The pathway from musculoskeletal pain to mobility difficulty in older disabled women

Abstract

Little is known about the pathway from musculoskeletal pain to mobility difficulty among older persons. We examined potential physical and psychological mediators of the pain-disability relationship in the Women's Health and Aging Study (WHAS), a cohort of women aged ≥65 who had at least mild disability at baseline. Pain was classified according to location and severity (widespread pain; lower extremity pain; other pain; none or mild pain in only one site). Among women without a lot of difficulty in stair climbing (n = 676) or walking (n = 510) at baseline, those who reported widespread pain were more likely than those with none or mild pain to develop a lot of difficulty with mobility during the 3 year follow-up. The likelihood for mobility difficulty was unchanged after adjusting for physical impairments and symptoms of depression and anxiety (walking aOR = 1.85, 95%CI, 1.08-3.17; stair climbing, aOR = 2.68, 95%CI, 1.56-4.62). Lower extremity pain was associated with increased likelihood for difficulty with climbing stairs but not with walking. However, this association was attenuated after adjusting for physical impairments and psychological symptoms (aOR = 1.66, 95%CI, 0.99-2.77). Pain was not associated with increased risk for becoming unable to walk or climb stairs. The findings suggest that pain is a unique domain as a cause of disablement, independent of the usual pathway to disability via physical impairments. Research is needed to better understand the development of pain-related disability in order to determine optimum approaches to prevent and treat mobility disability in older persons with persistent pain.

Effects of a Multicomponent Home-Based Physical Rehabilitation Program on Mobility Recovery After Hip Fracture: A Randomized Controlled Trial

“…Pain assessment and fear of falling management was regarded as an essential part of the program as older people who had had a hip fracture suffer from residual pain [12,49] and fear of falling [14]. Both pain [12,50,51] and fear of falling [52][53][54] have been independently associated with mobility limitation, activity restriction, low physical functioning and falls among older populations. To our knowledge and based on a recently updated Cochrane review [16] there is no previously published effectiveness RCT among community-dwelling hip fracture participants including a home-based intervention specifically targeting on mobility recovery and which has mobility limitation and disability as the main outcome.…”

The effects of acute experimental hip muscle pain on dynamic single-limb balance performance in healthy middle-aged adults

“…Chronic pain is of particular concern in middle-aged adults, as it appears to be a strong risk factor for falls in later life [11,12]. Consistent with an increased risk of falling, dynamic single-limb balance is impaired in adults who show early signs of hip joint degeneration and report mild pain [13].…”

Osteoarthritis and mortality: A prospective cohort study and systematic review with meta-analysis

“…1,2 The leading symptom associated with OA is chronic musculoskeletal pain, which is associated with mobility and function. 3,4 Physical inactivity is independently associated with an increased risk of cardiovascular diseases (CVD) and mortality in the general population. 5 Obesity is also commonly seen within the osteoarthritis population, whilst also being associated with morbidities such as type two diabetes, cancers and CVD.…”