Impact of Musculoskeletal Pain on Balance and Concerns of Falling in Mobility-limited, Community-dwelling Danes over 75 Years of Age: A Cross-sectional Study

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SOURCE:   Aging Clin Exp Res. 2018 (Aug);   30 (8):   969–975

Julie C. Kendall, Lars G. Hvid, Jan Hartvigsen,
Azharuddin Fazalbhoy, Michael F. Azari,
Mathias Skjødt, Stephen R. Robinson, Paolo Caserotti

School of Health and Biomedical Sciences,
RMIT University,
PO Box 71,
Bundoora, Melbourne, 3083, VIC, Australia.

BACKGROUND:   In older adults, musculoskeletal pain is associated with increased concerns of falling, reduced balance and increased occurrence of falls. In younger adults, the intensity of neck pain and low back pain is associated with increased postural sway. It is not known if pain further impairs balance and concerns of falling in mobility-limited older adults, and if so, whether this is associated with different intensities of pain.

OBJECTIVE:   This study examined whether mobility-limited older adults with mild or intense neck pain and/or low back pain have significantly increased postural sway as measured by centre of pressure (COP) changes and concerns of falling compared to those without pain.

METHODS:   48 older adults with a gait speed of < 0.9 m/s from Odense, Denmark were recruited through the public health service. Self-reported neck pain, low back pain, and concerns of falling were recorded on questionnaires. Sway range, velocity and area were recorded on a force plate in a comfortable standing stance. Pain intensity was rated on an 11 point numerical rating scale (0-10). Participants were sub-grouped into mild (0-4) and intense (> 5) neck pain or low back pain.

RESULTS:   Intense neck pain was associated with increased anterior-posterior sway range and area of sway. Intense low back pain was associated with increased concerns of falling.

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CONCLUSION:   Intense neck pain in mobility-limited older adults is associated with significant changes in postural balance, and intense low back pain is associated with significantly higher concerns of falling.

KEYWORDS:   Balance; Falls risk; Mobility-limitation; Musculoskeletal pain; Older adults

From the FULL TEXT Article:


Falls are one of the leading health concerns facing older adults, affecting their capacity to engage in activities of daily living, loss of independence, and the risk of sustaining moderate–severe injury. Several factors have been identified that lead to an increased risk of falls in this age group, including reduced gait speed. [1] One of the determinants gait speed is good postural control, and it has been observed that musculoskeletal pain is associated with reduced balance, increased concerns of falling, and increased occurrence of falls in older adults. [2–4]

Previous studies have demonstrated that older adults with a history of falls displayed an increased range and velocity of sway when their balance was tested in a static standing position on a force plate. [56] The resulting flexed posture and increase in rigidity may be an adaptation that facilitates the forward displacement of the centre of gravity, to reduce the likelihood of falling. [6] A retrospective study, in older adults, conducted to analyse balance control parameters in fallers and non-fallers suggested that fallers had increased medial–lateral (ML) sway rather than AP sway. [7] Despite these preliminary observations, the relationship between increased sway and falls risk in older adults remains to be fully investigated.

The speed of postural sway is influenced by a range of factors that are likely to be linked to the risk of falls. For instance, it has been demonstrated in older adults that a concern of falling, indicated by high Falls Efficacy Scale International Questionnaire (FES-I) scores, is associated with significant reductions in both AP and ML velocity. [8] In contrast, in studies on younger adults, neck pain and low back pain increase the extent of sway in the AP direction more so than the ML direction, and high intensity neck pain increases the velocity of both AP and ML sway. [9, 10] Yet, these studies on balance and musculoskeletal pain have been conducted in younger adults. There is a need to determine if mobility-limited older adults with musculoskeletal pain exhibit significant increases in sway and poor balance. This retrospective cross-sectional study examined neck pain, low back pain, postural stability, and concerns of falling in a group of mobility-limited older adults (low gait speed). Postural stability was assessed in terms of both the range and velocity of AP sway and ML sway.

The aims of this study were to:

(1)   examine whether mobility-limited older adults with mild or intense neck pain and/or low back pain have significantly increased centre of pressure (COP) sway compared to those without pain; and

(2)   examine whether concerns of falling are associated with increases in COP sway in this population.

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