o hese p o essionals
epo ing a leas one body pa wi h wo k- ela ed mus-
culoskele al symp oms [6]. Besides, p ospec i e s udies
wi h la ge samples ha e ound ha a highe in ensi y [7]
and equency [8] o pain, as well as a highe numbe o
pain loca ions [9], a e signi ican isk ac o s o long-
e m sickness absence in elde ca e wo ke s. Mo eo e ,
he p esence o pain- ela ed disabili y and a longe pain
du a ion p edic he isk o d opou o job u no e om
he elde ca e sec o [10]. In elde ca e wo ke s, muscu-
loskele al pain is o en accompanied by men al heal h
diso de s [11–13], which can be exace ba ed by he high
psychological demands o he p o ession [14–16].
Physical ac i i y and he apeu ic exe cise in e en-
ions ha e been shown o be e ec i e in educing mus-
culoskele al pain in he gene al adul popula ion [17], and
a e included as a i s -line ea men in all high-quali y
clinical p ac ice guidelines wi h he mos up- o-da e e i-
dence [18]. Al hough he biological mechanisms leading
o exe cise-induced hypoalgesia a e no ye ully unde -
s ood, i seems ha he ac i a ion o he endogenous opi-
oid sys em du ing exe cise plays a key ole [19]. Howe e ,
i has been sugges ed ha he endocannabinoid, se o on-
e gic, immune and au onomic ne ous sys ems may also
be in ol ed, and he e a e se e al psychosocial ac o s
ha could in luence he exe cise modula ion o pain [19].
F om a biomechanical poin o iew, imp o emen s in
he s uc u e and unc ion o he musculoskele al sys em,
especially muscle s eng h, could explain he pain educ-
ion induced by exe cise [20].
Tele ehabili a ion is an inc easingly used al e na-
i e o emo ely deli e ing heal h se ices using
elecommunica ions echnologies [21, 22]. Al hough p e-
ious s udies epo ed some posi i e e ec s on pain and
o he heal h- ela ed ou comes, a ecen e iew s a ed
ha i is impe a i e o conduc high quali y clinical i-
als in o de o iden i y e ec i e ele ehabili a ion in e -
en ions [21]. To he knowledge o he au ho s, he g ea
majo i y o in e ne -based in e en ions ha e consis ed
o websi es wi h con en o au onomous consul a ion,
o indi idual home- ideocon e ence sessions [21–25].
The e a e wo posi i e expe iences showing ha syn-
ch onous supe ised sessions a e a easible way o p e-
sen g oup he apeu ic exe cise in e en ions in people
wi h ch onic obs uc i e pulmona y disease [26] and
olde adul s [27], bu no s udy has been add essed o
assess hei e ec i eness on musculoskele al diso de s
ye . Synch onous supe ision and g oup dynamic could
be impo an o designing exe cise p og ams, as bo h
ea u es a e ela ed o highe pa icipan adhe ence, wha
may he e o e lead o a highe e ec i eness [28, 29]. In
addi ion, i could also allow o g ea e in e en ion
sa e y, since pa icipan s can be con inuously moni o ed
o co ec execu ion du ing exe cising.
Thus, a s udy p o ocol o a andomized con olled
ial was designed wi h he aim o assessing he e ec s
o a ideocon e ence-based g oup he apeu ic exe -
cise in e en ion in he medium and long e m on he
musculoskele al pain o elde ca e wo ke s. Seconda y
ou comes will include measu es ela ed o he psycho-
a ec i e s a e, wo k- ela ed a iables and physical
i ness.
Me hods
S udy design
A pa allel-assignmen , mul icen e andomized con-
olled ial will be ca ied ou . Pa icipan s will be
ec ui ed om ins i u ions p o iding elde ca e se ices
a home o in long- e m acili ies. In each o he ins i-
u ions, and ollowing baseline measu emen s, pa -
icipan s will be andomly assigned (1:1 a io) h ough
sealed opaque en elopes o ei he a con ol o expe i-
men al g oup by a coin- ossing sequence gene a ion.
Assessmen s o p ima y and seconda y ou comes will be
conduc ed a baseline and a 12weeks (pos -supe ised
phase) and 48weeks (pos -unsupe ised phase) om
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Espine al. BMC Musculoskele al Diso de s (2023) 24:463
he beginning o he in e en ion (Fig. 1). Ou come
assesso s and da a analys s will be blinded o g oup
alloca ion. Because o he na u e o he s udy, blinding
o he pa icipan s and he p o essional supe ising he
sessions is no possible. The s udy was designed, and he
esul s will be epo ed acco ding o he SPIRIT s a e-
men [30] and CONSORT guidelines o ials o non-
pha macologic ea men in e en ions [31].
Inclusion andexclusion c i e ia
Subjec s will be conside ed eligible o he s udy i hey
mee all he ollowing c i e ia: (a) a e o mal elde ca e
wo ke s om elde ca e ins i u ions, (b) a e ≥ 18yea s
o age, (c) ha e ≥ 3mon hs o expe ience in he p o-
ession, and (d) ha e an employmen con ac un il a
leas he da e o s udy comple ion. Pa icipan s will be
excluded i (a) hey a e p egnan o (b) hei pa ici-
pa ion is conside ed con aindica ed acco ding o he
Ame ican College o Spo s Medicine’s exe cise p e-
pa icipa ion heal h sc eening guidelines [32].
Con ol g oup
Pa icipan s in he con ol g oup will no ecei e any
in e en ion and will be ins uc ed o con inue wi h hei
usual li es yle.
Expe imen al g oup
Supe ised phase
Pa icipan s in he expe imen al g oup will ake pa in
a 12-week exe cise in e en ion, consis ing o wo ideo-
con e ence-supe ised sessions pe week o 45min each.
A minimum in e al o 48h will be ensu ed be ween ses-
sions. The sessions will be ca ied ou in g oups o a maxi-
mum o 10 pa icipan s, implemen ed in he wo kplace
bu ou side o wo king hou s, and emo ely supe ised
in eal- ime by a p o essional wi h p e ious expe ience in
deli e ing g oup exe cise sessions. Real- ime ideocon e -
ence pla o ms such as Webex (Cisco Sys ems, Milpi as,
USA) will be used, and audio and ideo will be con inu-
ously sha ed be ween pa icipan s and aine o allow
comple e bidi ec ional eedback (Fig.2).
Fig. 1 SPIRIT low diag am o he schedule o en ollmen , in e en ions, and assessmen s. Legend: Con: con ol g oup; Exp: expe imen al g oup; wk:
week
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The echnical con en o he p og am is based on a li -
e a u e e iew, au ho s’ expe ise and ield expe ience,
as well as on he esul s o a p e ious pilo ial ha we
ca ied ou be ween Janua y and Ma ch 2020 wi h 20
elde ca e wo ke s [33], ha allowed us o de ine he exe -
cises, in ensi ies, and easibili y o a p og am add essed
o educing he musculoskele al pain in his popula ion.
In e en ion de ails a e epo ed based on he Templa e
o In e en ion Desc ip ion and Replica ion (TIDieR)
Checklis [34]. Sessions will s a wi h a wa m-up
(5–10min), including join mobili y and ae obic ac i a-
ion exe cises ocused on inc easing hea a e. The main
pa o he session will consis o esis ance exe cises
(30min) pe o med a mode a e-high in ensi y. In o al,
9 exe cises will be pe o med h oughou he p og am
(Fig.3). In each session, 4 se s o 6 esis ance exe cises will
be pe o med, wi h a 2-min ac i e es (dynamic s e ch-
ing and b ea hing exe cises) be ween se s. Exe cises will
Fig. 2 Se ing up o he ideocon e ence‑supe ised exe cise sessions. Legend: A wo kplace se ing in a pa icipa ing nu sing home; B se ing o
he p o essional supe ising he session; C sc eensho o a ideocon e ence session
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Espine al. BMC Musculoskele al Diso de s (2023) 24:463
Fig. 3 Resis ance exe cises pe o med in he p og am

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Espine al. BMC Musculoskele al Diso de s (2023) 24:463
be sys ema ically a ied be ween sessions so ha each o
hem is e enly pe o med du ing he p og am. In each
se , exe cises o he di e en majo muscle g oups will
be al e na ed in a ci cui manne (e.g., lowe limb, uppe
limb, unk, lowe limb, uppe limb, unk) (Table 1).
Unila e al exe cises will be al e na ed be ween se s so
ha bo h sides o he body a e e enly wo ked in each ses-
sion. Exe cises will be pe o med wi h minimal equip-
men , combining body-weigh and 2-m-long elas ic band
exe cises. Th ee p og ession le els will be se o each o
he exe cises: p og ession 1 (weeks 1–4), p og ession 2
(weeks 5–8) and p og ession 3 (weeks 9–12) (Fig.3). All
pa icipan s will s a in p og ession 1, and ansi ion o
a subsequen p og ession will only be allowed i he pa -
icipan comple es ≥ 4 sessions in he p e ious p og es-
sion le el. P og ession le els a e achie ed by modi ying
he exe cise echnique (e.g., inc easing he o ce le e )
o u ilizing elas ic bands o di e en esis ances (1.7, 2.1
and 2.6kg a 100% elonga ion o p og essions 1, 2 and
3, espec i ely) (Fig.3). One minu e will be dedica ed o
he comple ion o each exe cise (including wo k and es
imes), and wi hin each p og ession le el, he wo k: es
a io will augmen om 30:30 o 45:15s, hus adding 5s
o wo k and educing 5s o es each week (Fig.4). Pa -
icipan s will be asked and moni o ed o wo k a a a e o
pe cei ed exe ion be ween 3 (mode a e) and 5 (s ong)
on he Bo g’s CR-10 scale [35] and no o each ailu e in
any o he exe cises. I any o he exe cises cause in ole a-
ble pain, he 4-s age exe cise adjus men model p oposed
by Jakobsen e al. [36] will be used: (1) educe loading
in ensi y (e.g., e u ning o a p e ious p og ession le el
o e en pe o ming he exe cise wi hou ex e nal esis -
ance), (2) educe mo emen eloci y, (3) educe ange o
mo ion, and (4) in e up exe cise. I an exe cise needs o
be in e up ed, i will be eplaced by a pain- ee exe cise
ocused on he same muscle g oup. Sessions will inish
wi h a cool-down (5–10min), including s a ic s e ching
and b ea hing/ elaxing exe cises. Daily a endance will be
Table 1 Example o he scheduling o he in e en ion o he 7 h week
Objec i e Session 1 Session 2
Wa m-up
(5–10 min) Join mobili y Join mobili y
Ae obic ac i a ion Ae obic ac i a ion
Resis ance aining (30 min)
4 se s wi h 2‑min ac i e es be ween se s 1. Squa (+ 3 s isome ic pause) 40’’ 1. Pull‑apa (2.1 kg elas ic band) 40’’
Res 20’’ Res 20’’
2. A m aise (2.1 kg elas ic band) 40’’ 2. Bi d dog (a ms and legs: egula ) 40’’
Res 20’’ Res 20’’
3. Dead bug (legs only) 40’’ 3. Glu e b idge (unila e al: sho le e ) 40’’
Res 20’’ Res 20’’
4. Glu e b idge (unila e al: sho le e ) 40’’ 4. Biceps cu l (2.1 kg elas ic band) 40’’
Res 20’’ Res 20’’
5. Pull‑apa (2.1 kg elas ic band) 40’’ 5. La e al plank (medium le e ) 40’’
Res 20’’ Res 20’’
6. Bi d dog (a ms and legs: egula ) 40’’ 6. Re e se lunge (dynamic) 40’’
Cool-down
(5–10 min) S a ic s e ching S a ic s e ching
B ea hing/ elaxing exe cises B ea hing/ elaxing exe cises
Fig. 4 P og ession o he exe cises du ing he 12 weeks o in e en ion
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Espine al. BMC Musculoskele al Diso de s (2023) 24:463
eco ded by he p o essional who supe ises he sessions.
This p o essional will also collec in o ma ion on he
comple ion and in ensi y o each pa icipan ’s aining
in each session. Adhe ence will be epo ed as he pe -
cen age o sessions in which pa icipan s pe o med he
planned aining ega ding comple ion and in ensi y (i.e.,
24 sessions = 100% o adhe ence) [37].
Unsupe ised phase
When he 12-week supe ised sessions a e inished, pa -
icipan s in he expe imen al g oup will be encou aged
o con inue pe o ming 2 weekly sessions on hei own
un il he 48-week ollow-up. To acili a e his au ono-
mous aining, we will c ea e suppo i e ma e ial o he
sessions ha will include wo 45-min eco dings wi h
he equi alen con en o a session planned o he 12 h
week, explana o y ideos o he 9 exe cises pe o med
in he supe ised p og am and hei co esponding p o-
g essions, as well as w i en ins uc ions abou how o
pe o m he exe cises. To eco d comple ion in his unsu-
pe ised phase, pa icipan s will be asked, e e y 12weeks
and un il he 48-week assessmen s (Fig.1), he ollowing
ques ions: (a) in he las 12weeks, in how many weeks
did you pe o m he exe cises? (0–12) and (b) on a e age,
in each o hose weeks in which you pe o med he exe -
cises, on how many days did you pe o m hem? (0–7).
The esul o he mul iplica ion o bo h answe s will be
conside ed he numbe o pe o med unsupe ised ses-
sions. In his case, sel - epo ed comple ion will be cal-
cula ed as a pe cen age o pe o med sessions (i.e., 72
sessions = 100% comple ion in he unsupe ised phase).
Ou comes
Baseline desc ip i e da a
Pa icipan s will epo by a sel -adminis e ed w i en
ques ionnai e he ollowing desc ip i e da a a baseline:
da e o bi h, sex (male/ emale), heigh (cm), mass (kg),
ma i al s a us (single/ma ied/di o ced/widowe ), edu-
ca ional le el (p ima y/seconda y/ e ia y educa ion),
numbe o child en (n), child en cohabi ing a home (no/
yes), ca e o dependen people ou side he wo k en i on-
men (no/yes), wo king hou s (hou s/week), expe ience
in he p o ession (yea s), ype o wo k shi ( o a i e/
ixed), nigh shi (no/yes), alcohol consump ion (ne e /
mon hly o less/2–4 imes a mon h/2–3 imes a week/ ≥ 4
imes a week) [38], obacco consump ion (daily/less han
daily/no a all) [39], ec ea ional physical ac i i y (1–8)
[40], and egula esis ance-exe cise aining (no/yes).
P ima y ou come
The p ima y ou come will be a e age pain in ensi y in
he low back du ing he las 7 days, measu ed by he
0–10 Nume ical Ra ing Scale (NRS) [41] anging om 0
(comple e absence o pain) o 10 (wo s imaginable pain)
(Table2).
Seconda y ou comes
A de ailed desc ip ion o all he seconda y ou comes is
shown in Table2. They will include alida ed ques ion-
nai es and es s o e alua ing: (a) musculoskele al pain
[41] (in ensi y, equency, and in e e ence) o he low
back, neck, shoulde s and hands/w is s; (b) psycho-
a ec i e s a e [42–46] (subjec i e happiness, anxie y
and dep ession, bu nou , sleep quali y, and quali y o
li e) which will be collec ed by a sel -adminis e ed w i -
en ques ionnai e; (c) wo k- ela ed a iables [47–49]
(wo k abili y, pe o mance, physical exe ion, and absen-
eeism) which will be ob ained by a sel -adminis e ed
w i en ques ionnai e and om he o icial egis y o
he pa icipa ing elde ca e ins i u ion; and (d) physi-
cal i ness ( unk, lowe and uppe limbs muscle pe o -
mance), which will be e alua ed by a ba e y o physical
pe o mance es s [50–52] p e iously alida ed by ou
esea ch g oup o be ca ied ou emo ely by eal- ime
ideocon e ence [53]. The pa icipan ’s sel - epo ed days
o medica ion consump ion o analgesics and hypno -
ics/anxioly ics du ing he las 7days a each assessmen
poin will also be eco ded.
Ad e se e en s
Ad e se e en s occu ing du ing he supe ised exe cise
sessions will be collec ed by he p o essional supe ising
he sessions and di ided in o 2 ypes: a) echnical (con-
nec ion and/o ope a ion p oblems wi h he ideocon-
e encing sys em) and b) pa icipan sa e y- ela ed (pain,
discom o , o any o he heal h- ela ed p oblem appea -
ing du ing he session). Ad e se e en s will also be classi-
ied as mino ( hose ha sligh ly hinde he de elopmen
o he exe cise session) and majo ( hose ha p e en he
de elopmen o he exe cise session).
Sample size calcula ion
The sample size was calcula ed o de ec a signi ican
change in low back pain ha could be ele an in e ms
o absen eeism om wo k [54]. Taking in o accoun he
a e age low back pain in ensi y o 5.0 ± 2.6 in he 0–10
NRS o pain obse ed in p e ious s udies ca ied ou
by ou esea ch g oup in elde ca e wo ke s [55] and
accep ing an alpha e o o 0.05 and a be a e o o 0.20
in a bila e al con as , 108 pa icipan s a e necessa y o
de ec a di e ence equal o o g ea e han 1 uni . The
sample size has been inc eased by 20% due o expec ed
d opou s. The e o e, he equi ed sample will be 130 pa -
icipan s (65 in he con ol g oup and 65 in he expe i-
men al g oup).
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Espine al. BMC Musculoskele al Diso de s (2023) 24:463
S a is ical analysis plan
IBM SPSS S a is ics 27 s a is ical so wa e package (SPSS,
Inc., Chicago, IL) will be used o da a analysis. No mal-
i y o dis ibu ion will be checked using he Kolmogo o ‒
Smi no es , and non-no mally dis ibu ed a iables
will be squa e- oo ans o med o s a is ical analy-
sis. Con inuous and ca ego ical da a will be epo ed as
mean (s anda d de ia ion) and equency (pe cen -
age), espec i ely. The p ima y analysis will be based on
in en ion- o- ea , including da a om all pa icipan s
ega dless o adhe ence o he in e en ion. Addi ionally,
a pe -p o ocol analysis will be pe o med, including only
da a om pa icipan s wi h ≥ 50% adhe ence. Finally, a
pos -hoc subg oup analysis will be pe o med o assess
he e ec s o he in e en ion on low back pain ou comes
sepa a ely in pa icipan s wi h (≥ 1 in a e age 0–10 NRS)
and wi hou (< 1 in a e age 0–10 NRS) low back pain
a baseline. Be ween-g oup compa isons a baseline
will be pe o med wi h he independen samples T and
Chi-squa ed es s o con inuous and ca ego ical a i-
ables, espec i ely. Fo con inuous a iables, in e en ion
e ec s will be analyzed wi h a g oup-by- ime ANCOVA
Table 2 De ailed desc ip ion o he ou come measu es ha will be assessed in he ial
a Pain in ensi y, equency and in e e ence will be collec ed sepa a ely in 4 body loca ions: he low back, neck, shoulde s, and hands/w is s. A e age pain in ensi y in
he low back will be he p ima y ou come measu e
Ques ionnai e/Tes Func ions/Pa ame e s Desc ip ion
Musculoskele al paina
0–10 Nume ical Ra ing Scale (NRS) o pain [41] Pain in ensi y (a e age and wo s ) In ensi y du ing las 7 days (0–10)
Ad hoc ques ion Pain equency Days in pain du ing las 7 days (0–7)
Ad hoc ques ion Pain in e e ence Days in which pain nega i ely in e e es wi h wo k
du ing he las 7 days (0–7)
Ad hoc ques ion Pain medica ion consump ion Days o analgesic medica ion consump ion du ing
las 7 days (0–7)
Psycho-a ec i e s a e
Subjec i e Happiness Scale [42] Happiness 4 i ems measu ing pe cei ed cu en happiness
(1–7)
Goldbe g Anxie y and Dep ession Scale [43] Anxie y and dep ession 9 i ems measu ing anxious (0–9) and 9 i ems
measu ing dep essi e (0–9) symp oms du ing las
mon h
Maslach Bu nou In en o y (MBI) [44] Bu nou 9, 5 and 8 i ems measu ing equency o eelings
ela ed o emo ional exhaus ion (0–54), depe ‑
sonaliza ion (0–30) and pe sonal accomplishmen
(0–48), espec i ely
Single‑I em Sleep Quali y Scale [45] Sleep quali y Single i em measu ing sleep quali y du ing las
7 days (0–10)
Ad hoc ques ion Hypno ic/anxioly ic medica ion consump ion Days o hypno ic/anxioly ic medica ion consump‑
ion du ing las 7 days (0–7)
Eu oQol‑5D 0–100 Heal h S a e Scale [46] Quali y o li e Single i em measu ing sel ‑pe cei ed cu en
heal h s a e (0–100)
Wo k- ela ed a iables
Wo k Abili y Sco e (WAS) [47] Wo k abili y Single i em measu ing sel ‑pe cei ed cu en wo k
abili y (0–10)
Wo ld Heal h O ganiza ion Heal h and Wo k
Pe o mance Ques ionnai e (HPQ) [48]Wo k pe o mance Single i em measu ing sel ‑pe cei ed wo k pe o ‑
mance du ing las 7 days (0–10)
Bo g’s CR‑10 Scale [49] Physical exe ion a wo k Single i em measu ing sel ‑pe cei ed physical exe ‑
ion a wo k du ing las 7 days (0–10)
Ins i u ion’s egis y and sel ‑ epo ed Wo k absen eeism P esence o absen eeism (yes/no), days o absence
(n) and eason du ing las yea
Physical i ness
5‑ epe i ion si o s and es (5RSTS) [50] Lowe ex emi y muscle pe o mance Time o s and up om and si down on a chai 5
imes, mean o wo a emp s (seconds)
Kneeling push‑up es (KPU) [51] Uppe body muscle pe o mance Maximum numbe o kneeling push‑ups ( epe i‑
ions)
Shi ado‑I o unk lexo endu ance es (SIF) [52] T unk muscle pe o mance Maximum ime in a de ined unk lexion posi ion
(seconds)
Page 9 o 11
Espine al. BMC Musculoskele al Diso de s (2023) 24:463
including baseline measu emen s as co a ia es. This
ANCOVA will be pe o med sepa a ely o assess in e -
en ion e ec s in wo ime pe iods: 0 s 12weeks and 0
s 48weeks. Wi hin-g oup changes in each ime pe iod
will be pe o med wi h he pai ed samples T es . E ec
size will be es ima ed by pa ial e a squa ed (η2). Values
o η2o 0.02, 0.13, and 0.26 will be conside ed small,
medium and la ge, espec i ely [56]. Fo ca ego ical a i-
ables, in e en ion e ec s will be analyzed wi h McNe-
ma ’s es . The le el o s a is ical signi icance will be se
a p < 0.05.
T ial s a us
The ial is cu en ly ongoing, wi h he i s pa icipan s
aking pa in he in e en ion. Rec ui men is s ill ac i e
and will cease when he equi ed sample size is achie ed.
E hics
All wo ke s om he pa icipa ing elde ca e ins i u-
ions will ecei e o al and w i en in o ma ion abou he
s udy, including objec i es, assessmen s and in e en ion
de ails. A e ully unde s anding he s udy, olun ee s
who mee he selec ion c i e ia will sign an in o med
w i en consen o m be o e en olling in he s udy. The
s udy p o ocol was app o ed by he E hics Commi ee o
Resea ch In ol ing Human Beings o he Uni e si y o
he Basque Coun y (M10/2019/200MR2), was p ospec-
i ely egis e ed in ClinicalT ials.go (NCT05050526),
and complies wi h he Decla a ion o Helsinki.
Discussion
This manusc ip desc ibes he design o he i s , o ou
knowledge, andomized con olled ial ha will assess
he e ec s o a ideocon e ence-based exe cise in e en-
ion on he musculoskele al pain o elde ca e wo ke s
in he medium and long e m. The he apeu ic exe cise
p og am is e idence-based, and has been well accep ed
in e ms o modali y, in ensi y and equency, and con-
side ed use ul by he elde ca e popula ion in a p e ious
pilo s udy.
We ha e p io i ized a design wi h simple exe cises ha
allows clea ins uc ion and easy execu ion, and ha
gua an ees a ainable emo e supe ision by ideocon e -
ence. The in e en ion is also ca ied ou wi h li le ma e-
ial and a a low cos , which, i p o en e ec i e, migh
acili a e scaling i o di e en se ings and popula ions.
Mo eo e , ideocon e ence-based deli e y is compa ible
wi h si ua ions in which in e pe sonal physical dis ancing
is needed. Consequen ly, his s udy will p o ide scien i ic
suppo o implemen he apeu ic exe cise in e en ions
in he wo kplace, p o iding inno a i e eleheal h ools
o he p e en ion and ea men o musculoskele al pain.
Besides, i is widely accep ed ha inc eased wellbeing
o elde ca e wo ke s could lead o a highe quali y o ca e
and, wi h ha , a be e s a e o heal h o he elde ly indi-
iduals in need o assis ance. In his ega d, a p e ious
s udy on in o mal ca egi e s ound ha a wo se heal h
s a us o he ca egi e inc eased he isk o hospi aliza-
ion o he elde ly pe son hey ca ed o [57]. In addi ion,
p io s udies analyzing he e ec s o ace- o- ace exe cise
in e en ions in elde ca e wo ke s epo ed imp o e-
men s in wo k abili y [58] and p oduc i i y [59], as well
as educ ions in los wo k days [60] and cos s o sickness
absence [61]. O e all, his s udy could con ibu e o he
de elopmen o mo e sus ainable sys ems o long- e m
ca e, which is a global challenge included among he s a-
egic objec i es o he Wo ld Heal h O ganiza ion [62].
Some o he s eng hs o his s udy a e i s andomized
con olled design, as well as i s p ope sample size cal-
cula ion. In addi ion, me hodological de ails ha e
been ho oughly desc ibed, hus ensu ing eplicabili y.
Besides, he un es ic i e selec ion c i e ia will allow he
g ea majo i y o elde ca e wo ke s o pa icipa e, gi ing
he s udy a p agma ic na u e ha allows i o be highly
applicable o wha would happen in a eal wo k en i on-
men . Finally, he long- e m e ec s o he in e en ion
will be measu ed wi h an addi ional 48-week ollow-up.
Howe e , some limi a ions should be acknowledged.
Fo example, he s udy migh no be powe ed enough o
assess he e ec s on he seconda y ou comes, so i would
p obably be necessa y o ca y ou new s udies o es ab-
lish eliable conclusions ega ding hose a iables. In
addi ion, compliance du ing he unsupe ised phase o
he s udy is sel - epo ed. Las ly, due o he speci ici y o
he sample in ou s udy, he esul s may no be di ec ly
applicable o o he p o essionals wi h high a es o mus-
culoskele al pain.
In conclusion, his s udy will assess he e ec i eness o
a ideocon e ence-based he apeu ic exe cise p og am
ha , i success ul, will allow o implemen e ec i e, scal-
able and a o dable in e en ions o ackle musculoskel-
e al diso de s in a c i ical popula ion o he u u e o he
aging socie ies as i is he elde ca e wo ke s.
Acknowledgemen s
We would like o hank all he ins i u ions ha ha e p e iously allowed us o
s udy he elde ca e sec o and ha e he e o e made i possible o launch his
p ojec : Case Residencial Be ha am, Fundación Aspaldiko, G upo Se icios
Sociales In eg ados, IMQ Igu co, and G upo Colisée.
Au ho s’ con ibu ions
AE, JI and ARL designed he s udy and w o e he manusc ip . AE coo dina es
he in e en ion. JI and ARL manage he p ojec , ob ained unding and will
analyze da a. ISC, AML and VGT ec ui ed pa icipan s and p o ided acili ies,
and a e helping wi h da a collec ion. All au ho s ead and app o ed he inal
manusc ip .
Au ho s’ in o ma ion
No applicable.