Pain Is Associated With Poor Balance in Community-Dwelling Older Adults: A Systematic Review and Meta-analysis

Sensory integration strategies on repeated postural stability and neuromuscular adaptation in individuals with low back pain

BACKGROUND

Individuals with low back pain (LBP) often exhibit balance impairments resulting from altered neuromuscular control and sensory integration deficits.

PURPOSE

This study aimed to compare differences in sway excursion and neuromuscular responses in maintaining spatial orientation and equilibrium between adults with and without LBP under eyes-open and eyes-closed conditions.

METHODS

Thirty-two adults with LBP and 40 control subjects performed three repeated trials of unilateral standing tasks on a force platform. Center of pressure (COP) displacement on anteroposterior (AP) and mediolateral (ML) directions, center of gravity (COG), and COP-COG displacement were analyzed to assess postural stability and neuromuscular responses.

RESULTS

For COP sway excursion, significant group interactions were observed between visual condition and repetition (F(2, 136) = 4.03, p < 0.05). Neuromuscular responses, assessed by COP-COG displacement, demonstrated significant group interactions across visual condition (F(1, 68) = 7.19, p < 0.01), repetition (F(2, 136) = 4.26, p < 0.05), and the combined effect of visual condition and direction (F(1, 68) = 8.15, p < 0.01). In the LBP group, neuromuscular response increased significantly in both eyes-open (t = -1.84, p < 0.05) and eyes-closed (t = 2.16, p < 0.05) conditions during the third trial in the ML direction.

CONCLUSION

These findings suggest that individuals with LBP exhibit distinct sway excursions under eyes-open conditions, but do not when their eyes are closed. The control group relied more on vision to maintain balance than the LBP group, who appeared to struggle with balance regulation independent of visual cues.

Changes in cerebral cortex activation during upright standing tasks in individuals with chronic neck pain: an fNIRS study

Introduction

Studies show that individuals with chronic neck pain (CNP) exhibit postural control deficits, potentially contributing to persistent and recurrent pain. However, the neural mechanisms underlying these deficits in CNP remain unexplored despite their importance for developing effective rehabilitation strategies. Therefore, this study aimed to investigate the neural activity during postural control using functional near-infrared spectroscopy (fNIRS), providing insights into the central mechanism underlying postural control deficits in individuals with CNP.

Methods

In this cross-sectional study, 10 individuals with CNP (CNP group) and 10 healthy controls (HC group) were assessed under three conditions: Task 1, standing on a force plate with eyes open and both feet; Task 2, standing on a force plate with eyes closed and both feet; Task 3, standing on a force plate with eyes closed and one foot. Cerebral cortex hemodynamic reactions, including bilateral prefrontal cortex (PFC), dorsolateral prefrontal cortex (DLPFC), pre-motor cortex and supplementary motor area (PMC/SMA), primary motor cortex (M1), and primary somatosensory cortex (S1) were measured using fNIRS. Balance parameters, including the sway area, total sway length, mean velocity, and center of pressure (COP) amplitude in the anterior-posterior (AP) and medial-lateral (ML) directions, were measured using a force plate.

Results

In Tasks 1 and 2, no differences were observed between both groups in balance parameters. However, the CNP group exhibited significantly higher activation in the left PMC/SMA (F = 4.788, p = 0.042) and M1 (F = 9.598, p = 0.006) in Task 1 and lower activation in the left (F = 4.952, p = 0.039) and right (F = 6.035, p = 0.024) PFC in Task 2 compared to that of the HC group. In Task 3, the CNP group exhibited a significantly larger COP amplitude in the AP direction (F = 7.057, p = 0.016) compared to that of the HC group. Additionally, activation in the right M1 (F = 7.873, p = 0.012) was significantly higher than in the HC group. Correlation analysis in Task 3 revealed stronger associations between the parameters in the CNP group.

Conclusion

Our findings suggest that individuals with CNP exhibit distinct patterns of cerebral cortex activities and postural control deficits. The PFC, M1, and PMC/SMA were involved in maintaining upright standing balance, and cerebral cortex changes associated with upright standing balance provide a more sensitive indicator of postural control deficits than peripheral balance parameters in individuals with CNP.

Effects of Visual Input on Postural Stability and Compensatory Strategies in Adults with Chronic Low Back Pain

Chronic low back pain (LBP) impairs balance control due to deficits in sensory integration, yet limited research examines postural sway under varying visual conditions. This study assessed the effects of visual input on postural stability using the normalized stability index, sway excursions, and contralateral toe-touch durations during repeated one-leg standing tasks. Thirty-two adults with LBP and 40 control subjects performed dominant limb standing on a force plate. Outcome measures included the Oswestry disability index, visual analog scale, normalized stability index, sway excursions (anteroposterior [AP], mediolateral [ML]), and contralateral toe-touch duration. The LBP group showed a significant interaction for the normalized stability index under visual conditions (F = 4.95, p = 0.03) with reduced stability in the second trial of the eyes-open condition (t = 1.71, p = 0.04). Sway excursions increased in the AP direction during the first trial (t = -2.43, p = 0.01) and in the ML (t = -2.09, p = 0.02) and AP (t = -1.84, p = 0.03) directions during the third trial. Contralateral toe-touch duration increased in the second trial (t = -2.06, p = 0.02). Individuals with LBP exhibited balance deficits, particularly under eyes-open conditions, relying on compensatory strategies. Optimizing neuromuscular control and sensory integration may improve postural stability.

Association of Pain With Falls and Fractures Among Middle-Aged Korean Community-Dwelling Adults

BACKGROUND

The relationship between pain and falls remains controversial. Therefore, this study explored the associations between pain and fall-related outcomes in 5 340 middle-aged (45-65 years) adults residing in the communities in Korea.

METHODS

Pain was defined as pain at any location, pain-related activity restriction, and persistent pain. The outcome measures included fall injuries, recurrent falls, injurious falls, and fall-related hip fractures. A multivariate logistic regression model was used to examine the relationship between pain and fall outcome.

RESULTS

Among the study participants, 54.0% reported having experienced pain. During a follow-up period of up to 14 years, those who reported pain and pain-related activity restriction at baseline exhibited a positive association with the occurrence of fall injury (odds ratio [OR] 1.79, 95% confidence interval [CI]: 1.27-2.53) and injurious falls (OR 1.72, 95% CI: 1.20-2.48) but not with recurrent falls (OR 1.90, 95% CI: 0.80-4.54). We also observed a positive association between persistent pain and the risk of fall injury (OR 1.41, 95% CI: 1.13-1.91), whereas no consistent conclusions were drawn regarding the risk of recurrent falls and injurious falls. We also did not identify any correlation between pain and hip fractures resulting from falls.

CONCLUSIONS

In conclusion, our findings of the positive correlations of pain and pain-related activity restriction at baseline with fall injuries and injurious falls but not recurrent falls during follow-up suggest that public health initiatives should prioritize pain screening, especially for participants reporting ankle and toe pain, and implement suitable interventions to mitigate the risk of falls and the associated adverse outcomes among middle-aged adults.

Implications for fall efficacy strategies on center of pressure and center of gravity sway distances in adults with chronic low back pain

BACKGROUND

Although chronic low back pain (LBP) is a complex condition often associated with altered motor control and compensatory postural adjustments, existing literature provides inconsistent reports on the underlying control mechanisms for maintaining balance.

PURPOSE

This study aimed to compare differences in sway distances between the center of pressure (COP) and the center of gravity (COG), while considering limb dominance, in adults with and without LBP.

METHODS

There were 26 subjects with LBP and 39 control subjects who performed three repeated unilateral standing tasks on a force platform. Outcome measures included the sway distances between COP and COG in the anteroposterior (AP) and mediolateral (ML) directions, as well as the results of the fall efficacy scale (FES).

RESULTS

A significant group interaction was demonstrated on limb dominance and direction for the sway distance (F = 5.46, p = 0.02). Specifically, the third trial in the ML direction while standing on the dominant limb indicated a significant difference in COP-COG sway distance (t = -2.30, p = 0.01). When FES scores were used as a covariate, a significant three-way interaction (dominance x direction x trial) was found (F = 4.06, p = 0.04).

CONCLUSION

Although no significant group interaction was observed for dominance, direction, and trial, the LBP group demonstrated an ability to leverage fall efficacy following repeated trials to reduce ML balance deficits. Clinicians should consider neuromuscular control and limb dominance when developing fall efficacy strategies for postural adaptations in adults with LBP.

Biomechanical analysis of limits of stability using computerized posturography: correlations with functional mobility in elderly individuals with hip osteoarthritis - a cross-sectional study

Background

Hip osteoarthritis (OA) is a degenerative joint disease that predominantly affects the elderly, causing significant morbidity due to joint pain, stiffness, and loss of function. This study aimed to assess the limits of stability (LOS) using computerized posturography and evaluate the correlations with functional mobility in elderly individuals with hip OA.

Methods

This cross-sectional study included elderly individuals aged 65 years and above with a clinical diagnosis of hip OA and age-matched asymptomatic controls. The LOS was measured using a computerized dynamic posturography system, which quantified the maximum distance and angle participants could shift their center of gravity without losing balance. Functional mobility was assessed using the Timed Up and Go (TUG) test, which measures the time taken for participants to stand up, walk 3 m, turn around, walk back, and sit down.

Results

The study included 86 elderly individuals with hip OA and 86 age-matched asymptomatic controls. LOS assessments showed that individuals with hip OA had significantly lower stability scores across all directions compared to controls (p < 0.001). TUG test times were significantly slower for the OA group (10.50 ± 2.20 s) compared to controls (8.70 ± 2.00 s, p < 0.001). Positive correlations were found between LOS and functional mobility (r = 0.50, p = 0.009). Moderation analysis revealed that age and duration of OA significantly influenced the relationship between stability and mobility.

Conclusion

Hip OA significantly impacts stability and functional mobility in elderly individuals. Enhanced stability is associated with improved mobility, and demographic and clinical variables such as age and duration of OA play crucial roles in these relationships. These findings underscore the importance of targeted therapeutic interventions to improve stability and mobility in this population.

Postural control among older adults with fear of falling and chronic low back pain

OBJECTIVE

Altered Postural control could increase the risk of falling in older adults. Factors such as low back pain and fear of falling can be contributing factors to postural control instability. This study aimed to investigate the effect of chronic low back pain (CLBP) and fear of falling (FOF) on postural control of older adults.

METHOD

Forty-one older adults were included (27 LBP and 14 control). Among the participants, 22 people had high FOF, and 19 had low FOF based on Falls efficacy scale cut-off of ≥ 26. For postural control evaluation Center of pressure parameters (COP) of Standard deviation (Sd) of velocity, Sd of amplitude, path length and mean velocity in both Medial-lateral (ML) and Anterior-Posterior (AP) directions were measured. Mixed-model anova with two between group factor (Health status; with and without CLBP, and with high and low FES-I groups) and one within factor postural condition (four conditions with and without vision and Achill tendon vibration) was used.

RESULT

No significant interaction between groups (health status and FES-I) and group with condition (health status and condition or FES-I and condition) was observed for all COP parameters in both AP and ML direction. There was main effect of FES-I for all COP parameters in ML direction, with greater Sd of velocity, Sd of amplitude, path length and mean velocity in older adults with high FES-I compared to low FES-I in the ML direction.

CONCLUSION

High levels of FOF influenced static postural control in the ML direction. Therefore, paying attention to the lateral stability of older adults is of great importance.

The relationship between kinesiophobia, balance, and upper extremity functions in patients with painful shoulder pathology

BACKGROUND

Poor balance ability may contribute to shoulder pathology in patients with existing shoulder pathologies or vice versa. The relationship between kinesiophobia and chronic shoulder pain intensity has been researched, although the conclusions are conflicting. To our knowledge, no study in the literature explores the association between kinesiophobia and balance in patients with shoulder pain.

OBJECTIVE

To investigate the relationship between kinesiophobia, upper extremity functions, and balance abilities in patients with shoulder pain.

DESIGN

Cross-sectional observational study.

SETTING

Physical medicine and rehabilitation hospital.

INTERVENTIONS

Not applicable.

PARTICIPANTS

A total of 44 patients with shoulder pain were included in the study.

MAIN OUTCOME MEASURES

The pain severity was assessed using a visual analog scale (VAS). The Tampa Scale for Kinesiophobia (TSK), Berg Balance Scale (BBS), and Shoulder Pain and Disability Index (SPADI) were used to assess the patients. Ultrasound was used to diagnose underlying shoulder joint problems. Static and dynamic postural control was evaluated.

RESULTS

The most common pathologies detected by ultrasound were supraspinatus tendinitis/rupture (77.3%), cortical irregularity (68.2%), and bursitis (63.6%). TSK score did not correlate with age, body mass index, symptom duration, or VAS score in rest (all p > .05), but it was associated with scores on the BBS (r = -0.437, p = .003), SPADI-pain (r = 0.474, p = .001), SPADI-disability (r = 0.355, p = .018), SPADI-total (r = 0.405, p = .006), and VAS in activity (r = 0.331, p = .028). According to multiple linear regression analysis, BBS score, SPADI-total score, and anterior-posterior sway length were significant predictors of TSK (r = 0.645, r2 = 0.416).

CONCLUSIONS

According to the findings of this study, the main risk factors for high levels of kinesiophobia are poor balance, severe pain, and disability. In addition to mechanical causes of shoulder pain, diagnosing and intervening on underlying balance issues and psychosocial causes of shoulder pain will improve treatment success.

Factors Related to Recurrent Falls Among Older Adults Attending Primary Health Care: A Biopsychosocial Perspective

The objective of this study was to investigate factors related to recurrent falls among older adults attending primary health care, considering the biopsychosocial perspective. A representative sample of 201 older adults were interviewed in three Primary Health Care units randomly selected in a city in southeastern Brazil. Outcome included self-report of two or more falls in the past 12 months. Exposures included personal and environmental aspects, according to domains of International Classification of Functioning of the World Health Organization (ICF-WHO). Recurrent falls were reported by 24.4% of the participants. Associations with depressive symptoms (p = .003), having osteoporosis (p = .031), chronic musculoskeletal pain (p = .020), frailty (p = .013), sleep satisfaction (p < .001), and functional status (p < .001) were found. In logistic regression models, cognitive status, musculoskeletal pain, and functional status were predictors of recurrent falls; however, only sleep satisfaction remained significant in the final model. Strategies aimed at preventing recurrent falls in primary health care should consider assessments and interventions targeting sleep aspects among older adults.

Divine resilience: Unveiling the impact of religious coping mechanisms on pain endurance in arab older adults battling chronic pain

BACKGROUND

Chronic pain diminishes the quality of life for many Older Adults individuals. Identifying effective coping methods to enhance pain resilience is imperative as populations age. Older Adults commonly use religious faith and spiritual practices to endure pain, yet little research has explored their impact on pain tolerance.

METHODS

This cross-sectional study examined relationships between positive/negative religious coping styles and pain endurance in 200 Arab elders with chronic pain. Participants completed the Brief Arab Religious Coping Scale, Numeric Pain Rating Scale, WHOQOL-BREF, and demographic/medical history questionnaires.

RESULTS

Quantitative analysis demonstrated significant positive associations between positive religious reappraisal and active spiritual coping with higher self-reported pain endurance (p<.05). Negative religious coping styles lacked meaningful relationships with pain tolerance. Multiple regression confirmed the unique effects of reappraisal and spiritual practice on improving pain resilience, controlling for covariates.

CONCLUSIONS

Outcomes align with perspectives highlighting multidimensional neurocognitive, emotional, and psychosocial pain relief from religious coping. Findings underscore integrating positive faith-based resources in biopsychosocial paradigms for Older Adult's pain management. Additional research should investigate causal pathways and contextual factors influencing religious coping effects on diverse Older Adult subgroups.

Association between central sensitization, pain sensitivity and balance control in patients with migraine

BACKGROUND

Balance alterations are prevalent among pain conditions, including migraine. The mechanisms explaining the association between pain and balance are unclear, as well as whether levels of pain sensitivity correlate with impaired balance. Our aim was therefore to investigate the association between balance, central sensitization symptoms and pain sensitivity in patients with migraine.

METHODS

This cross-sectional study included 50 patients and demographic, clinical information, central sensitization inventory (CSI) and pain catastrophizing (PCS) scores were obtained. Patients underwent a standardized protocol evaluating balance and pain thresholds for cold (CPT), heat (HPT), mechanical (MPT) and pressure (PPT) in trigeminal (V1) and extra-trigeminal (C6) dermatomes. Data were analysed using Person's correlation, linear regression models and contrasting the presence and absence of central sensitization symptoms through T-tests.

RESULTS

Mild-to-moderate correlations were observed between balance and MPT in V1 (r = -0.24, p = 0.046) and C6 (r = -0.41, p = 0.002), CPT in V1 (r = 0.31, p = 0.026), CSI scores (r = 0.27, p = 0.029) and migraine frequency (r = 0.25, p = 0.040). Balance was explained by CPT and MPT (R2 = 0.32, p = 0.001). The variance of CSI was explained by PCS scores and balance (R2 = 0.28, p = 0.001). Patients with symptoms of central sensitization presented an increased balance impairment (p = 0.044) and higher catastrophizing levels (p = 0.001) in contrast to patients without symptoms.

CONCLUSION

Balance impairment is associated with reduced pain thresholds and higher CSI scores. These results may help to elucidate the aetiology of balance alterations among chronic pain conditions.

SIGNIFICANCE

For the first time, it has been shown that balance alterations can reflect greater pain sensitivity and signs of central sensitization in patients with migraine. This opens up perspectives for future studies to understand the mechanisms and further factors associated with balance and pain sensitivity in migraine.

Balancing act: Unraveling the link between muscle strength, proprioception, and stability in unilateral hip osteoarthritis

The objectives of this study are to compare hip muscle strength, hip joint proprioception, and functional balance between individuals with unilateral hip OA and asymptomatic individuals and to examine the relationships among these variables in the hip OA population. In a prospective cross-sectional study, 122 participants (unilateral Hip OA: n = 56, asymptomatic: n = 56) were assessed at the CAMS/KKU musculoskeletal Physical Therapy laboratory. Ethical standards were upheld throughout the research, with informed consent obtained. Hip muscle strength was measured using a hand-held dynamometer, hip joint proprioception with a digital inclinometer, and functional balance using the Berg Balance Scale (BBS) and Timed Up and Go (TUG) test. Hip OA individuals exhibited significantly lower muscle strength and proprioceptive accuracy, and poorer functional balance than controls (p < 0.003). Correlation analyses revealed a positive correlation between muscle strength and BBS scores (r = 0.38 to 0.42) and a negative correlation with TUG test times (r = -0.36 to -0.41). Hip joint reposition sense (JRS) in flexion showed a negative correlation with balance (r = -0.46), while JRS in abduction was positively correlated (r = 0.46). The study highlights the clinical importance of muscle strength and proprioception in functional balance among individuals with unilateral hip OA. The results support the incorporation of muscle strengthening and proprioceptive training in interventions to improve balance and mobility in this population.

Examining the Role of Physical Function on Future Fall Likelihood in Older Adults With a Fear of Falling, With and Without Activity Restriction

ObjectivesAssess the influence of physical function on balance and future falls in older adults with fear of falling (FOF) and whether activity restriction modifies the contribution to falls. Methods: Analyses utilized data from Baltimore Longitudinal Study of Aging (n = 680) and National Health and Aging Trends Study (n = 4376) community-dwelling older adults. The role of physical function was examined by comparing balance performance and future fall odds before/after controlling for function in older adults with/without FOF. Fall likelihood analyses were repeated with FOF stratified by activity restriction. Results: When controlling for physical function, differences in balance and fall odds secondary to FOF/activity restricting FOF reduced but remained significant. Fall odds secondary to non-activity restricting FOF only slightly decreased. Discussion: Physical function contributes to balance and falls in older adults with FOF, more so in those restricting activity. Reduced balance and increased fall risk persists independent of function suggesting additional contributing factors.

Therapeutic Potential of Downregulated Interleukin-6 Signaling for the Treatment of Chronic Pain: A Mendelian Randomization Study

Introduction

While numerous studies have emphasized the pivotal involvement of the Interleukin 6 (IL-6) pathway in the development of chronic pain, the causal nature of this relationship remains uncertain.

Methods

In this study, we opted to include genetic variants situated within the locus of the IL-6 receptor (IL-6R) that exhibited associations with C-reactive protein (CRP) levels. CRP serves as a downstream effector in the IL-6 pathway. Utilizing these variants as genetic proxies, we aimed to modulate IL-6 signaling. Employing a two-sample Mendelian randomization (MR) approach, we investigated the potential link between the genetic proxy and seven distinct subtypes of chronic pain, categorized based on their corresponding body locations. Moreover, we examined the relationship between chronic pain and an alternative instrument of IL-6 signaling that was weighted based on s-IL-6R levels. Furthermore, we conducted exploratory analyses to estimate the plausible causal association between CRP, gp130, and the subtypes of chronic pain.

Results

Our analysis showed that genetic proxied downregulation of IL-6 signaling, weighted on CRP levels, was linked to a reduced risk of chronic back and knee pain. The sensitivity analyses across various MR methods confirmed the consistency of the findings and showed no evidence of horizontal pleiotropy or heterogeneity. Moreover, the results remained robust with different sets of instrument variables. A genetically increased level of s-IL-6R was also negatively associated with chronic back and knee pain. However, there was no causal relationship between CRP and gp130 with chronic pain.

Conclusion

Based on our findings, there is evidence to suggest a potential causal relationship between IL-6 signaling and chronic back and knee pain. Consequently, the downregulation of IL-6 signaling holds promise as a potential therapeutic target for addressing chronic back and knee pain.

Anterior knee pain as a potential risk factor for falls in older adults: insights from the osteoarthritis initiative data

BACKGROUND

Knee joint pain has been demonstrated to be a separate risk factor for falling. A common pain site in the knee, anterior knee pain(AKP), is believed to be associated with early knee osteoarthritis (KOA).This study investigated the relationship between falls and AKP in people with or at risk for KOA.

METHODS

Four years of follow-up data from the Osteoarthritis Initiative cohort trial, a large-scale, multicenter observational investigation, were analyzed in this study. A patellar quadriceps tenderness/tendinitis knee exam was performed to evaluate AKP. Falls were self-reported. The associations between falls (recurrent falls: ≥2 falls/year; any falls: ≥1 fall(s)/year) and AKP were analyzed using the generalized estimation equation of repeated logistic regression and adjusted for confounding variables.

RESULTS

The study analyzed data from 3,318 participants, split into two groups: those with AKP (720 participants) and those without AKP (2,598 participants). The primary outcome of the study, which focused on repeated falls, revealed that participants with AKP were 1.27 times more likely to experience repeated falls compared to those without AKP (95% CI: 1.07-1.52, P = 0.007). However, when considering any falls experienced by an individual as an additional outcome, it is important to note that our findings did not indicate a significant predictive effect of AKP on any falls investigated. Sensitivity analyses, which excluded knee arthroplasty cases, yielded consistent results with the aforementioned findings.

CONCLUSIONS

Older adults with AKP experience a higher frequency of falls compared to those without AKP in individuals diagnosed with KOA or at a high risk of developing KOA.

Functional and Neural Correlates Associated with Conditioned Pain Modulation in Patients with Chronic Knee Osteoarthritis Pain: A Cross-Sectional Study

Background: In this study, we aimed to assess the factors that predict a dysfunctional conditioned pain modulation (CPM) in chronic knee OA. Methods: This is a cross-sectional analysis of patients with chronic knee OA from a prospective cohort study in Brazil (n = 85). We performed linear and logistic multivariate regression models using the purposeful selection approach to test the relationship between the CPM in both knees (average) as a dependent variable and demographics, clinical, and neurophysiological as independent variables. Results: A significant negative association between WOMAC pain scores and CPM (β: -0.13) was found. This association was modified by the subjects' race, being stronger in the non-white subjects. In our logistic regression models, pain intensity indexed with the WOMAC pain scale remained a significant association with dichotomized CPM. Furthermore, a significant CPM association with balance, indexed with the Berg Balance score, was evidenced (β: 0.04). Neurophysiological variables showed a significant negative relationship with CPM, such as the relative power of delta oscillations in the frontal area (β: -3.11) and central area (β: -3.23). There was no significant relationship between CPM and the following domains: cognitive, emotion, sleep, opioid receptor polymorphisms, and intrinsic variables of OA disease. There was no association of CPM with TMS-indexed inhibitory markers. Conclusions: These results may indicate that less function of the pain descending inhibitory system in patients with OA is correlated with higher activity-related pain (WOMAC), less balance, and cortical plasticity especially with increased low-frequency (delta) brain oscillations. These associations seem modified by race.

Risk Factors for Falls and Fall-Related Fractures in Community-Living Older People with Pain: A Prospective Cohort Study

(1) Background: This prospective study aimed to identify predictors of falls and fall-related fractures in community-dwelling older people with pain; (2) Methods: Participants comprised 389 community-dwelling older people aged 70+ years who had musculoskeletal pain in the neck, back, hip, leg/knee and/or feet. Demographic, anthropometric, balance, mobility, cognitive function, psychological status and physical activity level measures were obtained at baseline. Falls were monitored with monthly falls calendars for 12 months. Logistic regression analyses were performed to identify predictors of falls and fall-related fractures during a 12-month follow-up; (3) Results: Of the 389 participants, 175 (45.0%) and 20 (5.1%) reported falls and fall-related fractures during the 12-month follow-up, respectively. Greater postural sway on foam, more depressive symptoms and lower physical activity levels at baseline were associated with falls during the 12-month follow-up. Slower walking speed at baseline was associated with fall-related fractures during the 12-month follow-up. These associations remained significant after adjusting for age, sex, body mass index, comorbidities and medication use; (4) Conclusions: This study suggests poor balance, low mood and a less active lifestyle are predictors of falls, and slower walking speed predicts fall-related fractures among community-dwelling older people with pain.

Pain severity, distribution, and duration are associated with spatiotemporal gait performance in community-dwelling older adults with chronic musculoskeletal pain

BACKGROUND

Our current understanding of the impact of chronic pain on spatiotemporal gait performance has mainly been achieved through comparison studies between individuals with and without chronic pain. Further investigation into the relationship between specific outcome measures of chronic pain and gait may improve our understanding of the impact of pain on gait and may benefit future interventions that aim to improve mobility in this population.

RESEARCH QUESTION

Which pain outcome measures are associated with spatiotemporal gait performance in older adults with chronic musculoskeletal pain?

METHODS

This study was secondary analysis of older adult participants enrolled in the Neuromodulatory Examination of Pain and Mobility Across the Lifespan (NEPAL) study (n = 43). Pain outcome measures were obtained using self-reported questionnaires, and spatiotemporal gait analysis was conducted using an instrumented gait mat. Separate multiple linear regressions were run to determine which pain outcome measurements were associated with gait performance.

RESULTS

Higher pain severities were associated with shorter stride lengths (β = -0.336, p = 0.041), shorter swing times (β = -0.345, p = 0.037), and longer double support times (β = 0.342, p = 0.034). A greater number of pain sites was associated with a wider step width (β = 0.391, p = 0.024). Longer pain durations were associated with shorter double support times (β = -0.373, p = 0.022).

SIGNIFICANCE

The results of our study illustrate that specific pain outcomes measures are associated with specific gait impairments in community-dwelling older adults with chronic musculoskeletal pain. As such, pain severity, number of pain sites, and pain duration should be considered when developing mobility interventions in this population to reduce disability.

A Cross-Sectional Study on Mediating Effect of Chronic Pain on the Relationship between Cervical Proprioception and Functional Balance in Elderly Individuals with Chronic Neck Pain: Mediation Analysis Study

(1) Background: Cervical proprioception maintains head orientation in space and contributes to maintaining bodily balance. Evaluating cervical proprioception in elderly individuals with chronic neck pain (CNP) and understanding how pain intensity mediates the relationship between proprioception and functional balance helps formulate treatment strategies for this population. The objectives of this study are to (a) compare the cervical proprioception and functional balance between CNP and asymptomatic, (b) investigate the relationship between cervical proprioception and functional balance ability in CNP individuals and (c) mediation effect of chronic pain on the relationship between cervical proprioception and functional balance tests (2) Methods: This cross-sectional comparative study recruited 60 elderly individuals with a diagnosis of CNP (mean age: 66.40 years) and 60 asymptomatic (mean age: 66.42 years). The cervical proprioception is measured using the target head repositing technique. The subjects were asked to close their eyes and reposition their head actively to the target position from the neutral position, and the reposition accuracy is estimated as joint position errors (JPE) in degrees. The cervical proprioception was measured in the directions of flexion, extension, and left and right rotation. The functional balance was assessed using the berg balance test (BBS) score and timed-up-and-go (TUG) test in seconds. (3) Results: The elderly individuals with CNP had increased cervical JPE compared to the asymptomatic group (p < 0.001) in all the directions tested, indicating that cervical proprioception is impaired in CNP patients. Moreover, the CNP individual functional balance is significantly impaired (p < 0.001) compared to asymptomatic. The BBS test scores were lower, and the TUG scores were higher in the CNP group. In CNP individuals, the cervical JPE showed a significant correlation with the BBS test scores (r = -0.672 to -0.732, p < 0.001) and TUG scores (r = 0.328 to -0.414, p < 0.001). (4) Conclusions: Cervical proprioception and functional balance are impaired in elderly individuals with CNP. Physical therapists and rehabilitation professionals may consider these factors during the evaluation and development of treatment strategies in elderly adults with CNP.

Foot and ankle characteristics associated with fear of falling and mobility in community-dwelling older people: a cross-sectional study

BACKGROUND

Fear of falling is multifactorial in etiology and is associated with falls. It has been demonstrated that foot problems increase the risk of falls in older people. Therefore, the objective of this study was to investigate the associations of foot and ankle characteristics with fear of falling and mobility in community-dwelling older people.

METHOD

One hundred and eighty-seven community-dwelling older adults (106 females) aged 62-90 years (mean 70.5 ± 5.2) from Isfahan, Iran, were recruited. Foot and ankle characteristics (including foot posture, range of motion, muscle strength, deformity, tactile sensation, pain and dynamic function), fear of falling (Fall Efficacy Scale International) and mobility (Timed Up and Go Test) were measured. Two multivariate linear regression analyses identified variables independently associated with fear of falling and mobility.

RESULTS

Linear regression analysis revealed that less ankle plantarflexor muscle strength, greater pressure-time integral, foot pain, and reduced tactile sensitivity of the ankle were significantly and independently associated with increased fear of falling. The total variance explained by the model was 59%. Less ankle plantarflexor muscle strength, greater pressure-time integral, and slower centre of pressure velocity were significantly and independently associated with poorer mobility. The total variance explained by the model was 48%.

CONCLUSION

Several foot and ankle characteristics are associated with fear of falling and mobility in older people. Targeting these modifiable risk factors may play a role in reducing fear of falling and enhancing mobility performance in this population.

Tai Chi for spatiotemporal gait features and dynamic balancing capacity in elderly female patients with non-specific low back pain: A six-week randomized controlled trial

BACKGROUND

Non-specific low back pain (NS-LBP) is a serious public health problem. Tai Chi is promising in reducing the risk of falls and alleviating symptoms in this population.

OBJECTIVE

To investigate the effect of Tai Chi on gait and dynamic balance in elderly women with NS-LBP.

METHODS

20 women (age > 65 yr.) with NS-LBP were randomly assigned to a Tai Chi group (n= 10) or a control group (n= 10). The Tai Chi group practiced Tai Chi exercise 3 times a week for 6 weeks. Each session lasted 60 minutes. Pain, spatiotemporal gait features and dynamic balancing capacity were assessed at 0 and 6 weeks.

RESULTS

Compared to the control group at 6 weeks, the Tai Chi group had a significant decrease in VAS (p= 0.027) and stride width (p= 0.019), significant improvement in gait velocity, stride length (p< 0.001). Regarding dynamic balance capacity, the Tai Chi group had significant improvements in anterior (Left: p= 0.001; Right: p= 0.038), postero-lateral (Left: p< 0.001; Right: p= 0.038), and postero-medial (Left: p= 0.015; Right: p= 0.018).

CONCLUSION

6-week Tai Chi can relieve pain and improve gait and dynamic balance in elderly women with NS-LBP, which suggests Tai Chi could be a promising rehabilitation intervention to reduce the risk of falls in this population.

Effectiveness of interventions for middle-aged and ageing population with neck pain: a systematic review and network meta-analysis protocol

INTRODUCTION

Neck pain (NP) is a common musculoskeletal complaint and is increasing in prevalence. Current clinical practice guidelines and systematic reviews recommended conservative, pharmacological and invasive interventions for individuals with NP. However, optimal management specifically for those who are middle-aged or older adults (≥45 years) is not available; and important considering our ageing population.

METHODS AND ANALYSIS

A systematic review with network meta-analysis (NMA) will be conducted following the Cochrane guidelines. Eligibility criteria include randomised controlled/clinical trials evaluating any of acute (<3 months) or chronic (≥3 months) non-specific NP, whiplash associated disorders, cervical radiculopathy and cervicogenic headache. Any interventions and outcome measures detailed within The International Classification of Functioning, Disability and Health domains will be included. Two independent reviewers will search key databases (AMED, CENTRAL, CINAHL, Embase, MEDLINE, PEDro and PsycINFO), grey literature, key journals and reference lists in May 2022. Two reviewers will decide eligibility and assess risk of bias (ROB) of included studies. The kappa statistic will be used to evaluate agreement between the reviewers at each stage. Data will be extracted by one reviewer and checked for accuracy by a second reviewer. Descriptive data and ROB will be summarised and tabulated. Traditional pairwise meta-analysis using random-effect model will be performed for all direct comparisons, and NMA using a frequentist random-effect model then performed based on NP classification where possible. A network of traditional pairwise meta-analysis allows comparisons of multiple interventions from both direct and indirect evidence to provide a hierarchal establishment for enhancing decision making of clinical practitioners.

ETHICS AND DISSEMINATION

Ethic approval is not required as the study is a literature review. The findings will be shared with the national and international researchers, healthcare professionals and the general public through publishing in a peer-reviewed journal and presentations at conferences.

PROSPERO REGISTRATION NUMBER

CRD42021284618.

Impact of pathological conditions on postural reflex latency and adaptability following unpredictable perturbations: A systematic review and meta-analysis

BACKGROUND

Pathological conditions can impair responses to postural perturbations and increase risk of falls.

RESEARCH QUESTION

To what extent are postural reflexes impaired in people with pathological conditions and can exercise interventions shorten postural reflexes?

METHODS

MEDLINE, EMBASE, Scopus, SportDiscus and Web of Science were systematically searched for articles comparing muscle activation onset latency in people with pathological conditions to healthy controls following unpredictable perturbations including the effect of exercise interventions (registration: CRD42020170861).

RESULTS

Fifty-three articles were included for systematic review. Significant delays in muscle activity onset following perturbations were evident in people with multiple sclerosis (n = 7, mean difference [MD]: 22 ms, 95% confidence interval [CI]: 11, 33), stroke (n = 10, MD: 34 ms, 95% CI: 19, 49), diabetes (n = 2, MD: 19 ms, 95% CI: 10, 27), HIV (n = 3, MD: 9 ms, 95% CI: 4, 14), incomplete spinal cord injury (n = 2, MD: 57 ms, 95% CI: 33, 80) and back and knee pain (n = 7, MD: 12 ms, 95% CI: 6, 18), but not in people with Parkinson's disease (n = 10) or cerebellar dysfunction (n = 4). Following exercise interventions, the paretic limb of stroke survivors (n = 3) displayed significantly faster muscle activation onset latency compared to pre-exercise (MD: -13 ms, 95% CI: -24, -4), with no significant changes in Parkinson's disease (n = 3).

CONCLUSIONS

This systematic review demonstrated that postural reflexes are significantly delayed in people with multiple sclerosis (+22 ms), stroke (+34 ms), diabetes (+19 ms), HIV (+9 ms), incomplete spinal cord injury (+57 ms), back and knee pain (+12 ms); pathological conditions characterized by impaired sensation or neural function. In contrast, timing of postural reflexes was not impaired in people with Parkinson's disease and cerebellar dysfunction, confirming the limited involvement of supraspinal structures. The meta-analysis showed exercise interventions can significantly shorten postural reflex latencies in stroke survivors (-14 ms), but more research is needed to confirm this finding and in people with other pathological conditions.

Characteristics associated with decrements in objective measures of physical function in older patients with cancer during chemotherapy

PURPOSE

Study purposes were to evaluate for inter-individual variability in the trajectories of three objective measures of physical function (PF) in older patients receiving chemotherapy (n = 112) and determine which characteristics were associated with worse PF.

METHODS

Balance, gait speed, and chair-stand test were evaluated at initiation and 1, 3, 6, 9, and 12 months following chemotherapy. Hierarchical linear modeling was used to assess inter-individual variability in the trajectories of the three tests. Demographic, clinical, and symptom characteristics, and levels of cognitive function associated with initial levels and changes over time in each of the tests were determined.

RESULTS

Gait speed and chair-stand tests improved over time. Balance declined until month 6, then increased. Characteristics associated with decreases in balance scores at initiation of chemotherapy were lower level of education and lower Karnofsky Performance Status (KPS) score. For initial levels of poorer gait speed, older age, poorer Trail Making Test B (TMTB), and worse Attentional Function Index scores were the associated characteristics. Lower KPS scores, higher body mass index, and poorer TMTB scores were associated with poorer chair-stand times at initiation of chemotherapy. Worse trajectories of chair-stand times were associated with poorer chair-stand time at enrollment. Characteristic associated with lower initial levels and improved trajectories of balance was older age at enrollment.

CONCLUSIONS

Determination of characteristics associated with decrements in balance, gait speed, and chair-stand can assist clinicians to identify older oncology patients at risk for decrements in PF. Interventions to maintain and improve PF need to be implemented with higher risk patients.

Social Support, General Self-Efficacy, Fear of Falling, and Physical Activity Among Older Adults in a Middle-Income Country

Objectives: To investigate the levels and interrelationships between fear of falling (FOF), physical activity (PA), social support (SS), and general self-efficacy (GSE) among older adults in a Nigerian community. Methods: This was a cross-sectional survey involving 100 older adults (65.0% females; mean age = 74.25 ± 8.01 years) consecutively recruited from Nnewi community. Participants’ FOF, PA, GSE, and SS were assessed using standardized questionnaires. Data were analyzed using descriptive statistics, Spearman rank order correlation, and structural equation modeling at a 0.05 level of significance. Results: The participants’ mean FOF, PA, GSE, and SS scores were 15.22 ± 7.43 (fearful), 114.76 ± 90.18 (low), 21.64 ± 8.25 (low) and 5.72 ± 1.19 (high) respectively. There were significant correlations between each pair of FOF, PA, GSE, and SS scores of the participants (p < .05). FOF and GSE were significant predictors of PA while GSE and SS were significant predictors of FOF. Conclusion: FOF and SS were high while PA and GSE were low in this sample of Nigerian older adults. Significant correlations existed between FOF, SS, GSE, and PA, with FOF and GSE being predictors of PA while GSE and SS significantly predicted FOF. Measures should be geared towards reducing FOF and improving PA, GSE, and SS in this group.

Does piriformis muscle syndrome impair postural balance? A case control study

BACKGROUND AND PURPOSE

While patients with musculoskeletal disorders reported postural balance impairments, it is unknown whether patients with piriformis muscle syndrome (PMS) may exhibit postural balance disorders compared to controls. The aim was to compare postural balance in patients with PMS to controls in static and dynamic conditions.

MATERIAL AND METHODS

Twelve patients with PMS and twelve controls were enrolled. Static postural balance was assessed by calculating the symmetry index (SI) in the unipedal posture. To measure vision contribution, the Romberg index (RI) was computed. Dynamic postural balance was evaluated with the Timed up and go test (TUGT). Besides, inter-limb strength asymmetry (SA), pain and the short form-36 (SF-36) were assessed.

RESULTS

The PMS group (PMSG) exhibited significant (p < 0.001) higher SI in eyes opened (EO) and eyes closed (EC) conditions compared to the control group (CG). Besides, PMSG had significant higher RI (p < 0.05), TUGT scores (p < 0.001), SA values (p < 0.05), pain intensity (p < 0.001), and worse SF-36 scores on all physical health (p < 0.05) and psychological health (only in vitality and mental health [p < 0.05]), compared to CG.

CONCLUSION

Our data revealed impaired static and dynamic postural balance, and reduced quality of life in PMSG compared to CG. Postural balance impairments could explain the poor quality of life, which are likely due to the higher SA and higher pain intensity. Clinicians and physiotherapists should consider postural balance disorders while designing rehabilitation programs in these patients.

A Case-Control Study of the Effects of Chronic Low Back Pain in Spatiotemporal Gait Parameters

Chronic low back pain and biomechanical walking imbalances are closely related. It is relevant to identify if there are alterations in spatiotemporal gait patterns in subjects with CLBP (cases) versus healthy subjects (controls) to plan training interventions of motor control gait patterns, and thus allowing normal physical activity of the individual. This study is intended to identify if spatiotemporal alterations occur in the gait cycle in CLBP subjects (cases) compared with a control group (healthy patients) analyzed with an OptoGait LED sensors gait program. Method: A total of n = 147 participants: n = 75 cases (CLBP) and n = 72 healthy controls subjects were studied with OptoGait gait program. Results: Significant differences were found between the two groups and both feet in foot stride, for the differences of the total stride and contact, for gait cadence and total stride length of the gait cycle (p < 0.05). Conclusions: CLBP may alter some normal gait patterns measured by OptoGait; this finding presents imbalances in gait cycle as an underlying factor. The gait is part of daily life of any individual and it is an important physical activity in relation to the maintenance of an optimal state of health. In addition, future studies are deemed necessary.

Predictors of development and persistence of musculoskeletal pain in community-dwelling older people: A two-year longitudinal study

AIM

The aim of this prospective cohort study was to identify the predictors of the development and persistence of musculoskeletal pain (MSKP) in older people.

METHODS

Participants comprised 431 community-dwelling older people aged 70+ years. Demographic, anthropometric, balance, mobility, cognitive function, psychological status and physical activity level measures were obtained at baseline. Participants were asked about the presence of MSKP in the neck/back, hip, knee/leg and/or feet at baseline and two-year follow-up. Logistic regression analyses were performed to identify predictors of the development and persistence of MSKP at two-year follow-up.

RESULTS

Of 179 participants who reported no MSKP at baseline, 84 (46.9%) reported MSKP at two-year follow-up, which was associated with a higher body mass index (odds ratio (OR) 1.10, 95% confidence interval (CI) 1.02-1.18), more reported depressive symptoms (OR 1.30, 95% CI 1.05-1.61) and lower physical activity levels (OR 0.92, 95% CI 0.84-1.00) at baseline. Of 252 participants who reported MSKP at baseline, 202 (80.2%) reported MSKP at follow-up, which was associated with a slower 6-m walking time (OR 1.27, 95% CI 1.08-1.49) and more reported depressive symptoms (OR 1.39, 95% CI 1.09-1.78). These associations remained significant after adjusting for age, sex, comorbidities and medication use.

CONCLUSIONS

This study suggests that higher body mass index, more depressive symptoms and less physical activity are predictors of developing MSKP, whereas slow gait speed and depressive symptoms are predictors of the persistence of MSKP among older people. The results highlight the importance of weight control, strategies to improve mental wellbeing and an active lifestyle for pain management among older people. Geriatr Gerontol Int 2021; 21: 519-524.

A Fall Within 3 Months Before Total Joint Arthroplasty is Associated With Adverse Outcomes in Elderly Patients

BACKGROUND

Falls are associated with morbidity and death in the elderly. The consequences of falls after total joint arthroplasty (TJA) are known, but the consequences of preoperative falls are unclear. We assessed associations between preoperative fall history and hospital readmission rates and discharge disposition after primary TJA.

METHODS

We queried the National Surgical Quality Improvement Program Geriatric Pilot Project for cases of primary total hip arthroplasty (THA) (n = 3671) and total knee arthroplasty (TKA) (n = 6194) performed between 2014 and 2018 for patients aged ≥65 years. Patient characteristics, comorbidities, functional status indicators, and 30-day outcomes were compared among patients with falls occurring within 3 months, from >3 to 6 months, and from >6 to 12 months before surgery, and patients with no falls in the year before surgery. The timing of falls was assessed for independent associations with hospital readmission and discharge to a skilled care facility (SCF). Alpha = 0.05.

RESULTS

Patients who fell within 3 months before surgery had greater odds of SCF discharge (for THA, odds ratio [OR] 2.5, 95% confidence interval [CI] 1.8-3.4; for TKA, OR 1.8, 95% CI 1.4-2.3) and hospital readmission (for THA, OR 1.8, 95% CI 1.1-3.0; for TKA, OR 2.4, 95% CI 1.6-3.5) compared with the no-fall cohort. No such associations were observed for the other two fall cohorts.

CONCLUSION

Falls within 3 months before primary TJA are associated with SCF discharge and readmission for patients aged ≥65 years. Fall history screening should be included in preoperative evaluation.

LEVEL OF EVIDENCE

III.

Cross-cultural adaptation and validation of the Finnish version of the central sensitization inventory and its relationship with dizziness and postural control

BACKGROUND

Central Sensitization (CS) involves dysfunction in neurophysiological mechanisms that increase neuronal responses to both noxious and non-noxious stimuli in the central nervous system. The Central Sensitization Inventory (CSI) is considered the leading patient-reported outcome measure for assessing CS-related symptoms. The aim of this study was to translate and cross-culturally adapt the CSI into Finnish (CSI-FI) and to evaluate its psychometric properties.

METHODS

Translation and cross-cultural validation of the CSI was conducted according to established guidelines. The validation sample was 229 subjects, including 42 pain free controls and 187 subjects with chronic musculoskeletal pain. The CSI-FI was evaluated for internal consistency, test-retest reliability, exploratory factor analysis with maximum likelihood extraction, relationship with subject-reported outcome measures [Tampa scale of kinesiophobia (TSK), the Depression scale (DEPS), 5-level EQ-5D version (EQ-5 L-5D), Roland-Morris Disability Questionnaire (RMDQ), and Pain and Sleep Questionnaire Three-Item Index (PSQ-3)], pain history, subjective symptoms of dizziness, and CS-related diagnoses on CSI part B. Furthermore, we studied the ability of the CSI-FI to distinguish pain free controls, subjects with chronic pain in a single body area, and subjects with multisite chronic pain. In addition, we studied the relationship of CSI-FI scores with postural control on a force plate.

RESULTS

The CSI-FI demonstrated good internal consistency (0.884) and excellent test-retest reliability (0.933) with a 7 ± 1 day gap between test administrations. Exploratory factor analysis with maximum likelihood extraction yielded a one factor solution. Fair to good correlations were found between the CSI-FI and the TSK, DEPS, EQ-5 L-5D, RMDQ, and PSQ-3. Subjective symptoms of dizziness correlated better with CSI-FI scores than any of the CS-related diagnoses on CSI part B. Total CSI-FI scores successfully distinguished between pain free controls, subjects with chronic pain in a single body area, and subjects with multisite chronic pain. The multisite pain group reported significantly more dizziness symptoms than the other two groups. Force plate measurements showed no relationship between postural control and CSI-FI scores.

CONCLUSION

The CSI-FI translation was successfully cross-culturally adapted and validated into Finnish. CSI-FI psychometric properties and scores were all in acceptable levels and in line with previous CSI validations. The CSI-FI appears to be a valid and reliable instrument for assessing CS-related symptomology in Finnish-speaking populations.

Cross-Validation of a Screening Tool to Distinguish Between Fallers and Nonfallers in Community-Dwelling Older Adults With Knee Osteoarthritis

OBJECTIVES

This study aimed to cross-validate a previously developed knee osteoarthritis falls (KOAF) screening tool to distinguish between fallers and nonfallers among community-dwelling older adults with knee osteoarthritis (OA).

DESIGN

Cross-sectional survey study.

SETTING

Three independent orthopedic clinics.

PARTICIPANTS

Older outpatients with knee OA (N=86; 71 women, 15 men; mean age, 75.2±6.2y).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The primary outcome was to identify fallers and nonfallers among outpatients with OA based on their history of falls within the past year. We investigated factors including sex, age, body mass index, Kellgren-Lawrence grade, affected side (bilateral or unilateral knee OA), number of comorbidities, pharmacotherapy, physical therapy, pain, and activity as individual predictors of falls. Participants performed the one-leg standing test and the 5 times sit-to-stand test to determine motor function. Sensitivity, specificity, likelihood ratio, and post-test probability of the KOAF screening tool were calculated using receiver operating characteristic (ROC) curve analysis.

RESULTS

The results of the one-leg standing test and 5 times sit-to-stand test differed significantly between the 2 groups (P<.05). ROC curve analysis showed that the area under the curve was 0.88 (95% confidence interval, 0.80-0.96; P<.001). The post-test probability of falls was 83.3% (positive likelihood ratio, 11.54) when the total score of KOAF screening tool was 2 points and 2.6% (negative likelihood ratio, 0.06) when the total score of KOAF screening tool was less than 1 point.

CONCLUSIONS

Cross-validation results for the KOAF screening tool were better, confirming that the screening tool could distinguish between fallers and nonfallers with high accuracy. Our findings suggest that this simple screening tool could be readily used in clinical practice and could aid in clinical decision-making through providing choices for physical therapy evaluation and recommendations for physical therapy programs.

Impact of Knee Pain on Fear of Falling, Changes in Instrumental Activities of Daily Living, and Falls Among Malaysians Age 55 Years and Above

Objectives: To determine the temporal relationship between the presence of knee pain and knee pain severity identified at baseline with fall risk, fear of falling and changes in instrumental activity of daily living at 12-months follow-up.

Methods: This was a prospective study from the Malaysian Elders Longitudinal Research (MELoR) study involving community dwelling older persons aged 55 years and older. The presence of one fall in the preceding 12 months, knee pain, and functional capacity were determined at baseline (2013–2015) and follow-up (2015–2016). Function was determined as loss of at least one of seven instrumental activities of daily living (IADL). Physical performance was evaluated at baseline using the timed-up-and-go (TUG) test. Fear of falling (FoF) was determined using the single question “Are you afraid of falling?”

Results: Data were available for 605 participants, mean (SD) age = 69.10 (7.24) years. Knee pain was present in 30.2% at baseline. Neither the presence of knee pain nor knee pain severity at baseline were associated with falls at 1-year follow-up. Knee pain was significantly associated with FoF at follow-up [aRR (95%CI) = 1.76 (1.02–3.04)] but not changes in IADL. Among individuals with no falls at baseline, the presence of knee pain was protective of falls at follow-up after adjustment for baseline physical performance [adjusted rate ratio, aRR (95% confidence interval, CI) = 0.35 (0.13–0.97)].

Conclusion: Knee pain is associated with increased FoF at 1.5 years' follow-up within a multi-ethnic population aged 55 years, residing in an urban location in a middle-income South East Asian nation. Interestingly, after differences in muscle strength was accounted for, knee pain was protective against falls at follow-up. Our findings challenge previous assumptions on joint pain and falls and highlights the importance of large prospective studies and further mechanistic research incorporating psychological factors in this area of increasing prominence.

Reliability of an Integrated Inertial Sensor for the Continuous Measurement of Active Cervical Range of Motion in a Group of Younger and Elderly Individuals

The aim of this study was to evaluate the test-retest reliability of an integrated inertial sensor (IIS) for cervical range of motion assessment. An integrated inertial sensor was placed on the forehead center of thirty older adults (OA) and thirty younger adults (YA). Participants had to perform three continuous rotations, lateral bandings and flexion-extensions with their head. Test-retest reliability was assessed after 7 days. YA showed moderate to good agreement for rotation (0.54-0.82), lateral bending (0.74-0.8), and flexion-extension (0.74-0.81) movements and poor agreement for zero point (ZP). OA showed moderate to good agreement for rotation (0.65-0.86), good to excellent agreement in lateral bending (0.79-0.92), and poor to moderate agreement for flexion-extension (0.37-0.72). Zero point showed poor to moderate agreement. In conclusion, we can affirm that this IIS is a reliable device for cervical range of motion assessment in young and older adults; on the contrary, the ZP seems to be unreliable and the addition of an external reference point could help the subject to solve this shortcoming and reduce possible biases.

Falls in Community-Dwelling Older Adults with Lower Back or Knee Pain Are Associated with Cognitive and Emotional Factors

(1) Background: The present study aimed to examine physical, cognitive and emotional factors affecting falls in community-dwelling older adults with and without pain; (2) Methods: Data from 789 older adults who participated in a community-based health survey were analyzed. Participants completed questionnaires on the presence of pain and previous falls. Muscle weakness (handgrip strength < 26.0 kg for men and < 18.0 kg for women) and low skeletal muscle mass (appendicular skeletal muscle mass index < 7.0 kg/m2 for men and < 5.7 kg/m2 for women) were determined. Mild cognitive impairment (MCI) and depressive symptoms were assessed using the National Center for Geriatrics and Gerontology-Functional Assessment Tool and 15-item geriatric depression scale (GDS-15), respectively; (3) Results: In participants with pain, MCI and GDS-15 were associated with previous falls after adjusting for age, sex, education and medication use. In participants without pain, muscle weakness and low skeletal muscle mass were associated with previous falls when adjusting for the above covariates; (4) Conclusions: Falls in participants with pain were associated with cognitive and emotional factors, whereas falls in those without pain were associated with physical factors. Fall prevention interventions for older adults with pain may require tailored strategies to address cognitive and emotional factors.