Background: Smart displays and speakers offer voice interaction, which may be more accessible and appealing to older adults with chronic pain and other multimorbid conditions. Previous trials found stronger socioemotional benefits of ElderTree (vs control) among those with high primary care use and multiple chronic conditions.

Objective: This study aims to test whether older adults with chronic pain and multiple other chronic conditions use and benefit more from ElderTree, an eHealth intervention targeting pain and quality of life, when delivered on a smart display.

Methods: We recruited 269 participants from the University of Wisconsin-Madison health system and community organizations and randomly assigned 1:1:1 to (1) smart display with internet and ElderTree, plus usual care; (2) touchscreen laptop with internet and ElderTree, plus usual care; or (3) usual care alone. Participants were aged ≥60 years, had a chronic pain diagnosis or reported chronic pain, and at least 3 common chronic conditions. Primary outcomes were pain interference and psychosocial quality of life. Data sources were baseline, 4-month, and 8-month surveys and continuous ElderTree usage data.

Results: No significant differences were found between the laptop versus smart display groups for pain interference (b=-0.11, 95% CI -1.07 to 0.85; P=.82) or psychosocial quality (b=-0.21, 95% CI -0.96 to 0.55; P=.56), nor between the combined laptop+smart display group versus control group for either outcome (pain interference: b=-0.41, 95% CI -1.23 to 0.41; P=.33; psychosocial quality of life: b=0.04, 95% CI -0.61 to 0.69; P=.90). Mediation was not tested because effects on primary outcomes were nonsignificant. Gender did not moderate the effect of laptop versus smart display groups in pain interference (b=-1.56, 95% CI -3.56 to 0.44; P=.13). Gender did moderate the effect of the combined laptop+smart display group versus control group (b=1.91, 95% CI 0.11 to 3.71; P=.04). Women showed a significant decrease in pain interference (b=-0.69, 95% CI -1.29 to -0.10; P=.02), whereas women in the control group showed no significant change (b=0.25, 95% CI -0.53 to 1.04; P=.53). Men in the combined group showed a nonsignificant decrease (b=-0.67, 95% CI -1.47 to 0.14; P=.10), whereas men in the control group showed a significant decrease (b=-1.61, 95% CI -2.88 to -0.35; P=.01). Participants assigned to the laptop versus smart display used ElderTree more frequently and had more favorable perceptions. Analyses of secondary and exploratory outcomes showed no significant differences between groups.

Conclusions: We found no significant differences between the combined ElderTree group and the control group for changes over time in any primary, secondary, or exploratory outcomes. Moderation analyses indicated that only gender moderated study arm effects, and only for the laptop+smart display versus control group on changes over time in the two primary outcomes.

Trial registration: ClinicalTrials.gov NCT04798196; https://clinicaltrials.gov/ct2/show/NCT04798196. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/37522.