Relationship Between Postural Stability and Proprioception, Pain, Quadriceps Strength, and Muscle Tightness in Athletes With Patellar Tendinopathy

BACKGROUND

Athletes with patellar tendinopathy (PT) have postural stability deficits; however, the underlying mechanisms and factors responsible remain unknown. The effect on postural stability in PT of decreased quadriceps strength, altered proprioception, lower-limb muscle tightness, and knee pain, which explain postural stability deficiency in other populations, is uninvestigated.

HYPOTHESIS

Proprioceptive acuity, muscle tightness, quadriceps strength, and pain predict postural stability in athletes with PT.

STUDY DESIGN

Cross-sectional comparative study.

LEVEL OF EVIDENCE

Level 2.

METHODS

A total of 43 athletes with PT and 43 healthy athletes were enrolled. Static and dynamic postural stability, proprioceptive acuity, muscle tightness, quadriceps strength, and pain were evaluated using a force platform, Y-balance test (YBT), a weight discrimination protocol, a goniometer, an isometric dynamometer, and a valid questionnaire, respectively.

RESULTS

Athletes with PT had significantly worse static and dynamic postural stability in the affected limb (AL) compared with the nonaffected limb (NAL) (P < 0.01) and the control group (P < 0.01). Athletes suffering from PT revealed lower quadriceps strength (P < 0.01), proprioceptive acuity (P = 0.02), and higher muscle tightness in the AL compared with the NAL and controls. Quadriceps weakness of the AL and pain in athletes with PT explained the variance of dynamic postural stability impairment.

CONCLUSION

Athletes with PT have postural stability deficiency compared with healthy peers. Our results demonstrate that quadriceps muscle weakness and pain are the factors that explain postural stability impairment.

CLINICAL RELEVANCE

These results can assist clinicians in the design of therapeutic balance rehabilitation programs by acting not only on pain relief but also on quadriceps strengthening through resistance training to avoid subsequent injuries in athletes with PT.

The relationship between kinesiophobia, balance, and upper extremity functions in patients with painful shoulder pathology

BACKGROUND

Poor balance ability may contribute to shoulder pathology in patients with existing shoulder pathologies or vice versa. The relationship between kinesiophobia and chronic shoulder pain intensity has been researched, although the conclusions are conflicting. To our knowledge, no study in the literature explores the association between kinesiophobia and balance in patients with shoulder pain.

OBJECTIVE

To investigate the relationship between kinesiophobia, upper extremity functions, and balance abilities in patients with shoulder pain.

DESIGN

Cross-sectional observational study.

SETTING

Physical medicine and rehabilitation hospital.

INTERVENTIONS

Not applicable.

PARTICIPANTS

A total of 44 patients with shoulder pain were included in the study.

MAIN OUTCOME MEASURES

The pain severity was assessed using a visual analog scale (VAS). The Tampa Scale for Kinesiophobia (TSK), Berg Balance Scale (BBS), and Shoulder Pain and Disability Index (SPADI) were used to assess the patients. Ultrasound was used to diagnose underlying shoulder joint problems. Static and dynamic postural control was evaluated.

RESULTS

The most common pathologies detected by ultrasound were supraspinatus tendinitis/rupture (77.3%), cortical irregularity (68.2%), and bursitis (63.6%). TSK score did not correlate with age, body mass index, symptom duration, or VAS score in rest (all p > .05), but it was associated with scores on the BBS (r = -0.437, p = .003), SPADI-pain (r = 0.474, p = .001), SPADI-disability (r = 0.355, p = .018), SPADI-total (r = 0.405, p = .006), and VAS in activity (r = 0.331, p = .028). According to multiple linear regression analysis, BBS score, SPADI-total score, and anterior-posterior sway length were significant predictors of TSK (r = 0.645, r2 = 0.416).

CONCLUSIONS

According to the findings of this study, the main risk factors for high levels of kinesiophobia are poor balance, severe pain, and disability. In addition to mechanical causes of shoulder pain, diagnosing and intervening on underlying balance issues and psychosocial causes of shoulder pain will improve treatment success.

Association between central sensitization, pain sensitivity and balance control in patients with migraine

BACKGROUND

Balance alterations are prevalent among pain conditions, including migraine. The mechanisms explaining the association between pain and balance are unclear, as well as whether levels of pain sensitivity correlate with impaired balance. Our aim was therefore to investigate the association between balance, central sensitization symptoms and pain sensitivity in patients with migraine.

METHODS

This cross-sectional study included 50 patients and demographic, clinical information, central sensitization inventory (CSI) and pain catastrophizing (PCS) scores were obtained. Patients underwent a standardized protocol evaluating balance and pain thresholds for cold (CPT), heat (HPT), mechanical (MPT) and pressure (PPT) in trigeminal (V1) and extra-trigeminal (C6) dermatomes. Data were analysed using Person's correlation, linear regression models and contrasting the presence and absence of central sensitization symptoms through T-tests.

RESULTS

Mild-to-moderate correlations were observed between balance and MPT in V1 (r = -0.24, p = 0.046) and C6 (r = -0.41, p = 0.002), CPT in V1 (r = 0.31, p = 0.026), CSI scores (r = 0.27, p = 0.029) and migraine frequency (r = 0.25, p = 0.040). Balance was explained by CPT and MPT (R2 = 0.32, p = 0.001). The variance of CSI was explained by PCS scores and balance (R2 = 0.28, p = 0.001). Patients with symptoms of central sensitization presented an increased balance impairment (p = 0.044) and higher catastrophizing levels (p = 0.001) in contrast to patients without symptoms.

CONCLUSION

Balance impairment is associated with reduced pain thresholds and higher CSI scores. These results may help to elucidate the aetiology of balance alterations among chronic pain conditions.

SIGNIFICANCE

For the first time, it has been shown that balance alterations can reflect greater pain sensitivity and signs of central sensitization in patients with migraine. This opens up perspectives for future studies to understand the mechanisms and further factors associated with balance and pain sensitivity in migraine.

Relationship between chronic pain, depressive symptoms, and functional disability in community-dwelling older adults: mediating role of frailty

BACKGROUND

Borim et al. showed that older adults with chronic pain exhibited more depressive symptoms and frailty components. Depressive symptoms were associated with more frailty components, and those with more depressive symptoms and frailty faced greater limitations in IADL performance. Frailty appears to mediate the pathway from chronic pain to functional impairment Chronic pain is directly associated with depressive symptoms and frailty. Chronic pain is not directly associated with functional disability. Depression and frailty are both directly associated with functional disabilities. Frailty mediates the association between chronic pain and functional disability. Depression; Disability evaluation; Frailty; Frail elderly.

OBJECTIVE

To evaluate the direct and indirect effects of chronic pain, depressive symptoms, frailty components, and functional disability through a pathway analysis approach in a sample of community-dwelling older adults.

METHODS

Data of 419 participants were cross-sectionally evaluated for the presence of depressive symptoms (Geriatric Depression Scale [15 items]), physical frailty components (phenotype criteria), chronic pain, and limitations in performing instrumental activities of daily living (functional disability scale by Lawton and Brody). Structural equation modeling via path analysis was used to explore the direct and indirect effects among these four variables. Statistical significance was set at p<0.05.

RESULTS

Of the total participants, 69.8% were women and 59.3% had low education (1-4 years); the mean age was 80.3±4.6 years. Chronic pain and depressive symptoms were directly related and were associated to frailty. The number of frailty components and depressive symptoms were directly associated with functional disability. Frailty had an indirect effect on the association between chronic pain, depressive symptoms, and functional disabilities.

CONCLUSION

The pathway from chronic pain and depressive symptoms to functional disability is potentially mediated by the number of frailty components.

Comparison of the immediate effects of plantar vibration of both feet with the plantar vibration of the affected foot on balance in patients with stroke: Preliminary findings

OBJECTIVE

Plantar vibration is one of the strategies to enhance balance in stroke patients. This study compared the effects of the plantar vibration of both feet and the plantar vibration of the most affected side in patients with stroke.

METHODS

This study was a single-blind clinical trial. Post-stroke patients with balance impairment were enrolled in the study and underwent two treatment sessions with a one-week interval. They received both feet's plantar vibration in one session and plantar vibration of the most affected side in the other session (frequency 100 Hz, 5 min). Mini-BESTest, Modified Modified Ashworth Scale (MMAS), and Semmes-Weinstein monofilament examination (SWME) were used to evaluate balance, spasticity, and plantar sensation, before and after the treatment sessions.

RESULTS

Ten patients with a mean age of 52.9 (SD = 5.48) years were enrolled in the study. Mini-BESTest scores of balance and plantar flexor muscle spasticity were significantly improved after both feet plantar vibration and plantar vibration of the more affected side. There was no significant difference between the effectiveness of both sides plantar vibration and the most affected side plantar vibration. There were no significant improvements in SWME sensory scores after plantar vibration of either both sides or the most affected side.

CONCLUSION

Plantar vibration of both sides had no additional benefits in this group of patients with chronic stroke. Plantar vibration of more affected side can be used for improving balance and plantar flexor spasticity post-stroke. The Plantar vibration had no effects on the affected foot sensibility.

Can a rigid antipronation foot orthosis change the effects of prolonged standing on postural control in men with patellofemoral pain?

BACKGROUND

Pronated foot posture is known as a contributing factor for patellofemoral pain (PFP) development. Patients with patellofemoral pain often experience poor postural control. Implementation of optimal management strategies for enhancing their postural performance is important.

OBJECTIVES

The aim of this study was to determine whether a rigid antipronation foot orthosis changes prolonged standing effects on postural control in men with PFP.

STUDY DESIGN

Case-control study.

METHODS

Twenty-eight men with PFP and pronated foot and 28 healthy men were enrolled in this study. Center-of-pressure parameters were measured during short trials (60 seconds) of single-leg standing before and immediately after prolonged standing (20 minutes) using force platform. In patients with PFP, postural control was examined on 2 separate days with and without rigid antipronation foot orthosis.

RESULTS

Findings showed that the pre-post differences of sway area (t(48) = -2.22, p = 0.03), mediolateral (ML) displacement (t (48) = -2.51, p = 0.01), and mean velocity (t(48) = -2.01, p = 0.04) were significantly greater in patients with PFP without foot orthosis compared with those in the healthy group. Significant intervention main effect ( p = 0.04) and time-by-intervention interaction ( p = 0.006) for sway area were shown. Significant intervention main effects were noted for ML displacement ( p = 0.007) and mean velocity ( p = 0.003). For these variables, significant time-by-intervention interactions were found. Further analysis showed greater values of ML displacement and mean velocity parameters before the prolonged standing in patients with PFP without foot orthosis compared with patients with PFP with orthosis.

CONCLUSIONS

Rigid antipronation foot orthosis can improve the postural performance after prolonged standing in young adult men with PFP.

Risk Factors for Falls and Fall-Related Fractures in Community-Living Older People with Pain: A Prospective Cohort Study

(1) Background: This prospective study aimed to identify predictors of falls and fall-related fractures in community-dwelling older people with pain; (2) Methods: Participants comprised 389 community-dwelling older people aged 70+ years who had musculoskeletal pain in the neck, back, hip, leg/knee and/or feet. Demographic, anthropometric, balance, mobility, cognitive function, psychological status and physical activity level measures were obtained at baseline. Falls were monitored with monthly falls calendars for 12 months. Logistic regression analyses were performed to identify predictors of falls and fall-related fractures during a 12-month follow-up; (3) Results: Of the 389 participants, 175 (45.0%) and 20 (5.1%) reported falls and fall-related fractures during the 12-month follow-up, respectively. Greater postural sway on foam, more depressive symptoms and lower physical activity levels at baseline were associated with falls during the 12-month follow-up. Slower walking speed at baseline was associated with fall-related fractures during the 12-month follow-up. These associations remained significant after adjusting for age, sex, body mass index, comorbidities and medication use; (4) Conclusions: This study suggests poor balance, low mood and a less active lifestyle are predictors of falls, and slower walking speed predicts fall-related fractures among community-dwelling older people with pain.

A Comprehensive Review of Pain Interference on Postural Control: From Experimental to Chronic Pain

Motor control, movement impairment, and postural control recovery targeted in rehabilitation could be affected by pain. The main objective of this comprehensive review is to provide a synthesis of the effect of experimental and chronic pain on postural control throughout the available literature. After presenting the neurophysiological pathways of pain, we demonstrated that pain, preferentially localized in the lower back or in the leg induced postural control alteration. Although proprioceptive and cortical excitability seem modified with pain, spinal modulation assessment might provide a new understanding of the pain phenomenon related to postural control. The literature highlights that the motor control of trunk muscles in patient presenting with lower back pain could be dichotomized in two populations, where the first over-activates the trunk muscles, and the second under-activates the trunk muscles; both generate an increase in tissue loading. Taking all these findings into account will help clinician to provide adapted treatment for managing both pain and postural control.

Associations of neuroticism with falls in older adults: do psychological factors mediate the association?

OBJECTIVES

Neuroticism predicts falls in older people. In addition, concern about falling and depressive symptoms are associated with fall risk. This study examined whether concern about falling and depressive symptoms mediate the association between neuroticism and falls.

METHOD

Cross-sectional data on 314 community-dwelling people aged 70-85 years were utilized. Neuroticism was assessed with a short modified form of the Eysenck Personality Inventory. Indoor and outdoor falls during the past year were self-reported. Concern about falling was assessed with the Falls Efficacy Scale-International and depressive symptoms with the Geriatric Depression Scale-15. Path modeling was used to examine the associations between variables.

RESULTS

Mediating pathways linking neuroticism and falls were found: neuroticism was positively associated with concern about falling, which was subsequently linked to indoor falls (indirect effect β = 0.34, p = 0.002) and recurrent outdoor falls (β = 0.19, p = 0.045). Moreover, a pathway from neuroticism to indoor falls through depressive symptoms was also found (β = 0.21, p = 0.054). In other words, higher neuroticism was associated with higher concern about falling and depressive symptoms, both of which were linked to falls. The associations were independent of age, sex, use of psychotropic, chronic diseases, persistent pain, physical performance, physical activity, and executive functioning that are known risk factors for falls.

DISCUSSION

The results indicate that concern about falling and depressive symptoms mediate the association between neuroticism and falling. Longitudinal studies are needed to confirm the causality of the findings and to examine the potential to reduce falls by targeting concern about falling and depressive symptoms among older adults higher in neuroticism.

Balance is impaired in symptomatic ankle osteoarthritis: A cross-sectional study

BACKGROUND

Ankle osteoarthritis (OA) is associated with several physical impairments but investigations into balance impairments in this population are limited. Understanding balance impairments in ankle OA may help inform the management of this condition.

RESEARCH QUESTION

Does balance overall performance differ between individuals with symptomatic radiographic ankle OA, asymptomatic radiographic ankle OA and healthy controls? Are there any differences in mediolateral or anteroposterior balance, or confidence to perform balance tasks between these groups?

METHODS

Ninety-six volunteers (31 symptomatic radiographic ankle OA, 41 asymptomatic radiographic ankle OA and 24 healthy controls) completed six static balance tasks: bilateral stance on a firm surface, bilateral stance on foam, and tandem stance, all performed with eyes open and closed. Centre of pressure (COP) data were collected using force plates. Confidence to perform each balance task was collected using an 11-point numerical rating scale.

RESULTS

Compared to controls, participants with symptomatic radiographic ankle OA had greater COP area when standing on a firm surface, foam and in tandem with eyes closed (all p < 0.05) and greater total COP sway in both firm surface and tandem stance conditions (p < 0.04). Participants with symptomatic ankle OA had greater COP area (p < 0.04) and total COP sway (p = 0.01) than those with asymptomatic ankle OA during tandem stance. Total COP sway and area were similar between asymptomatic ankle OA and control participants. Some differences in mediolateral and anteroposterior balance were identified between groups. Individuals with symptomatic ankle OA had lower confidence to perform the tandem stance eyes closed task compared to controls.

SIGNIFICANCE

Balance impairments and decreased balance confidence were identified in those with symptomatic radiographic ankle OA compared to asymptomatic individuals with and without radiographic ankle OA. This suggests that balance deficits in ankle OA may be related to symptoms, rather than radiographic evidence of disease.

Dizziness and physical health are associated with pain in dizzy patients-A cross-sectional study

BACKGROUND AND PURPOSE

Associations between dizziness, health-related quality of life, and musculoskeletal pain have not been systematically explored in patients with vestibular disorders. Such knowledge may be important for choice of treatments. The study objectives were to examine the extent and localization of musculoskeletal pain and explore whether pain was associated with dizziness and health-related quality of life.

METHODS

The cross-sectional study investigated anonymized data from an earlier survey on patients with long-lasting dizziness (>3 months) examined in an oto-rhino-laryngological department. The sample includes patient between 18 and 70 years with Ménière's disease, vestibular schwannoma, benign positional paroxysmal vertigo, vestibular neuritis, non-otogenic dizziness, and cervicogenic dizziness. General musculoskeletal, that is, pain in muscles, tendons, and joints was registered by a yes/no question. A pain drawing registered localization of pain. Multiple binary logistic regression models were used to determine the association between pain and vertigo-balance and autonomic-anxiety related dizziness by the short Vertigo Symptom Scale (VSS) and sub-scales (VSS-V, VSS-A), and between pain and health-related quality of life by the SF-36, mental and physical component summary scale (SF-36 MCS, SF-36 PCS).

RESULTS

The sample consisted of 503 patients, 60.2% were women, the median age was 50 years. General musculoskeletal pain was reported by 72.8% of patients, neck pain by 59.2% and widespread pain by 21.9%. Multiple binary logistic regression models demonstrated that all the pain measures were significantly associated with VSS-V and VSS-A and SF-36 PCS, but not SF-36 MCS.

DISCUSSIONS

Musculoskeletal pain is prevalent in patients with long-lasting dizziness. The strong associations between pain, VSS, and SF-36 PCS could result in a self-sustaining complex condition. The findings imply that in addition to assessing and treating the vestibular symptoms, musculoskeletal symptoms and physical health should be addressed.

Cross-Sectional Examination of Musculoskeletal Pain and Physical Function in a Racially and Socioeconomically Diverse Sample of Adults

BACKGROUND

Musculoskeletal pain alters physiological function, which may be evidenced as early as middle age. Previous research has concluded that middle-aged adults are a high-risk group for musculoskeletal pain and report functional limitations similar to older adults. However, few studies have examined the relationships between musculoskeletal pain and physical function, using objective performance measures in a sample of racially and socioeconomically diverse adults. Thus, this study examined musculoskeletal pain in relation to physical function in middle-aged (30-64 years) White and Black adults and investigated whether the relationship varied by sociodemographic characteristics.

METHODS

This cross-sectional examination incorporated data from the Healthy Aging in Neighborhoods of Diversity across the Life-Span Study. Participants (n = 875) completed measures of musculoskeletal pain and objective measures of physical performance (ie, lower and upper body strength, balance, and gait abnormalities). Physical performance measures were standardized to derive a global measure of physical function as the dependent variable.

RESULTS

Approximately, 59% of participants identified at least 1 pain sites (n = 518). Multivariable regression analyses identified significant relationships between greater musculoskeletal pain and poorer physical function (β = -0.07, p = .031), in mid midlife (β = -0.04, p = .041; age 40-54) and late midlife (β = -0.05, p = .027; age 55-64).

CONCLUSIONS

This study observed that musculoskeletal pain was associated with poorer physical function within a diverse group of middle-aged adults. Future research should longitudinally explore whether chronic musculoskeletal pain identified at younger ages is associated with greater risk for functional limitation and dependence in later life.

Pain Is Associated With Poor Balance in Community-Dwelling Older Adults: A Systematic Review and Meta-analysis

OBJECTIVES

Pain is a risk factor for falls in older adults, but the mechanisms are not well understood, limiting our ability to implement effective preventive strategies. The aim of this study was to systematically review and synthesize the literature that has examined the impact of pain on static, dynamic, multicomponent, and reactive balance in community-dwelling older adults.

DESIGN

Systematic review and meta-analysis.

SETTING AND PARTICIPANTS

Studies from inception to March 2019 were identified from electronic databases (MEDLINE, EMBASE, PsycINFO, CINAHL), contact with the primary authors, and reference lists of included articles.

METHODS

Cross-sectional and case-control studies that compared objective balance measures between older (minimum age 60 years) adults with and without pain were included.

RESULTS

Thirty-nine eligible studies (n = 17,626) were identified. All balance modalities (static, dynamic, multicomponent, and reactive) were significantly poorer in participants with pain compared to those without pain. Subgroup analyses revealed that chronic pain (pain persisting ≥3 months) impaired balance more than pain of unspecified duration. The effects of pain at specific sites (neck, lower back, hip, knee, and foot) on balance were not significantly different.

CONCLUSIONS AND IMPLICATIONS

Pain is associated with poor static, dynamic, multicomponent, and reactive balance in community-dwelling older adults. Pain in the neck, lower back, hip, knee, and foot all contribute to poor balance, and this is even more pronounced for chronic pain. Comprehensive balance and pain characteristic assessments may reveal mechanisms underlying the contribution of pain to instability and increased fall risk in older people.

Effects of low back pain on balance performance in elderly people: a systematic review and meta-analysis

Background

Research suggests that individuals with low back pain (LBP) may have poorer motor control compared to their healthy counterparts. However, the sample population of almost 90% of related articles are young and middle-aged people. There is still a lack of a systematic review about the balance performance of elderly people with low back pain. This study aimed to conduct a systematic review and meta-analysis to understand the effects of LBP on balance performance in elderly people.

Methods

This systematic review and meta-analysis included a comprehensive search of PubMed, Embase, and Cochrane Library databases for full-text articles published before January 2020. We included the articles that 1) investigated the elderly people with LBP; 2) assessed balance performance with any quantifiable clinical assessment or measurement tool and during static or dynamic activity; 3) were original research. Two independent reviewers screened the relevant articles, and disagreements were resolved by a third reviewer.

Results

Thirteen case-control studies comparing balance performance parameters between LBP and healthy subjects were included. The experimental group (LBP group) was associated with significantly larger area of centre of pressure movement (P < 0.001), higher velocity of centre of pressure sway in the anteroposterior and mediolateral directions (P = 0.01 and P = 0.02, respectively), longer path length in the anteroposterior direction (P < 0.001), slower walking speed (P = 0.05), and longer timed up and go test time (P = 0.004) than the control group.

Conclusion

The results showed that balance performance was impaired in elderly people with LBP. We should pay more attention to the balance control of elderly people with LBP.

Association between musculoskeletal function and postural balance in patients with long-lasting dizziness. A cross-sectional study

BACKGROUND AND PURPOSE

Reduced balance and musculoskeletal pain are frequently reported among patients with long-lasting dizziness. However, the association between musculoskeletal function and postural sway among these patients has not been examined. The objective of this study was to examine if there is an association between aspects of musculoskeletal function and postural balance in patients with long-lasting dizziness.

METHODS

This was a cross-sectional study, using data of 105 outpatients with long-lasting dizziness. Aspects of musculoskeletal function was assessed by examining body flexibility, grip strength, preferred and fast walking speed, in addition to musculoskeletal pain. Musculoskeletal pain was evaluated using the Subjective Health Complaints questionnaire. Postural balance was assessed by path length of postural sway by using a balance platform on both firm and soft surfaces, with eyes open and closed. The association between musculoskeletal function and postural sway was assessed using linear regression analyses.

RESULTS

When adjusting for age and gender we found that on a firm surface, there was an association between increased musculoskeletal pain and increased postural sway measured with eyes open (p = 0.038). In addition, there was an association between decreased body flexibility and decreased postural sway with eyes open (p = 0.025). On a soft surface, decreased fast walking speed was associated with increased postural sway with eyes open (p = 0.027). In addition, decreased grip strength was associated with increased postural sway on a soft surface with eyes closed (p = 0.015).

DISCUSSION

The findings from this study imply that musculoskeletal function may associate with postural sway in patients with long-lasting dizziness, although the associations were weak.

Self-perceived functional ability and performance-based testing of physical function in older women with or without long-term back pain - results of the H70 study

Background

The proportion of older adults is increasing rapidly, and the majority are female. In 2050, the number of persons aged 60 years and over is estimated to reach 2.1 billion worldwide, constituting one-third of the total population of Europe. Long-term back pain is a disabling and common condition, primarily affecting older women. Although standardized functional evaluations are essential in the screening of older adults, self-rated activities of daily living capture a different aspect of the person’s ability in the context of his or her environment and social support system. This study aimed to describe how older women with or without long-term back pain self-rate their activities of daily living (ADL) and instrumental activities of daily living (IADL) in relation to their performance-based testing of physical function, including walking test, leg muscle strength, balance, and endurance.

Method

This study is part of the Gothenburg H70 Birth Cohort Studies in Sweden (H70 studies) and uses data from the 1944 birth cohort examined in 2015–16 at age 70. In the present study, only female participants were included in the analysis, and all cases of dementia (n = 17) and cases of acute and sub-acute back pain excluded (n = 181), leaving an effective sample of 446 female participants.

Results

Women with long-term back pain self-perceived their ADL and IADL as being as good as those without back pain, although they performed poorer in all performance-based tests and perceived themselves as less physically fit.

Conclusion

The discrepancy between self-perceived functional ability (ADL/IADL) and performance-based testing of functioning based on clinical tests calls for further investigation to incentivize person-centered care in older women with long-term back pain in municipal or emergency health-care settings.

Lower extremity alignment due to patellofemoral syndrome and dynamic postural balance

STUDY DESIGN

This study is a prospective study.

AIM

Lower extremity malalignment is an important etiologic factor in patellofemoral pain syndrome (PFPS). We hypothesized that lower limb malalignment may affect dynamic balance and physical function. This prospective study was conducted to investigate the relationship between the lower limb alignment and the dynamic balance and physical function in patients with PFPS.

METHODS

The study included 62 individuals with unilateral PFPS. Pain severity was assessed by the numerical pain scale and the pain duration was recorded. Lower extremity bone alignment was evaluated by the lateral distal femoral angle (LDFA) and the medial proximal tibia angle. Dynamic postural balance was assessed by the star excursion balance test. The functional status of the patients was evaluated by the 30-second chair stand test.

RESULTS

The mean duration of the pain was 24.2 ± 31.5 months and the mean pain severity was 8.1 ± 1.4. Although there was a significant difference found between the affected and unaffected LDFA values of lower extremities (p < 0.05), there was no difference found with regard to the dynamic balance values of the lower extremities (p > 0.05). However, significant changes of posterolateral balance were identified at a painful side without causing a postural dynamic imbalance (p < 0.05).

CONCLUSION

In our study, we found a valgus deformity as a deterioration in the lower limb alignment of patients with PFPS which may cause a deterioration of posterolateral balance only. However, no change in postural dynamic balance was observed in the comparison of affected side and unaffected side. Dynamic postural balance has been influenced by many kinematic changes related to lower extremities including pelvis, hip, and ankle. Thus, reciprocal mechanisms in the anatomical structures may compensate the postural balance dynamically.

Association between chronic pain and pre-frailty in Japanese community-dwelling older adults: A cross-sectional study

A relationship between chronic pain and frailty has been reported. The early detection and prevention of frailty are recommended, in part because community-dwelling older adults in a pre-frailty state may return to a healthy state. The relationship between chronic pain and pre-frailty is not known. Toward the goal of promoting a reversible return to health from pre-frailty, we investigated the relationship between chronic pain and pre-frailty among community-dwelling older adults. We assessed the frailty and chronic pain of 107 older adults who were participating in community health checks. The status of physical frailty was based on the five components described by Fried (2001): muscle weakness shown by handgrip strength, slowness of gait speed, weight loss, low physical activity, and exhaustion. Chronic pain was assessed based on pain intensity, the Pain Catastrophizing Scale (PCS), the Japanese version of the Geriatric Depression Scale-15 (GDS-15), and the Central Sensitization Inventory (CSI). The prevalence of chronic pain with pre-frailty was 40.2%. A hierarchical analysis revealed that PCS-measured helplessness (odds ratio [OR]: 0.88) and the CSI (OR: 0.87) were significant factors associated with the presence of chronic pain with pre-frailty. The prevalence of chronic pain with pre-frailty was high, and chronic pain and pre-frailty were strongly related. New intervention or prevention programs that take into account both chronic pain and pre-frailty must be created as soon as possible.

Effect of sensory stimulation applied under the great toe on postural ability in patients with fibromyalgia

Fibromyalgia (FM) is a chronic pain syndrome, characterised by several symptoms. One of the most prevalent symptoms in FM is balance impairment that compromise the autonomy, function and performance status of patients.Purpose: The main objective of the present study was to evaluate the effect of sensory stimulation provided by the use of a low additional thickness of 0.8 mm placed under the great toes bilaterally on the centre of pressure (CoP) measures in patients with FM. It was hypothesised that postural ability would change with a low focal additional thickness used to compute these measures.Materials and Method: Twenty-four patients with FM voluntarily participated in this study. Postural performance during quiet standing was investigated through the CoP displacements recorded using a force-plate. Sensory stimulation was provided by a small additional thickness of 0.8 mm placed under the great toe bilaterally and two conditions were compared: additional thickness 0 (control) and 0.8 mm.Results: An improvement of body balance through spatial parameters with sensory cutaneous stimulation applied under the great toe bilaterally were observed in patients with FM. Our results showed a significant decrease of surface area and mean speed of CoP, associated to a significant decrease of variance of speed. An additional observation is that sagittal (Y) mean position of the CoP gets more anterior (+ 5 mm) relative to control condition.Conclusion: These findings brings new clinical perspectives in the development of intervention strategies in the management of patients with FM and balance disorders, completing validated therapeutic strategies.

The importance of weak physical performance in older adults for the development of musculoskeletal pain that interferes with normal life. A prospective cohort study

BACKGROUND AND AIMS

There are associations between pain, comorbidity and risk of falling, and falling increases the risk of mortality in older persons, but few studies have investigated the development of pain as a result of impaired physical function. The aim of this study was to examine possible associations between weak physical performance and the development of musculoskeletal pain that interferes with normal life in a sample of older adults. The sample derived from a national, longitudinal multicenter study; the Swedish National Study on Ageing and Care; SNAC-B.

METHODS

The participants (n = 490) were between 60 and 78 years at the baseline examinations. Three variables were chosen for the exposure physical function, from the baseline examinations; One Leg Stand, Grip strength and Sit-to-Stand. The outcome musculoskeletal pain that interferes with normal life was measured using EQ5D and SF-12 6 years later, and logistic regression was used to investigate possible associations between the exposures and the outcome.

RESULTS

Maximum grip strength (Grippit) was inversely associated with musculoskeletal pain that interferes with normal life (OR 2.31; 95% CI 1.15-4.61), and One-Leg Stand and Sit-to-Stand were not associated with the development of pain (OR 1.30; 95% CI 0.64-2.64) and (OR 0.91; 95% CI 0.45-1.86), respectively.

CONCLUSIONS

Weak grip strength was inversely associated with the development of musculoskeletal pain that interferes with normal life in older adults.

IMPLICATIONS

Impaired proprioceptive function, strength and mobility in elderly with pain have been found in earlier research. Since pain increases the risk of falling, it is important to investigate if it may develop as a function of an impaired physical function. The results of the present study could be of importance for future prevention programs aiming to protect elderly from falling.

Effects of a Multimodal Exercise Program Plus Neural Gliding on Postural Control, Pain, and Flexibility of Institutionalized Older Adults: A Randomized, Parallel, and Double-Blind Study

BACKGROUND AND PURPOSE

The effect of adding neural mobilization to a multimodal program of exercises has not been investigated, despite its potential positive effects. The aim of this study was to compare the acute effects of a multimodal exercise program and neural gliding against a multimodal exercise program only, on pain intensity, gait speed, Timed Up and Go (TUG) test, lower limb flexibility, and static balance of institutionalized older adults.

METHODS

Older adults who were institutionalized (n = 26) were randomized to receive a multimodal exercise program plus neural gliding or a multimodal exercise program only. Both interventions were delivered twice a week for 8 weeks. Participants were assessed for pain, gait velocity, balance, flexibility, and TUG at baseline and postintervention.

RESULTS

A significant main effect of time for pain intensity (F1,24 = 8.95, P = .006), balance (F1,24 = 10.29, P = .004), and gait velocity (F1,24 = 5.51, P = .028) was observed, indicating a positive impact of both interventions. No other significant effects were found (TUG and flexibility; P > .05).

DISCUSSION

A 45-minute multimodal exercise program, twice a week for 8 weeks, has a positive impact on pain intensity, balance, and gait velocity, but neural gliding has no additional benefit. It is unclear whether dose and type of neural mobilization may have had an impact on results. Considering the structural and physiological changes that tend to occur with age, future studies could explore the effects of neural tensioning or of higher doses of neural mobilization.

CONCLUSIONS

This study suggests that adding neural gliding to a multimodal exercise program has no additional benefit.

Persistent Pain Quality as a Novel Approach to Assessing Risk for Disability in Community-Dwelling Elders With Chronic Pain

BACKGROUND

This study aims to test whether persistent pain quality is associated with incident or worsening disability in four domains: mobility, activity of daily living (ADL) and instrumental activity of daily living (IADL) difficulty, and physical performance.

METHODS

From the MOBILIZE Boston Study, a population-based cohort of adults aged ≥70 years, we studied participants with chronic pain who endorsed at least one pain quality descriptor (N = 398) and completed baseline and 18-month assessments. Pain quality was assessed using an adapted short-form McGill Pain Questionnaire with 20 pain quality descriptors in three categories: sensory, cognitive/affective, neuropathic. Persistence was defined as endorsing the same category at baseline and 18 months. Self-reported outcomes included mobility, ADL, and IADL difficulty. Physical performance was assessed using the short physical performance battery.

RESULTS

After adjusting for baseline pain severity and other covariates, individuals with three persistent categories had a greater risk of developing new or worsening IADL difficulty relative to those with one persistent category (relative risk [RR] 2.69, 95% confidence interval [CI] 1.34, 7.79). Similar results were observed for ADL difficulty (RR 5.83, 95% CI 1.32, 25.85), but no differences were noted in risk for mobility difficulty. There was no significant linear trend in physical performance over 18 months according to number of persistent categories (p =.68).

CONCLUSION

Elders with persistent pain quality experienced a higher risk of developing new or worsening IADL and ADL disability with each additional category but not mobility difficulty or poorer physical performance. Longitudinal assessment of pain quality could be useful in determining risk for global disability among elders with chronic pain.

Association between Chronic Pain and Physical Frailty in Community-Dwelling Older Adults

This cross-sectional study investigated the association between chronic pain and physical frailty in community-dwelling older adults. We analyzed data obtained from 323 older adults (women: 74.6%) who participated in a community-based health check survey (the Tarumizu Study, 2017). Physical frailty was defined in terms of five parameters (exhaustion, slowness, weakness, low physical activity, and weight loss). We assessed the prevalence of chronic low back and knee pain using questionnaires. Participants whose pain had lasted ≥two months were considered to have chronic pain. Among all participants, 138 (42.7%) had chronic pain, and 171 (53.0%) were categorized as having physical frailty or pre-frailty. Logistic regression analysis showed that chronic pain was significantly associated with the group combining frailty and pre-frailty (odds ratio 1.68, 95% confidence interval 1.03–2.76, p = 0.040) after adjustment for age, sex, body mass index, score on the 15-item Geriatric Depression Scale, and medications. Comparing the proportions of chronic pain among participants who responded to the sub-items, exhaustion (yes: 65.9%, no: 39.4%) demonstrated a significant association (p < 0.001). Chronic pain could be associated with the group combining frailty and pre-frailty and is particularly associated with exhaustion in community-dwelling older adults. Therefore, there is a need for early intervention and consideration of the role of exhaustion when devising interventions for physical frailty in older individuals with chronic pain.

Effect of six-week intervention program on postural stability measures and muscle coactivation in senior-aged women

Objective

The objective involved the analysis of the efficiency of the Program of Movement Recreation of Elderly People (PMREP) exercise program expressed in terms of the stabilography measures and coactivation of muscles in women in the age group of 60–70 years. The assumption that was assumed stems from theoretical implications that the adequate postural stability is manifested in the decrease of the body sways measured by means of a force plate.

Materials and methods

The study involved a group of 60 females, all members of the active seniors’ association. The subjects were in the age range from 60 to 70 years. The subjects were divided into 2 groups of equal size: control and experimental. Subjects in both groups participated in the rehabilitation exercises: experimental (n=16, PMREP – twice a week/60 minutes), control (n=27, PMREP – only once a week/60 minutes).

Results

The study demonstrated that the completion of a 6-week PMREP program resulted in a decrease in the variability and velocity as well as indicators representing center of pressure displacement measured in the feet for the exercises performed with closed eyes with subjects standing on a high foam pad located on a force plate (P=0.001). No significant changes in coactivation of the calf muscles were recorded in the subjects.

Conclusion

The study concludes that a PMREP rehabilitation plan with an adequate program and frequency leads to an improvement of the vestibular system coupled with proprioception understood as an integrated process of sensor activation in the body. However, in regard to the coactivation of the muscles involved in maintaining postural stability, no significant differences have been observed.

Do plantar hyperkeratoses affect balance in people older than 65 years old?

Tactile information picked up by plantar receptors provides afferent sensory information that is fundamental for controlling body balance. Plantar hyperkeratoses may alter the quality and quantity of such information, thereby modifying balance.

AIM

Analyse how plantar hyperkeratosis debridement affects static body balance in subjects of 65 years of age or older.

METHODS

In order to analyse the impact of hyperkeratoses on balance, 50 older people took part in this study. Pain caused by plantar hyperkeratoses was measured on a visual analogue scale. Static balance was assessed on a pressure sensitive platform. The treatment was scalpel debridement of hyperkeratoses.

RESULTS

Pain decreased significantly (p=0.03). Regarding the variables analysed, significant differences were found between pre- and post-treatment values in anteroposterior length (Length, mm) (p=0.032) and anteroposterior amplitude (Amp, mm) (p=0.044) of the centre of plantar pressure with eyes open.

CONCLUSIONS

Plantar hyperkeratosis debridement is capable of interfering favourably with sensory afferent inputs, thereby improving control of stability and modifying stabilometric readings in the AP component when a subject balance with eyes open.

Prevalence of fear of falling and associated factors among Japanese community-dwelling older adults

To determine the prevalence of fear of falling and associated factors among Japanese community-dwelling older adults.Cross-sectional study between 2011 and 2013.Community in which residents voluntarily attended a health examination.We recruited 844 older adults (male, n = 350; female, n = 494) aged 60 to 92 years from among those who presented at the health examination.We assessed fear of falling, falls in the previous year, pain, comorbidity, and cataracts. Five times chair stand time was applied as an indicator of physical performance.The prevalence of fear of falling was 26.9% and 43.3% among the men and women, respectively. Men and women who feared falling were older (P < .01), had longer 5 times chair stand time (P < .01), and more falls in the previous year (P < .05), pain (P < .01), and comorbidity (P < .05). Multivariate logistic regression analysis identified advanced age (odds ratios [OR], 1.57; 95% confidence interval [CI], 1.03-2.39), falls in the previous year (OR, 2.44; 95%CI, 1.29-4.64), and pain (OR, 1.82; 95%CI, 1.03-3.22) in men, and advanced age (OR, 1.59; 95%CI, 1.13-2.24), longer 5 times chair stand times (OR, 1.28; 95%CI, 1.04-1.59), falls in the previous year (OR, 2.59; 95%CI, 1.54-4.34), and pain (OR, 1.65; 95%CI, 1.06-2.55) in women as being independently associated with fear of falling.The prevalence of fear of falling was similar to previous reports. Advanced age, falls in previous year, and pain were associated with fear of falling in men. A longer 5 times chair stand time was also associated with fear of falling among older adult women. Maintenance of physical function and pain management might be important for older adults with fear of falling.

Does the lower extremity alignment affect the risk of falling?

Objectives

This study aims to investigate the effects of knee and foot alignments on the risk of falling.

Patients and methods

Between April 2016 and December 2016, a total of 74 individuals (24 males, 50 females; mean age 32.2±4.9 years; range 18 to 65 years) were included in the study. The knee Q angle and Chippaux-Smirak Index (CSI), Arch Index, and foot progression angle (FPA) evaluated by pedobarography were used for the assessment of the lower extremity alignment. The fall risk was evaluated by the Fall Index, Fourier 56 Index (F56), and Stability Index.

Results

The fall index was found to be correlated with the Q angle, CSI, the Arch index, and FPA (p<0.05). Q angle, Arch Index, and FPA which were explained 40% of the variance of the fall index. The Q angle was correlated with F56 and the stability index at the most position (p<0.05). The CSI was correlated with the F56 and the stability index at two and three positions, respectively (p<0.05); however, the Arch Index and FPA were not correlated with the F56 and Stability Index at any of the eight positions (p>0.05). According to the categorical regression analysis, the Q angle was the most effective on the F56 and Stability Index.

Conclusion

Our study results suggest that lower extremity malalignment increases the risk of falling. We believe that the risk of falling can be decreased by the reduction of these malalingments and, thus, mortality and morbidity associated with the fall can be reduced as well.

Factors associated with chronic musculoskeletal pain in Japanese community-dwelling older adults: A cross-sectional study

Identifying older adults with chronic musculoskeletal pain (CMP) earlier is urgent because CMP is reportedly associated with deterioration in physical function, poor psychological status, and low physical activity level. The objective of this study was to identify factors that were most strongly associated with CMP in Japanese community-dwelling older adults.Using a cross-sectional design, we assessed 263 older adults (mean age = 79.1 ± 5.9 years, 85.9% women) who participated in community exercise classes. Participants' physical function, psychological status, and activity levels were evaluated as outcome measures using a variety of tests and instruments. These assessments were conducted prior to beginning the exercise intervention program and compared participants with and without CMP. Additionally, relevant participant characteristics were collected and analyzed. In this study, CMP was defined as the presence of related symptoms within the past month that continued for at least 6 months and corresponded to a numerical rating scale of at least 5 or more at the site of maximum pain.A total of 143 (54.4%) participants met the criteria for CMP, and a high number of them had chronic lower back pain (64.3%). Outcome measures for the CMP group were significantly worse than for the non-CMP group (P < .05). Logistic regression analysis revealed that the Pain Catastrophizing Scale helplessness domain scores (odds ratio: 1.20, 95% confidence interval: 1.09-1.32) with an estimated value of 10 points was the factor most significantly associated with the presence of CMP.These findings suggest that assessment of the helplessness associated with pain-related catastrophizing is important for identification and the creation of interventions for older adults with CMP.

Influência do estado nutricional, distribuição da gordura corporal e força muscular na estabilometria de idosas

OBJETIVO: Investigar as associações entre diversas medidas indicadoras do estado nutricional, a força muscular e as diferentes variáveis estabilométricas em uma amostra de idosas. MÉTODOS: Neste estudo exploratório de corte transversal, 108 idosas tiveram suas variáveis estabilométricas avaliadas através de uma plataforma de força, em duas condições experimentais: olhos abertos e olhos fechados. Verificaram-se as associações entre as variáveis explicativas: idade, massa corporal, estatura, índice de massa corporal, circunferência de quadril, circunferência de cintura, relação cintura/quadril, percentual de gordura corporal, massa gorda, massa magra, área muscular de braço corrigida, força isométrica voluntária máxima e diversas variáveis estabilométricas: amplitude anteroposterior, deslocamento da oscilação e área elíptica da superfície, dentre outras. RESULTADOS: Com exceção da estatura, todas as variáveis explicativas associaram-se significativamente com as variáveis estabilométricas. A regressão múltipla (forward) revelou que a circunferência de cintura e a força isométrica voluntária máxima foram as variáveis que mais influenciaram as variáveis estabilométricas, entretanto sem diferenças significativas entre as condições olhos abertos e olhos fechados. O percentual de gordura parece não sobrecarregar o sistema de controle postural. Na condição olhos abertos, a variável estabilométrica desvio--padrão médio-lateral foi a mais influenciada pelas variáveis explicativas. A circunferência de cintura foi respon-sável por 8,8% de toda variação do desvio-padrão médio-lateral e a força isométrica voluntária máxima contribuiu com 9,4% adicionais. CONCLUSÃO: Os resultados sugerem que a distribuição centrípeta de gordura corporal associada à diminuição da força muscular são as principais responsáveis pelas alterações estabilométricas em idosas.

Pain, range of motion and activity level as correlates of dynamic balance among elderly people with musculoskeletal disorder

BACKGROUND

Assessment of impairment and disability measures on dynamic balance status of elderly patients is well documented in the rehabilitation of neuromuscular disorders. Few studies however considered similar evaluation in musculoskeletal disorders.

OBJECTIVE

To determine the influence of pain, hip range of motion and level of activity on dynamic balance among elderly people with hip osteoarthritis (OA).

METHODS

Elderly patients with hip OA participated in the cross-sectional survey. The impairment measures were assessed using the visual analogue scale and double-arm universal goniometer whilst their levels of activity were assessed with the Barthel Index. Participants performed Turn-180 on two trials by taking steps clockwise and anti-clockwise round a sturdy arm chair. The total number of steps taken to complete each Turn- 180 was determined. Descriptive statistics were used to summarize data whilst Pearson moment correlation coefficient determined the correlations of the variables at 95% confidence interval.

RESULTS

The study involved 87 participants comprising 40(46%) males and 47(54%) females. The age of the participants ranged from 60 to 74 years with a mean of 65.8±4.5 years. There was a positive and significant correlation (r=0.596; p<0.001) between the participants' pain and steps taken to complete Turn-180. The participants' hip flexibility and the level of activity were also significantly and inversely correlated with the performance of Turn-180.

CONCLUSION

The dynamic balance of the sampled elderly patients was considerably influenced by pain, hip flexibility and level of activity, thereby putting premium on the assessment of the variables during musculoskeletal rehabilitation of elderly patients.

Type of surgery is associated with pain and walking difficulties among older people with previous hip fracture

AIM

The aim was to assess the level of lower body pain among people with previous femoral neck fracture, and whether the type of surgery was associated with pain and physical function a mean of 2 years after surgery.

METHODS

The study included 115 community-dwelling older adults aged 60 years and older with previous femoral neck fracture, and 31 reference subjects without previous lower limb injuries. A total of 30 patients had internal fixation surgery, 70 had hemiarthroplasty and 15 had total hip replacement. All patients had surgery in the same hospital and received typical inpatient rehabilitation. From 1.6 months to 7.5 years after the fracture, the patients underwent examination including clinical evaluation, measurements of pain in the lower body (visual analog scale), physical function (maximal walking speed, Timed Up & Go, Berg Balance Scale) and self-reported walking difficulties.

RESULTS

Hip fracture patients reported more pain (81 ± 88 mm) compared with the reference group (25 ± 39 mm, P = 0.004). Patients with internal fixation reported significantly more pain than the other study groups. Significantly more patients with internal fixation (53%) reported walking difficulties compared with patients who had hemiarthroplasty (29%, P = 0.028) or total hip replacement (13%, P = 0.018). No significant difference was observed in performance-based physical function between the fracture groups, but participants in the reference group had better physical function than any of the fracture groups.

CONCLUSIONS

Hip fracture patients treated with internal fixation experienced more pain and walking difficulties than the hemiarthroplasty and total hip replacement groups. Different types of surgical fixation might require different rehabilitation and pain management strategies after hip fracture. Geriatr Gerontol Int 2015; ●●: ●●-●●.

The influence of somatosensory and muscular deficits on postural stabilization: Insights from an instrumented analysis of subjects affected by different types of Charcot-Marie-Tooth disease

•

We studied the role of sensory and muscular deficits in balance impairments in CMT.

•

Large sensory fibers and dorsi-flexor muscles affect the dynamic phase of stabilization.

•

Small sensory fibers and plantar-flexor muscles influence the static phase of balance.

•

Residual sensory and muscle functions must be evaluated for a proper rehabilitation.

Charcot–Marie–Tooth (CMT) disease is the most common hereditary neuromuscular disorder. CMT1 is primarily demyelinating, CMT2 is primarily axonal, and CMTX1 is characterized by both axonal and demyelinating abnormalities. We investigated the role of somatosensory and muscular deficits on quiet standing and postural stabilization in patients affected by different forms of CMT, comparing their performances with those of healthy subjects. Seventy-six CMT subjects (CMT1A, CMT2 and CMTX1) and 41 healthy controls were evaluated during a sit-to-stand transition and the subsequent quiet upright posture by means of a dynamometric platform. All CMT patients showed altered balance and postural stabilization compared to controls. Multivariate analysis showed that in CMT patients worsening of postural stabilization was related to vibration sense deficit and to dorsi-flexor's weakness, while quiet standing instability was related to the reduction of pinprick sensibility and to plantar-flexor's weakness. Our results show that specific sensory and muscular deficits play different roles in balance impairment of CMT patients, both during postural stabilization and in static posture. An accurate evaluation of residual sensory and muscular functions is therefore necessary to plan for the appropriate balance rehabilitation treatment for each patient, besides the CMT type.

Work-related stress in midlife is associated with higher number of mobility limitation in older age-results from the FLAME study

The aim of this study is to investigate whether work-related stress symptoms in midlife are associated with a number of mobility limitations during three decades from midlife to late life. Data for the study come from the Finnish Longitudinal Study of Municipal Employees (FLAME). The study includes a total of 5429 public sector employees aged 44-58 years at baseline who had information available on work-related stress symptoms in 1981 and 1985 and mobility limitation score during the subsequent 28-year follow-up. Four midlife work-related stress profiles were identified: negative reactions to work and depressiveness, perceived decrease in cognition, sleep disturbances, and somatic symptoms. People with a high number of stress symptoms in 1981 and 1985 were categorized as having constant stress. The number of self-reported mobility limitations was computed based on an eight-item list of mobility tasks presented to the participants in 1992, 1997, and 2009. Data were analyzed using joint Poisson regression models. The study showed that depending on the stress profile, persons suffering from constant stress in midlife had a higher risk of 30-70 % for having one more mobility limitation during the following 28 years compared to persons without stress after adjusting for mortality, several lifestyle factors, and chronic conditions. A less pronounced risk increase (20-40 %) was observed for persons with occasional symptoms. The study suggests that effective interventions aiming to reduce work-related stress should focus on both primary and secondary prevention.

High prevalence of falls, fear of falling, and impaired balance in older adults with pain in the United States: findings from the 2011 National Health and Aging Trends Study

OBJECTIVES

To determine the prevalence of clinically relevant falls-related outcomes according to pain status in older adults in the United States.

DESIGN

Cross-sectional analysis of the 2011 National Health and Aging Trends Study, a sample of Medicare enrollees aged 65 and older (response rate 71.0%).

SETTING

In-person assessments were conducted in the home or residential care facility of the sampled study participant.

PARTICIPANTS

Individuals aged 65 and older (n = 7,601, representing 35.3 million Medicare beneficiaries).

MEASUREMENTS

Participants were asked whether they had been "bothered by pain" and the location of pain, as well as questions about balance and coordination, fear of falling, and falls.

RESULTS

Fifty-three percent of the participants reported bothersome pain. The prevalence of recurrent falls in the past year (≥ 2 falls) was 19.5% in participants with pain and 7.4% in those without (age- and sex-adjusted prevalence ratio (PR) = 2.63, 95% confidence interval (CI) = 2.28-3.05). The prevalence of fear of falling that limits activity was 18.0% in those with pain and 4.4% in those without (adjusted PR = 3.98, 95% CI = 3.24-4.87). Prevalence of balance and falls outcomes increased with number of pain sites. For example, prevalence of problems with balance and coordination that limited activity was 6.6% in participants with no pain, 11.6% in those with one site of pain, 17.7% in those with two sites, 25.0% in those with three sites, and 41.4% in those with four or more sites (P < .001 for trend). Associations were robust to adjustment for several potential confounders, including cognitive and physical performance.

CONCLUSION

Falls-related outcomes were substantially more common in older adults with pain than in those without. Accordingly, pain management strategies should be developed and evaluated for falls prevention.

Impaired postural balance in the morning in patients with knee osteoarthritis

Postural balance (PB) is frequently used as an outcome measure in clinical and research settings when assessing patients with knee osteoarthritis (OA). Pain and stiffness is known to affect PB, and is elevated in the morning and evening in OA patients. The aim of this study was to explore if time-of-day affects PB control in knee OA patients. Centre Of Pressure (COP) excursion was measured (100Hz) by force plate technique at selected time-points (9.00 a.m., 12.30 p.m. and 4.00 p.m.) during a single day in 32 knee OA patients aged 66.0 (10.3) years. A rigorous protocol was followed to ensure comparable testing conditions across time-points. PB control was quantified by the COP variables: velocity moment (mm(2)/s), total sway area (mm(2)), total sway length (mm) and confidence ellipse area (mm(2)). A two-way mixed-effects model showed that PB significantly improved between 9.00 a.m. and 12.30 p.m. in three out of four COP variables. The observed improvement was 11.9% (p=0.011) for velocity moment, 12.2% (p=0.011) for total sway area and 9.4% (p<0.001) for total sway length. PB appears to be impaired in the morning relative to midday in knee OA patients. Thus, it is recommended that time of assessment is standardized between sessions when assessing PB in clinical and research settings in knee OA patients.

Balance ability and postural stability among patients with painful shoulder disorders and healthy controls

Background

In therapeutic settings, patients with shoulder pain often exhibit deficient coordinative abilities in their trunk and lower extremities. The aim of the study was to investigate 1) if there is a connection between shoulder pain and deficits in balance ability and postural stability, 2) if pain intensity is related to balance ability and postural stability, and 3) if there is a connection between body mass index (BMI) and balance ability and postural stability.

Methods

In this case–control study, patients (n = 40) with pathological shoulder pain (> 4 months) were matched with a healthy controls (n = 40) and were compared with regard to their balance ability and postural stability. Outcome parameters were postural stability, balance ability and symmetry index which were measured using the S3-Check system. In addition, the influence of shoulder pain intensity and BMI on the outcome parameters was analysed.

Results

Patients with shoulder pain showed significantly worse results in measurements of postural stability right/left (p < 0.01) and front/back (p < 0.01) as well as balance ability right/left (p = 0.01) and front/back (p < 0.01) compared to healthy controls. There were no significant group differences with regard to symmetry index. However, there was a significant (p < 0.01) symmetry shift towards the affected side within the shoulder pain group. There was no correlation between pain intensity and measurements of balance ability or postural stability. Likewise, no correlation between BMI and deficiencies in balance ability and postural stability was established.

Conclusions

Patients with pathological shoulder pain (> 4 months) have deficiencies in balance ability and postural stability; however the underlying mechanisms for this remain unclear. Neither pain intensity nor BMI influenced the outcome parameters. Patients with shoulder pain shift their weight to the affected side. Further research is needed to determine if balance training can improve rehabilitation results in patients with shoulder pathologies.

Fear of Falling and Balance Ability in Older Men: The Priest Study

Studies examining fear of falling among older adult men remain limited. The objectives of this study were to compare balance confidence in 2 age cohorts of older clergy and identify predictive determinants of balance confidence in a liturgical research initiative. Participants included 131 community-dwelling Roman Catholic priests age 60–97 yr living in religious communities in 10 mid-Atlantic states. Subjects completed the Activities-specific Balance Confidence Scale (ABC), Berg Balance Scale (BBS), timed up-and-go (TUG) test, and 15-item Geriatric Depression Scale (GDS). Younger priests (60–74 yr) demonstrated a significantly higher ABC score than the older cohort (75 and above yr) of priests (89.1 ± 12.6 vs.78.4 ± 13.9,p= .001). Confidence was significantly correlated with BBS (rho = .69,p< .01), TUG (r= –.58,p< .01), and GDS (r= –.39,p< .01) scores. A stepwise-regression model demonstrated that balance ability, mood, assistive-device use, and physical activity predicted 52% of the variance in balance confidence.

Pain in chemotherapy-induced neuropathy--more than neuropathic?

Chemotherapy-induced neuropathy (CIN) is an adverse effect of chemotherapy. Pain in CIN might comprise neuropathic and nonneuropathic (ie, musculoskeletal) pain components, which might be characterized by pain patterns, electrophysiology, and somatosensory profiling. Included were 146 patients (100 female, 46 male; aged 56 ± 0.8 years) with CIN arising from different chemotherapy regimens. Patients were characterized clinically through nerve conduction studies (NCS) and quantitative sensory testing (QST). Questionnaires for pain (McGill) and anxiety/depression (Hospital Anxiety and Depression Scale) were supplied. Patients were followed-up after 17 days. Large- (61%) and mixed- (35%) fibre neuropathies were more frequent than small-fibre neuropathy (1.4%). The 5 major chemotherapeutic regimens impacted differently on large- but not on small-fibre function and did not predict painfulness. Chronic pain associated with CIN was reported in 41.7%. Painless and painful CIN did not differ in QST profiles or electrophysiological findings, but different somatosensory patterns were found in CIN subgroups (pain at rest [RestP], n = 25; movement-associated pain [MovP], n = 15; both pain characteristics [MovP+RestP], n = 21; or no pain [NonP], n = 85): small-fibre function (cold-detection threshold, CDT: z score: -1.46 ± 0.21, P < 0.01) was most impaired in RestP; mechanical hyperalgesia was exclusively found in MovP (z score: +0.81 ± 0.30, P < 0.05). "Anxiety" discriminated between painful and painless CIN; "CDT" and "anxiety" discriminated between patients with ongoing (RestP) and movement-associated pain (MovP) or pain components (MovP+RestP). The detrimental effect of chemotherapy on large fibres failed to differentiate painful from painless CIN. Patients stratified for musculoskeletal or neuropathic pain, however, differed in psychological and somatosensory parameters. This stratification might allow for the application of a more specific therapy.

Musculoskeletal pain and physical functioning in the oldest old

BACKGROUND

Little is known about the impact of pain on physical functioning among the oldest-old subjects. In this study, we first examined the associations between the number of painful sites and measures of physical functioning reflecting different stages of the disablement process (physical impairment, functional limitation and disability) among nonagenarians (more than ninety years old persons). Second, we described the effect of painful sites on disability during a 2-year follow-up period.

METHODS

This study is based on baseline (n = 1177) and 2-year follow-up (n = 709) data of the nationwide Danish 1905 cohort study. Musculoskeletal pain was assessed as reported pain in back, hips or knees when moving or resting. Physical performance measures included maximum grip strength and habitual walking speed. Disability in performing activities of daily living was defined as the need for assistive device or personal help in transferring, dressing, washing, using toilet and/or walking indoors.

RESULTS

At baseline, the number of painful sites was significantly associated with measured grip strength and walking speed as well as self-reported disability in a stepwise manner; the more sites with pain, the poorer the physical functioning. The follow-up analyses showed corresponding but slightly weaker stepwise associations between baseline pain and disability level at follow-up, and indicated that although on the whole, single or multi-site pain did not predict the onset of disability, multi-site pain increased the risk of developing severe disability.

CONCLUSIONS

The findings of this study suggest that musculoskeletal pain in nonagenarians is highly prevalent and is associated with poor physical performance and disability.

Effects of a multimodal exercise program in pedal dexterity and balance: study with Portuguese older adults of different contexts

This study investigated the effects of a multimodal exercise program (MEP) on pedal dexterity and balance in two groups of older adult participants (65–92 years of age) from a psychiatric hospital center (HC), a residential care home (RCH), and a daily living center (DLC). The experimental group (EG) trained three times per week for 12 months, and the control group (CG) maintained their normal activities. The Mini-Mental State Examination and the Modified Baecke Questionnaire, as well as the Pedal Dexterity and the Tinetti tests, were applied to all subjects before and after the experimental protocol. Furthermore, the foot preference was controlled using the Lateral Preference Questionnaire proposed by Coren [10]. In the EG, the results from the Pedal Dexterity test showed that both males and females from the RCH and DLC improved their performances after the MEP. In the HC, the males slightly decreased their performance with both feet, contrarily to females. Both males and females from the CG decreased their pedal dexterity performance, namely, with the non-preferred foot. Concerning the Tinetti test, the EG of both males and females from the HC, the RCH (males were better than females regarding the gender factor), and the DLC improved their balance after the MEP. In the CG, no significant effects or interactions were found for any of the context groups.

Low back pain and postural sway during quiet standing with and without sensory manipulation: a systematic review

A previous review concluded that postural sway is increased in patients with low back pain (LBP). However, more detailed analysis of the literature shows that postural deficit may be dependent on experimental conditions in which patients with LBP have been assessed. The research question to be answered in this review was: "Is there any difference in postural sway between subjects with and without LBP across several sensory manipulation conditions?". A literature search in Pubmed, Scopus, Embase and PsychInfo was performed followed by hand search and contact with authors. Studies investigating postural sway during bipedal stance without applying external forces in patients with specific and non-specific LBP compared to healthy controls were included. Twenty three articles fulfilled the eligibility criteria. Most studies reported an increased postural sway in LBP, or no effect of LBP on postural sway. In a minority of studies, a decreased sway was found in LBP patients. There were no systematic differences between studies finding an effect and those reporting no effect of LBP. The proportion of studies finding between-group differences did not increase with increased complexity of sensory manipulations. Potential factors that may have caused inconsistencies in the literature are discussed in this systematic review.

Static balance in patients with patellofemoral pain syndrome

Background:

The relationship between one-leg static standing balance (OLSSB) and patellofemoral pain syndrome (PFPS) is unknown.

Hypothesis:

OLSSB decreases in patients with PFPS.

Design:

Prospective case series.

Methods:

Fifty-two women with unilateral PFPS were enrolled in this study. OLSSB was evaluated with a stabilometer. Q angle was measured with a lengthened-arm universal goniometer. Lower extremity alignment was analyzed with full-length standing anteroposterior teleroentgenograms. Quadriceps and hamstring strength was measured on an isokinetic dynamometer.

Results:

There were significant differences in OLSSB, Q angle, and strength of quadriceps and hamstring between the symptomatic and asymptomatic sides. There was a correlation between the strength of the quadriceps and hamstring and OLSSB, while there was no correlation between OLSSB and the severity of pain, lower extremity alignment, and Q angle on the symptomatic side.

Conclusions:

OLSSB and quadriceps and hamstring strength decreased and Q angle increased on the symptomatic side in PFPS patients. A relationship between OLSSB and pain, Q angle, and lower extremity alignment was not detected, while there was a correlation between the strength of the quadriceps and hamstring and OLSSB.

Clinical Relevance:

A quadriceps and hamstring strengthening may be beneficial to improve OLSSB in patients with PFPS.

Fatigability in basic indoor mobility in nonagenarians

OBJECTIVES

To evaluate the prevalence and associated health factors of indoor mobility-related fatigability in nonagenarians.

DESIGN

A cross-sectional observational study of all Danes born in 1905 and assessed in 1998.

SETTING

Community, sheltered housing and nursing homes.

PARTICIPANTS

Individuals aged 92 and 93 (N = 1,181) who were independent of help in basic indoor mobility.

MEASUREMENTS

Fatigability in basic indoor mobility was defined as a subjective feeling of fatigue when transferring or walking indoors. Other standardized assessments include self-report measures of medical history and performance-based assessments of walking speed and maximum handgrip strength.

RESULTS

Twenty-six percent of participants reported fatigability when transferring or walking indoors; fatigability was more common in participants living in sheltered housing (32%) than in those living independently (23%, P < .001). Cardiovascular diseases, musculoskeletal pain, medications, walking speed, and depressive symptoms were independently associated with fatigability.

CONCLUSION

Fatigability in basic everyday mobility is common in nondisabled nonagenarians. The results also indicate important associations between fatigability and potentially modifiable health factors.