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

Publication date: Available online 18 October 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Elisa F. Ogawa, Ling Shi, Jonathan F. Bean, Jeffrey M. Hausdorff, Zhiyong Dong, Brad Manor, Robert R. McLean, Suzanne G. Leveille

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) aged 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 (e.g. counting backwards). 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, BMI, medication, and vision. Decrements in gait measures related to pain were comparable to 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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