Background & Aims

Population-based figures have shown that the prevalence of pain in people aged over 60 is twice as high as in people aged under 60, with 60% of older people suffering from acute and chronic pain. Multi-site pain is common among older people. It is associated with a high risk of falls and is a major contributor to disability in older people. To prevent and treat disabilities associated with pain, it is crucial to identify the mechanisms underlying these associations. There is some evidence suggesting that pain leads to changes in walking patterns, such as slower walking speed and shorter steps, which are associated with an increased risk of falls. To compile and assess the strength of this evidence, we conducted a systematic review and meta-analysis of the relationship between pain and gait characteristics in older people.

Methods

We conducted a comprehensive search of the PubMed and Embase databases, which included all study designs comparing objective measures of walking (gait speed, cadence, stride length, and double limb support time) between older people with and without pain. The protocol was prospectively registered with the PROSPERO database under the ID CRD42022327542. 1218 studies were identified for screening. Studies were screened independently by two reviewers against the inclusion criteria using Covidence (systematic review software, Veritas Health Innovation, Australia), with a third reviewer to resolve any disagreements. The Joanna Briggs Institute (JBI) critical appraisal checklist was used to assess the quality of the included studies. The standardised mean difference, or Hedges’ g values, was used to measure the size of the effects. A meta-analysis was conducted using a random-effects model in R (2023.12.1+402). Heterogeneity was assessed using I2, and sensitivity analyses were performed.

Results

Thirteen studies were included. These studies had data on 2835 people, of whom 1156 (41%) were classified as experiencing pain and 1679 (59%) were classified as healthy controls. The gender distribution of the participants was approximately 57% female and 43% male. The mean age of the people experiencing pain was 71 years, whereas the mean age of the healthy control participants was 69.6 years. Studies used yes-or-no questions, the Visual Analogue Scale (VAS), the Numeric Rating Scale (NRS), and WOMAC-pain to measure pain. Participants in the included studies had back (30.7%), knee (30.7%), neck (15.4%), and multisite (7.7%) pain. Study quality was moderate to high. The meta-analysis revealed that people with pain had, on average, a gait speed that is 0.3113 m/s (95% CI: -0.4328, -0.1898) slower than people without pain (P<0.0001). It did not show any significant differences in cadence, stride length, and time spent in double limb support for people with compared to people without pain

Conclusions

Pain significantly impacts walking speed in older people, which may contribute to their increased risk of falling. Therefore, recognising the link between pain and walking in older people is critical to prevent pain-associated disabilities, such as mobility deficits and falls.

References

1.Crook J, Rideout E, Browne G. The prevalence of pain complaints in a general population. Pain. 1984;18(3):299-314.
2.Leveille SG, Jones RN, Kiely DK, Hausdorff JM, Shmerling RH, Guralnik JM, et al. Chronic musculoskeletal pain and the occurrence of falls in an older population. Jama. 2009;302(20):2214-21.
3.White DK, Niu J, Zhang Y. Is symptomatic knee osteoarthritis a risk factor for a trajectory of fast decline in gait speed? Results from a longitudinal cohort study. Arthritis care & research. 2013;65(2):187-94.

Presenting Author

Mahsa Seydi

Poster Authors

Mahsa Seydi

PhD

Neuroscience research Australia

Lead Author

Kimberley S van Schooten

PhD

University of New South Wales, Neuroscience Research Australia

Lead Author

Kim Delbaere

PhD

University of New South Wales, Neuroscience Research Australia

Lead Author

Dae UK Han

MsC

Lead Author

Lloyd Chan

PhD

Neuroscience Research Australia

Lead Author

Meghan Ambrens

University of New South Wales, Neuroscience Research Australia

Lead Author

Topics

  • Pain in Special Populations: Elderly