# MOTIVATE to Improve Outcomes for Older Veterans with Musculoskeletal Pain and Depression

> **NIH VA I01** · VA NORTH TEXAS HEALTH CARE SYSTEM · 2024 · —

## Abstract

Background: Musculoskeletal (MSK) pain is the leading cause of disability and reduced quality of life among
older adults. We also know that depressive symptoms frequently co-exist with MSK pain and complicate
management. Despite rising costs attributed to MSK pain and depressive symptoms, few behavioral
interventions have been developed to address these comorbid conditions in this vulnerable aging population.
Significance: The PI, during her VA HSR&D CDA2, developed and tested the feasibility of a novel behavioral
intervention targeting older Veterans with chronic back pain and depressive symptoms. MOTIVATE (Moving to
Improve Pain and Depression in Older Veterans) incorporates evidence-based components of motivational
interviewing (MI), values elicitation, goal setting and patient activation to motivate older Veterans to become
more physically active, thereby improving pain interference, function, and depressive symptoms. MOTIVATE is
delivered by a health coach via telephone or video during eight sessions over 12-weeks. Preliminary findings
from the PI’s ongoing pilot trial of MOTIVATE show it is feasible, improves step counts, pain interference, and
depressive symptoms. In response to VA HSR&D research priority areas, this application focuses on improving
access to care, augmenting resources for primary care practices – specifically in the areas of pain
management and aging, and leveraging virtual care to deliver behavioral interventions to vulnerable Veterans.
Innovation/Impact: This research is innovative because we 1) target both MSK pain and depressive
symptoms and enhance generalizability of our findings, 2) incorporate older Veterans’ motivation to change as
a key behavioral determinant, 3) use remote delivery to enhance reach of both pain and mental health services
to older Veterans; and 4) involved older Veterans and other stakeholders at every stage of development.
Specific Aims: We propose a hybrid type 1 implementation-effectiveness randomized controlled trial at two
large VA sites to establish the effectiveness and scalability of MOTIVATE. The overall goals of this study are to
1) examine the effectiveness of MOTIVATE compared to a waitlist control arm on clinical and behavioral
outcomes; 2) explore implementation processes for the MOTIVATE intervention, and 3) evaluate preliminary
cost with a budget impact analysis for MOTIVATE in older Veterans with chronic MSK pain and depressive
symptoms. We hypothesize that MOTIVATE will improve clinical and behavioral outcomes in this population.
Methodology: We will recruit older Veterans with MSK pain and depressive symptoms (n=264) to determine
effectiveness of MOTIVATE versus waitlist control arm to improve clinical and behavioral outcomes at 3
(primary endpoint) and 6 months post-enrollment. The primary outcome is pain interference (a subscale of the
Brief Pain Inventory) and secondary outcomes include depressive symptoms (PHQ-9), pain intensity, arthritis
self-efficacy, pain catastrophizi...

## Key facts

- **NIH application ID:** 10703217
- **Project number:** 5I01HX003350-02
- **Recipient organization:** VA NORTH TEXAS HEALTH CARE SYSTEM
- **Principal Investigator:** UNA E. MAKRIS
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2022-10-01 → 2026-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10703217

## Citation

> US National Institutes of Health, RePORTER application 10703217, MOTIVATE to Improve Outcomes for Older Veterans with Musculoskeletal Pain and Depression (5I01HX003350-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10703217. Licensed CC0.

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