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

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.

SUBMITTER: Ogawa EF

PROVIDER: S-EPMC7050337 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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

Ogawa Elisa F EF Shi Ling L Bean Jonathan F JF Hausdorff Jeffrey M JM Dong Zhiyong Z Manor Brad B McLean Robert R RR Leveille Suzanne G SG

Archives of physical medicine and rehabilitation 20191018 3

<h4>Objective</h4>To investigate a proposed cognitively-mediated pathway whereby pain contributes to gait impairments by acting as a distractor in community-living older adults.<h4>Design</h4>A cross-sectional study of a population-based cohort of older adults.<h4>Setting</h4>Urban and suburban communities in a large metropolitan area.<h4>Participants</h4>Community-living participants (N=302) 70 years and older recruited from a previous population-based cohort.<h4>Interventions</h4>Not applicabl ...[more]

PMID: 31634443

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Project description:To determine the effects of chronic pain on the development of disability and decline in physical performance over time in older adults.Longitudinal cohort study with 18 months of follow-up.Urban and suburban communities.Community-dwelling older adults aged 65 and older (N = 634).Chronic pain assessment consisted of musculoskeletal pain locations and pain severity and pain interference according to the subscales of the Brief Pain Inventory. Disability was self-reported as any difficulty in mobility and basic and instrumental activities of daily living (ADLs, IADLs). Mobility performance was measured using the Short Physical Performance Battery (SPPB). Relationships between baseline pain and incident disability in 18 months were determined using risk ratios (RRs) from multivariable Poisson regression models.Almost 65% of participants reported chronic musculoskeletal pain at baseline. New onset of mobility difficulty at 18 months was strongly associated with baseline pain distribution: 7% (no sites), 18% (1 site), 24% (multisite), and 39% (widespread pain, P-value for trend < .001). Similar graded effects were found for other disability measures. Elderly adults with multisite or widespread pain had at a risk of onset of mobility difficulty at least three times as great as that of their peers without pain after adjusting for disability risk factors (multisite pain: risk ratio (RR) = 2.95, 95% confidence interval (CI) 1.58-5.50; widespread pain: RR = 3.57, 95% CI = 1.71-7.48). Widespread pain contributed to decline in mobility performance (1-point decline in SPPB, RR = 1.47, 95% CI = 1.08-2.01). Similar associations were found for baseline pain interference predicting subsequent mobility decline and ADL and IADL disability. Weaker and less-consistent associations were observed with pain severity.Older community-dwelling adults living with chronic pain in multiple musculoskeletal locations have a substantially greater risk for developing disability over time and for clinically meaningful decline in mobility performance than those without pain.

Project description:Background: Recent studies associated gait patterns with cognitive impairment stages. The current study examined the relation between dementia type and spatiotemporal gait characteristics under different walking conditions in pre and mild neurocognitive disorder stage. Methods: Community-dwelling older adults (age 50+) with memory complaints consulting a memory clinic underwent, at baseline and during follow-up (every 4 months), a standard dementia assessment and a comprehensive spatiotemporal gait analysis [walking on an electronic walkway at usual pace (UP) with and without a counting-backwards (CW) or animal-reciting dual-task (AW), at fast (FP) and at slow (SP) pace]. At baseline the participants were categorized according to the Clinical Dementia Rating (CDR) scale. At the end of the study, the dementia diagnosis was used to stratify the categories in three outcome groups: developed "No-dementia," "AD+FTD" (grouping Alzheimer's or Fronto-temporal dementia) or "VascD+LBD" dementia (grouping Vascular dementia or Lewy body dementia). The gait characteristics were compared per category in paired groups. Sub-analyzing in the ≥70-years-old participants evaluated the age effect. Results: Five hundred and thirty-six participants, age 50-to-95-years old were followed for 31-to-41 months. In the CDR 0, no differences were seen between eventual dementia and no-dementia individuals. In the CDR 0.5, CW dual task cost (DTC) step width was larger in the imminent "AD+FTD" and AW (normalized) gait speed was slower in the future "VascD+LBD" group compared to the no-dementia participants. Slower UP (normalized) gait speed differed the future "VascD+LBD" from the "AD+FTD" individuals. In the CDR 1: Wider steps in UP, SP and CW differed the "VascD+LBD" from the "AD+FTD" group. In the ≥70-years old CDR 0 category, higher AW cycle time variability in the imminent "AD+FTD" dementia group, wider UP step width and higher AW cycle time variability in the "VascD+LBD" group differed them from the no-dementia group up to 3 years before dementia diagnosis. The distinctive gait characteristics between the no-dementia and the imminent dementia groups in CDR 0.5 and CDR 1 remained the same as in the overall group. However, no gait differences were found between "VascD+LBD" and "AD+FTD" groups in the pre-dementia stages. Conclusion: Distinctive spatiotemporal gait characteristics were associated with specific dementia types up to 3 years before diagnosis. The association is influenced by the cognitive stage and age.

Dataset Information

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

Publications

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

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