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

  • Elisa F. Ogawa
    Affiliations
    New England GRECC, VA Boston Healthcare System, Boston, Massachusetts
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  • Ling Shi
    Affiliations
    College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
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  • Jonathan F. Bean
    Affiliations
    New England GRECC, VA Boston Healthcare System, Boston, Massachusetts

    Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts

    Spaulding Rehabilitation Hospital, Boston, Massachusetts
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  • Jeffrey M. Hausdorff
    Affiliations
    Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Department of Physical Therapy, Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel

    Rush Alzheimer’s Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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  • Zhiyong Dong
    Affiliations
    College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
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  • Brad Manor
    Affiliations
    Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts

    Department of Medicine, Harvard Medical School, Boston, Massachusetts
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  • Robert R. McLean
    Affiliations
    Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts

    Department of Medicine, Harvard Medical School, Boston, Massachusetts

    Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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  • Suzanne G. Leveille
    Correspondence
    Corresponding author Suzanne G. Leveille, PhD, College of Nursing and Health Sciences, University of Massachusetts Boston, 100 Morrissey Blvd, Boston, MA 02125.
    Affiliations
    College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts

    Department of Medicine, Harvard Medical School, Boston, Massachusetts

    Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Published:October 18, 2019DOI:https://doi.org/10.1016/j.apmr.2019.09.010

      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.

      Keywords

      List of abbreviations:

      MBSI (MOBILIZE Boston Study I), MBSII (MOBILIZE Boston Study II), MOBILIZE (Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly), TEA (Test of Everyday Attention)
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