Chronic Pain Characteristics and Gait in Older Adults: The MOBILIZE Boston Study II

Overview

Journal Arch Phys Med Rehabil

Specialty Rehabilitation Medicine

Date 2019 Oct 22

PMID 31634443

Citations 20

Authors

Elisa F Ogawa

Ling Shi

Jonathan F Bean

Jeffrey M Hausdorff

Zhiyong Dong

Brad Manor

Robert R McLean

Suzanne G Leveille

Affiliations

Soon will be listed here.

Abstract

Objective: To investigate a proposed cognitively-mediated pathway whereby pain contributes to gait impairments by acting as a distractor in community-living older adults.

Design: A cross-sectional study of a population-based cohort of older adults.

Setting: Urban and suburban communities in a large metropolitan area.

Participants: Community-living participants (N=302) 70 years and older recruited from a previous population-based cohort.

Interventions: Not applicable.

Main Outcome Measures: Gait parameters including gait speed, stride length, double support and swing characteristics, and variability were assessed under single- and dual-task conditions involving cognitive challenges (eg, counting backward). A joint pain questionnaire assessed pain distribution in the back and major joints. We examined pain-gait relationships using multivariable linear regression and bootstrapping mediation procedures.

Results: Forty-three percent of participants had pain in 2 or more musculoskeletal sites. Pain distribution was related to slower gait speed and other gait characteristics for all gait conditions. Associations persisted after adjustment for age, sex, education, body mass index, medication, and vision. Decrements in gait measures related to pain were comparable with decrements in gait related to dual-task conditions. There were no differences in dual-task cost among the pain distribution groups. Adjusted for confounders, pain-gait relationships appear mediated by selective attention.

Conclusions: These findings suggest that chronic pain contributes to decrements in gait, including slower gait speed, and that it operates through a cognitively-mediated pathway. Further research is needed to understand the mechanisms via pain alters mobility and to develop interventions to improve mobility among older adults with chronic pain.

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References

Hausdorff J, Schweiger A, Herman T, Yogev-Seligmann G, Giladi N . Dual-task decrements in gait: contributing factors among healthy older adults. J Gerontol A Biol Sci Med Sci. 2009; 63(12):1335-43. PMC: 3181497. DOI: 10.1093/gerona/63.12.1335. View

Leveille S, Jones R, Kiely D, Hausdorff J, Shmerling R, Guralnik J . Chronic musculoskeletal pain and the occurrence of falls in an older population. JAMA. 2009; 302(20):2214-21. PMC: 2927855. DOI: 10.1001/jama.2009.1738. View

Callisaya M, Blizzard L, Schmidt M, McGinley J, Srikanth V . Sex modifies the relationship between age and gait: a population-based study of older adults. J Gerontol A Biol Sci Med Sci. 2008; 63(2):165-70. DOI: 10.1093/gerona/63.2.165. View

Baron R, Kenny D . The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986; 51(6):1173-82. DOI: 10.1037//0022-3514.51.6.1173. View

Cruz-Almeida Y, Rosso A, Marcum Z, Harris T, Newman A, Nevitt M . Associations of Musculoskeletal Pain With Mobility in Older Adults: Potential Cerebral Mechanisms. J Gerontol A Biol Sci Med Sci. 2017; 72(9):1270-1276. PMC: 5861958. DOI: 10.1093/gerona/glx084. View

Makris U, Paul T, Holt N, Latham N, Ni P, Jette A . The Relationship Among Neuromuscular Impairments, Chronic Back Pain, and Mobility in Older Adults. PM R. 2016; 8(8):738-47. PMC: 4958029. DOI: 10.1016/j.pmrj.2016.01.007. View

Best J, Liu-Ambrose T, Boudreau R, Ayonayon H, Satterfield S, Simonsick E . An Evaluation of the Longitudinal, Bidirectional Associations Between Gait Speed and Cognition in Older Women and Men. J Gerontol A Biol Sci Med Sci. 2016; 71(12):1616-1623. PMC: 5106856. DOI: 10.1093/gerona/glw066. View

Parmar V, Shyam Kumar A, Harper W . Reliability of the GAITRite walkway system for the quantification of temporo-spatial parameters of gait in young and older people. Gait Posture. 2005; 23(4):523. DOI: 10.1016/j.gaitpost.2005.06.001. View

Montero-Odasso M, Verghese J, Beauchet O, Hausdorff J . Gait and cognition: a complementary approach to understanding brain function and the risk of falling. J Am Geriatr Soc. 2012; 60(11):2127-36. PMC: 3498517. DOI: 10.1111/j.1532-5415.2012.04209.x. View

10.

Leveille S, Fried L, Guralnik J . Disabling symptoms: what do older women report?. J Gen Intern Med. 2002; 17(10):766-73. PMC: 1495119. DOI: 10.1046/j.1525-1497.2002.20229.x. View

11.

Hausdorff J, Peng C, Goldberger A, Stoll A . Gait unsteadiness and fall risk in two affective disorders: a preliminary study. BMC Psychiatry. 2004; 4:39. PMC: 538754. DOI: 10.1186/1471-244X-4-39. View

12.

Verghese J, Holtzer R, Lipton R, Wang C . Quantitative gait markers and incident fall risk in older adults. J Gerontol A Biol Sci Med Sci. 2009; 64(8):896-901. PMC: 2709543. DOI: 10.1093/gerona/glp033. View

13.

Asai T, Misu S, Sawa R, Doi T, Yamada M . Multi-chronic musculoskeletal pain is a useful clinical index to predict the risk of falls in older adults with normal motor function. Aging Clin Exp Res. 2015; 27(5):711-6. DOI: 10.1007/s40520-015-0340-5. View

14.

Yogev-Seligmann G, Hausdorff J, Giladi N . The role of executive function and attention in gait. Mov Disord. 2007; 23(3):329-42. PMC: 2535903. DOI: 10.1002/mds.21720. View

15.

Allali G, Kressig R, Assal F, Herrmann F, Dubost V, Beauchet O . Changes in gait while backward counting in demented older adults with frontal lobe dysfunction. Gait Posture. 2007; 26(4):572-6. DOI: 10.1016/j.gaitpost.2006.12.011. View

16.

Lundin-Olsson L, Nyberg L, Gustafson Y . Attention, frailty, and falls: the effect of a manual task on basic mobility. J Am Geriatr Soc. 1998; 46(6):758-61. DOI: 10.1111/j.1532-5415.1998.tb03813.x. View

17.

Shah R, Buchman A, Boyle P, Leurgans S, Wilson R, Andersson G . Musculoskeletal pain is associated with incident mobility disability in community-dwelling elders. J Gerontol A Biol Sci Med Sci. 2010; 66(1):82-8. PMC: 3011961. DOI: 10.1093/gerona/glq187. View

18.

Coyle P, Velasco T, Sions J, Hicks G . Lumbar Mobility and Performance-Based Function: An Investigation in Older Adults with and without Chronic Low Back Pain. Pain Med. 2016; 18(1):161-168. PMC: 5283703. DOI: 10.1093/pm/pnw136. View

19.

Leveille S, Bean J, Ngo L, McMullen W, Guralnik J . The pathway from musculoskeletal pain to mobility difficulty in older disabled women. Pain. 2006; 128(1-2):69-77. PMC: 2555988. DOI: 10.1016/j.pain.2006.08.031. View

20.

Patel K, Guralnik J, Dansie E, Turk D . Prevalence and impact of pain among older adults in the United States: findings from the 2011 National Health and Aging Trends Study. Pain. 2013; 154(12):2649-2657. PMC: 3843850. DOI: 10.1016/j.pain.2013.07.029. View