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)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- 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: 2649-2657
- Disabling symptoms: what do older women report?.J Gen Int Med. 2002; 17: 766-773
- Pain characteristics associated with the onset of disability in older adults: the maintenance of balance, independent living, intellect, and zest in the Elderly Boston Study.J Am Geriatr Soc. 2014; 62: 1007-1016
- Musculoskeletal pain is associated with incident mobility disability in community-dwelling elders.J Gerontol A Biol Sci Med Sci. 2011; 66: 82-88
- Chronic musculoskeletal pain and the occurrence of falls in an older population.JAMA. 2009; 302: 2214-2221
- Cognitive contributions to gait and falls: evidence and implications.Mov disord. 2013; 28: 1520-1533
- Gait and cognition: a complementary approach to understanding brain function and the risk of falling.J Am Geriatr Soc. 2012; 60: 2127-2136
- Associations of musculoskeletal pain with mobility in older adults: potential cerebral mechanisms.J Gerontol A Sci Med Sci. 2017; 72: 1270-1276
- The relationship between pain, neuropsychological performance, and physical function in community-dwelling older adults with chronic low back pain.Pain Med. 2006; 7: 60-70
- Pain and cognitive function among older adults living in the community.J Gerontol A Biol Sci Med Sci. 2016; 71: 398-405
- Depressive symptoms, chronic pain, and falls in older community-dwelling adults: the MOBILIZE Boston Study.J Am Geriatr Soc. 2012; 60: 230-237
- Gait changes in patients with knee osteoarthritis are replicated by experimental knee pain.Arthritis Care Res (Hoboken). 2010; 62: 501-509
- The effect of age and knee osteoarthritis on muscle activation patterns and knee joint biomechanics during dual belt treadmill gait.J Electromyogr Kinesiol. 2017; 34: 58-64
- The pathway from musculoskeletal pain to mobility difficulty in older disabled women.Pain. 2007; 128: 69-77
- Gait unsteadiness and fall risk in two affective disorders: a preliminary study.BMC Psychiatry. 2004; 4: 1-7
- Normative spatiotemporal gait parameters in older adults.Gait Posture. 2011; 34: 111-118
- Gait dynamics, fractals and falls: findings meaning in the stride-to-stride fluctuations of human walking.Hum Mov Sci. 2007; 26: 555-589
- Biomechanical deviations during level walking associated with knee osteoarthritis: a systematic review and meta-analysis.Arthritis Care Res (Hoboken). 2013; 65: 1643-1665
- Quantitative gait markers and incident fall risk in older adults.J Gerontol A Biol Sci Med Sci. 2009; 64: 896-901
- Dual-task decrements in gait: contributing factors among healthy older adults.J Gerontol A Biol Sci Med Sci. 2008; 63: 1335-1343
- Dual-tasking effects on gait variability: the role of aging, falls, and executive function.Mov Disorder. 2006; 21: 950-957
- Dual tasking, gait rhythmicity, and Parkinson’s disease: which aspects of gait are attention demanding?.Eur J Neurosci. 2005; 22: 1248-1256
- The MOBILIZE Boston Study: design and methods of a prospective cohort study of novel risk factors for falls in an older population.BMC Geriatr. 2008; 8: 16
- Chronic pain and attention in older community-dwelling adults.J Am Geriatr Soc. 2018; 66: 1318-1324
- Dual-task costs while walking increase in old age for some, but not for other tasks: an experimental study of healthy young and elderly persons.J NeuroEng Rehabil. 2008; 5: 1-9
- Changes in gait while backward counting in demented older adults with frontal lobe dysfunction.Gait Posture. 2007; 26: 572-576
- Does fear of falling influence spatial and temporal gait parameters in elderly persons beyond changes associated with normal aging?.J Gerontol A Biol Sci Med Sci. 2005; 60: 1163-1167
- Sex modifies the relationship between age and gait: a population-based study of older adults.j gerontol A Biol sci med sci. 2008; 63: 165-170
- Reliability of the GAITRite walkway system for the quantification of temporo-spatial parameters of gait in young and older people.Gait Post. 2004; 20: 20-25
- Reliability of the GAITRite walkway system for the quantification of temporo-spatial parameters of gait in young and older people.Gait Posture. 2006; 23 ([author reply 524-5]): 523
- The structure of normal human attention: the Test of Everyday Attention.J Int Neuropsychol Soc. 1996; 2: 525-534
- Measuring attention in very old adults using the Test of Everyday Attention.Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2017; 24: 543-554
- Performance on the Test of Everyday Attention and standard tests of attention following severe traumatic brain injury.Clin Neuropsychol. 2003; 15: 405-422
- Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: executive summary. Expert panel on the identification, evaluation, and treatment of overweight in adults.Am J Clin Nutr. 2018; 68: 899-917
- The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations.J Pers Soc Psychol. 1986; 51: 1173-1182
- SAS/STAT ® 14.3 User’s Guide The CAUSALMED Procedure.SAS Institute Inc, Cary, NC2017
- The severity and number of musculoskeletal pain associated with gait in community-dwelling elderly individuals.Gait Posture. 2017; 54: 242-247
- 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: 711-716
- The role of executive function and attention in gait.Mov Disord. 2008; 23: 329-342
- Gait stability and variability measures show effects of impaired cognition and dual tasking in frail people.J NeuroEng Rehabil. 2011; 8: 2
- Attention, frailty, and falls: the effect.J Am Geriatr Soc. 1998; 46: 758-761
- Systematic review of quantitative clinical gait analysis in patients with dementia.Z Gerontol Geriatr. 2004 Feb; 37: 27-32
- Quantitative normative gait data in a large cohort of ambulatory persons with parkinson’s disease.PLoS One. 2012; 7: 4-8
- 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: 1616-1623
- The relationship among neuromuscular impairments, chronic back pain, and mobility in older adults.PM. R 2016; 8: 738-747
- Lumbar mobility and performance-based function: an investigation in older adults with and without chronic low back pain.Pain Med. 2017; 18: 161-168
- Fear-avoidance beliefs are associated with disability in older American adults with low back pain.Phys Ther. 2011; 91: 525-534
- Fear of falling and gait parameters in older adults with and without fall history.Geriatr Gerontol Int. 2017; 17: 2455-2459
Article info
Publication history
Published online: October 18, 2019
Footnotes
Supported by the National Institute on Aging (grant nos. R01AG041525 and P01AG004390).
Disclosures: none.
Identification
Copyright
© 2019 by the American Congress of Rehabilitation Medicine
