Geriatric Rehabilitation
Pain Rehabilitation
Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)
Oral Presentation
Eric Roseen, DC, MSc
PhD Student in Rehabilitation Sciences
MGH Institute of Health Professions
Brookline, Massachusetts
Rachel Ward, PhD, MPH
Instructor
Harvard Medical School
Boston, Massachusetts
Jonathan Bean, MD, MPH
Associate Professor of Physical Medicine and Rehabilitation
Harvard Medical School
Jamaica Plain, Massachusetts
The objective of this study was to determine whether pain phenotype is associated with neuromuscular impairments and mobility limitations among older adults. We performed a cross-sectional analysis of baseline data from the Boston Rehabilitative Impairment Study of the Elderly (Boston RISE) which enrolled 430 older adults from primary care clinics at two urban academic hospitals. Our exposure, pain severity (mild, moderate, or severe), was defined using tertiles of the 4-item Brief Pain Inventory questionnaire. Additionally, we counted the number of musculoskeletal pain locations (none, single-site, multi-site, or widespread), using the McGill pain map. We assessed performance-based measures of neuromuscular attributes (trunk extensor endurance, leg strength, leg speed, leg strength asymmetry, and range of motion at knee and ankle) and mobility (Late Life Disability Index [LLFDI], Short Physical Performance Battery [SPPB]). For tests of neuromuscular function and LLFDI, participants in the lowest tertile were characterized as having neuromuscular impairment or activity limitation, respectively. For SPPB, a score of less than 7 indicated activity limitation. Pain severity was associated with neuromuscular impairment (poor trunk extensor endurance and limited ankle range of motion) and activity limitation on two validated measures of mobility.
Objective:
To determine whether pain phenotype is associated with neuromuscular impairments and mobility limitations among older adults.
Design:
Cross-sectional analysis of baseline data from the Boston Rehabilitative Impairment Study of the Elderly (Boston RISE).
Setting : Primary care clinics at two urban academic hospitals.
Participants (or Animals, Specimens, Cadavers):
Four hundred and thirty older adults.
Interventions : Our exposure, pain severity (mild, moderate, or severe), was defined using tertiles of the 4-item Brief Pain Inventory questionnaire. Additionally, we counted the number of musculoskeletal pain locations (none, single-site, multi-site, or widespread), using the McGill pain map.
Main Outcome Measure(s):
We assessed performance-based measures of neuromuscular attributes (trunk extensor endurance, leg strength, leg speed, leg strength asymmetry, and range of motion at knee and ankle) and mobility (Late Life Disability Index [LLFDI], Short Physical Performance Battery [SPPB]). For tests of neuromuscular function and LLFDI, participants in the lowest tertile were characterized as having neuromuscular impairment or activity limitation, respectively. For SPPB, a score of less than 7 indicated activity limitation.
Results : Out of 430 participants (mean age=77; 68% female; 83% white), most had multi-site (50%) or widespread (14%) pain. After adjusting for sociodemographic and health characteristics we found that severe pain, compared to mild pain, was associated with poor trunk extensor endurance (Odds Ratio and 95% confidence interval: OR=2.3, 1.3-4.1), limited ankle range of motion (OR=2.1, 1.2-3.6) and activity limitation on LLFDI (OR=4.1, 2.3-7.1) and SPPB (OR=2.4, 1.3-4.2). Similar associations were observed among participants with multi-site or widespread pain when compared to those not reporting pain.
Conclusions : Pain severity was associated with neuromuscular impairment (poor trunk extensor endurance and limited ankle range of motion) and activity limitation on two validated measures of mobility.