Musculoskeletal pain is associated with incident mobility disability in community-dwelling elders

Abstract

Background: Identifying mobility disability risk factors may facilitate development of interventions promoting functional independence in older persons. We tested the hypothesis that musculoskeletal pain is associated with first occurrence of severe mobility disability.

Methods: In a prospective observational study at 40 community-based sites, 759 older Catholic clergy in the Rush Religious Orders Study without baseline dementia, stroke, Parkinson's disease, or severe performance-based mobility disability (defined as gait speed less than or equal to 0.4 m/s) and at least one follow-up mobility evaluation were evaluated over a mean of 8.5 (SD = 3.8) years. All participants were queried about musculoskeletal pain in the year before baseline and underwent annual assessment of mobility.

Results: Using a proportional hazards model adjusted for age, sex, and education, the hazard for incident severe mobility disability was greater for participants reporting pain in the year before baseline (odds ratio = 1.47, 95% confidence interval = 1.17-1.85). Results were unchanged after adjusting for self-reported mobility disability, gait speed, depressive symptoms, body mass index, physical activity, chronic medical conditions, and analgesic use. Compared with no report of musculoskeletal pain, musculoskeletal pain in one or two areas was associated with a 30% greater hazard for incident disability (odds ratio = 1.31, 95% confidence interval = 1.00-1.70). Musculoskeletal pain in three or more areas was associated with an 80% greater hazard for incident disability (odds ratio = 1.80, 95% confidence interval = 1.31-2.47). In participants without baseline self-reported mobility disability (n = 486), musculoskeletal pain was associated with greater hazard for incident self-reported mobility disability (odds ratio = 1.38, 95% confidence interval = 1.11-1.73).

Conclusion: In older persons, musculoskeletal pain is associated with incident mobility disability.

Figure 1.

Kaplan–Meier survival functions showing estimated proportion of participants without incident severe performance-based mobility disability as a function of time in study, separately for participants with (dashed) and without (solid) musculoskeletal pain in the year before baseline.

Figure 2.

Estimated cumulative hazard function for performance-based mobility disability (gait speed ≤0.4 m/s) for illustrative participants (80-year-old females with 18 years of education) with (1) no musculoskeletal areas with reported pain (solid), (2) one or two areas with reported pain (dashed), and (3) three or more areas with reported pain (broken line).

Figure 3.

Kaplan–Meier survival functions showing estimated proportion of participants without incident self-reported mobility disability as a function of time in study, separately for participants with (dashed) and without (solid) musculoskeletal pain in the year before baseline.