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Pain Intensity and Functional Outcomes for Activities of Daily Living, Gait and Balance in Older Adults Accessing Outpatient Rehabilitation Services: A Retrospective Study.

ABSTRACT: Purpose:Older adults are referred for outpatient physical therapy to improve their functional capacities. The goal of the present study was to determine if pain had an influence on functional outcomes in older adults who took part in an outpatient physical rehabilitation program. Patients and Methods:A retrospective study was performed on the medical records of patients aged 65 and over referred for outpatient physical therapy to improve physical functioning (n=178). Pain intensity (11-point numeric pain scale) and results from functional outcome measures (Timed Up and Go [TUG], Berg Balance Scale [BBS], 10-meter walk test, 6-minute walk test and Functional Autonomy Measuring System [SMAF]) were extracted at initial (T1) and final (T2) consultations. Paired t-tests were performed to determine if there were differences in functional outcome measures between T1 and T2 in all the patients. Patients were stratified to those with pain (PAIN, n=136) and those without pain (NO PAIN, n=42). Differences in functional outcome measures between T1 and T2 (delta scores) were compared between groups with independent t-tests with Welch corrections for unequal variances. Pearson correlation coefficients between initial pain intensity and changes in functional outcome measures (T2-T1) were also performed. Correcting for multiple comparisons, a p-value of p?0.01 was considered as statistically significant. Results:The TUG, BBS, 10-meter walk test, 6-minute walk test all demonstrated improvement between T1 and T2 (all p<0.01). There was no difference between groups for delta scores for TUG (p=0.14), BBS (p=0.03), 10-meter walk test (p=0.54), 6-minute walk test (p=0.94) and SMAF (p=0.23). Pearson correlation coefficients were weak between initial pain intensity and changes in functional outcome scores between T1 and T2 (r= -0.16 to 0.15, all p-values >0.10). Conclusion:These results suggest that pain is not an impediment to functional improvements in older individuals who participated in an outpatient physical rehabilitation program.

SUBMITTER: Pelletier R

PROVIDER: S-EPMC7423354 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Pain Intensity and Functional Outcomes for Activities of Daily Living, Gait and Balance in Older Adults Accessing Outpatient Rehabilitation Services: A Retrospective Study.

Pelletier R R Purcell-Levesque L L Girard M-C MC Roy P-M PM Leonard G G

Journal of pain research 20200807

<h4>Purpose</h4>Older adults are referred for outpatient physical therapy to improve their functional capacities. The goal of the present study was to determine if pain had an influence on functional outcomes in older adults who took part in an outpatient physical rehabilitation program.<h4>Patients and methods</h4>A retrospective study was performed on the medical records of patients aged 65 and over referred for outpatient physical therapy to improve physical functioning (n=178). Pain intensit ...[more]

PMID: 32821153

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Project description:BackgroundAging degrades the balance and locomotion ability due to frailty and pathological conditions. This demands balance rehabilitation and assistive technologies that help the affected population to regain mobility, independence, and improve their quality of life. While many overground gait rehabilitation and assistive robots exist in the market, none are designed to be used at home or in community settings.MethodsA device named Mobile Robotic Balance Assistant (MRBA) is developed to address this problem. MRBA is a hybrid of a gait assistive robot and a powered wheelchair. When the user is walking around performing activities of daily living, the robot follows the person and provides support at the pelvic area in case of loss of balance. It can also be transformed into a wheelchair if the user wants to sit down or commute. To achieve instability detection, sensory data from the robot are compared with a predefined threshold; a fall is identified if the value exceeds the threshold. The experiments involve both healthy young subjects and an individual with spinal cord injury (SCI). Spatial Parametric Mapping is used to assess the effect of the robot on lower limb joint kinematics during walking. The instability detection algorithm is evaluated by calculating the sensitivity and specificity in identifying normal walking and simulated falls.ResultsWhen walking with MRBA, the healthy subjects have a lower speed, smaller step length and longer step time. The SCI subject experiences similar changes as well as a decrease in step width that indicates better stability. Both groups of subjects have reduced joint range of motion. By comparing the force sensor measurement with a calibrated threshold, the instability detection algorithm can identify more than 93% of self-induced falls with a false alarm rate of 0%.ConclusionsWhile there is still room for improvement in the robot compliance and the instability identification, the study demonstrates the first step in bringing gait assistive technologies into homes. We hope that the robot can encourage the balance-impaired population to engage in more activities of daily living to improve their quality of life. Future research includes recruiting more subjects with balance difficulty to further refine the device functionalities.

Dataset Information

Pain Intensity and Functional Outcomes for Activities of Daily Living, Gait and Balance in Older Adults Accessing Outpatient Rehabilitation Services: A Retrospective Study.

Publications

Pain Intensity and Functional Outcomes for Activities of Daily Living, Gait and Balance in Older Adults Accessing Outpatient Rehabilitation Services: A Retrospective Study.

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