Dual-task Training for Frail Older Adults With Chronic Musculoskeletal Pain (Pilot)

The primary outcomes will be feasibility and acceptability of the dual task training program. Feasibility will be evaluated through recruitment and compliance rates of the program. Recruitment rate will be defined as the total number of participants recruited out of the total number of participants screened. Treatment compliance will be defined as the proportion of scheduled sessions attended in each group. Acceptability will be assessed by a six-question post-program questionnaire based on the barriers to engaging in physical activity. Questions relating to perceived importance and satisfaction with the program, any discomfort felt during training, difficulty of the exercises, appropriateness of duration and usefulness on daily activity will be asked to rate from a 5-point Likert scale from 'Strongly disagree' to 'Strongly agree', and be collected at the end of the intervention.

Measured by the Tilburg frailty indicator (TFI).

• There are 15 items in total, with a score of 0 or 1 on each item. The total score ranges from 0 to 15 points. A higher score mean a worse outcome (Higher frailty level).
• A total score of >/=5 has a validity of 0.86 to determine the frailty status of the community-dwelling older Chinese population (Dong et al., 2017).

Measured by Fried Frailty Phenotype (FFP).

• It consists of 5 components in assessing the severity of frailty, including weight loss, weakness, exhaustion, slowness and low physical activity, with a score of 0 or 1 for each component.
• The total score ranges from 0 to 5 points. A higher score mean a worse outcome. The frailty status is categorized into robust (0), pre-frail (1-2), and frail (3-5).

Measured by Short Physical Performance Battery (SPPB).

• The SPPB is an assessment tool for participants' physical function and can be used to show the physical frailty.
• It includes 3 components: standing balance, 4-m gait speed, and five-repetition sit-to-stand motion. Each component has a score of 0-4. The total score ranges from 0 to 12 points. A higher score mean a worse outcome.
• A total score of <9 is regarded as frail.

Measured by Hong Kong version Montreal Cognitive Assessment (HK-MoCA).

• The score ranges from 0 to 30 points. A higher score indicates better cognitive function.
• A score of 25 or below may indicate the presence of mild cognitive impairment.

Measured by forward digit span test.

• Participants will be presented with a random series of digits and be asked to repeat them in the order presented.
• A longer span indicates better working memory with high internal reliability.

Measured by Cognitive failures questionnaire (CFQ) (Chinese version), a self-report measure to assess individual forgetfulness, distractibility, and false triggering in everyday life.

• It has 25 items (0-4 points). The total score ranges from 0 to 100 points. A higher point indicates fewer cognitive difficulties in daily life.

The average pain score will be assessed by the Numerical Pain Rating Scale (NPRS).

• Participants will be asked to rate the average pain level on a scale from 0 (no pain) to 10 (maximal pain).
• A higher score mean a worse outcome (higher pain level).

Measured by EuroQoL 5-Dimension 5-Level (EQ-5D-5L) (Hong Kong Chinese version) questionnaire.

• The questionnaire consists of 5 dimensions of health, including mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension will be rated from 1 (no problem) to 5 (extreme problems). A higher score mean a worse outcome.
• It also has an EQ-VAS scale to self-rate the overall health perception from 0 (worst health) to 100 (best health). A higher score mean a better outcome.