Impact of pain on reactive balance and falls in community-dwelling older adults: a prospective cohort study

• Published in: Age and ageing Vol. 49; no. 6; pp. 982 - 988
• Main Authors: Hirase, Tatsuya, Okubo, Yoshiro, Menant, Jasmine, Lord, Stephen R, Sturnieks, Daina L
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.11.2020; Oxford Publishing Limited (England)
• Subjects: Balance; Body mass index; Cohort analysis; Community; Falls; Fractures; Neck; Neck pain; Older people; Pain; Posture; Prescription drugs; Thresholds; Velocity; Walking; Walking speed; accidental falls; pain; older people; reactive balance
• ISSN: 0002-0729; 1468-2834
• DOI: 10.1093/ageing/afaa070

Abstract Background pain is associated with increased postural sway and falls in older adults. However, the impact of pain on reactive balance induced by postural perturbations and how this might predispose older adults to falls is not known. Objective to investigate whether any pain, back/neck pain and lower limb pain are associated with poor reactive balance and prospective fall outcomes in older adults. Design 12-month prospective cohort study. Setting community. Subjects 242 community-dwelling older adults aged 70+ years. Methods participants completed a questionnaire on the presence of pain and underwent force-controlled waist-pull postural perturbations while standing. Force thresholds for stepping, step initiation time, step velocity and step length were quantified. Falls were monitored with monthly falls calendars for 12-months. Results participants with lower limb pain had significantly lower force thresholds for stepping. Those with any pain or pain in the back/neck had longer step initiation time, slower step velocity and shorter step length. The three pain measures (any pain, back/neck pain, lower limb pain) were significantly associated with multiple falls when adjusted for age, sex, body mass index, use of polypharmacy, strength and walking speed. In mediation analyses, there was a significant indirect effect of reactive balance for the relationship between back/neck pain and falls with fractures. Conclusions older people with pain have impaired reactive balance and an increased risk of falls. Reactive balance partially mediated the association between pain and fall-related fractures. Further research is required to confirm the findings of this study.