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. 2014 Jun;62(6):1007-16.
doi: 10.1111/jgs.12848. Epub 2014 May 13.

Pain characteristics associated with the onset of disability in older adults: the maintenance of balance, independent living, intellect, and zest in the Elderly Boston Study

Laura H P Eggermont  1 , Suzanne G Leveille, Ling Shi, Dan K Kiely, Robert H Shmerling, Rich N Jones, Jack M Guralnik, Jonathan F Bean
Affiliations

Pain characteristics associated with the onset of disability in older adults: the maintenance of balance, independent living, intellect, and zest in the Elderly Boston Study

Laura H P Eggermont et al. J Am Geriatr Soc. 2014 Jun.

Abstract

Objectives: To determine the effects of chronic pain on the development of disability and decline in physical performance over time in older adults.

Design: Longitudinal cohort study with 18 months of follow-up.

Setting: Urban and suburban communities.

Participants: Community-dwelling older adults aged 65 and older (N = 634).

Measurements: Chronic pain assessment consisted of musculoskeletal pain locations and pain severity and pain interference according to the subscales of the Brief Pain Inventory. Disability was self-reported as any difficulty in mobility and basic and instrumental activities of daily living (ADLs, IADLs). Mobility performance was measured using the Short Physical Performance Battery (SPPB). Relationships between baseline pain and incident disability in 18 months were determined using risk ratios (RRs) from multivariable Poisson regression models.

Results: Almost 65% of participants reported chronic musculoskeletal pain at baseline. New onset of mobility difficulty at 18 months was strongly associated with baseline pain distribution: 7% (no sites), 18% (1 site), 24% (multisite), and 39% (widespread pain, P-value for trend < .001). Similar graded effects were found for other disability measures. Elderly adults with multisite or widespread pain had at a risk of onset of mobility difficulty at least three times as great as that of their peers without pain after adjusting for disability risk factors (multisite pain: risk ratio (RR) = 2.95, 95% confidence interval (CI) 1.58-5.50; widespread pain: RR = 3.57, 95% CI = 1.71-7.48). Widespread pain contributed to decline in mobility performance (1-point decline in SPPB, RR = 1.47, 95% CI = 1.08-2.01). Similar associations were found for baseline pain interference predicting subsequent mobility decline and ADL and IADL disability. Weaker and less-consistent associations were observed with pain severity.

Conclusion: Older community-dwelling adults living with chronic pain in multiple musculoskeletal locations have a substantially greater risk for developing disability over time and for clinically meaningful decline in mobility performance than those without pain.

Keywords: activities of daily living; mobility limitation; older adults; widespread chronic pain.

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Conflict of interest statement

Conflict of Interest

All authors declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1
a. Onset of Self-reported Mobility Difficulty, (I)ADL Difficulty and Clinically Meaningful SPPB Decline in 18 Months by Baseline Pain Distribution Categories. aChi-square test for trend p-value <.001 bChi-square test for trend p-value <.05 ADL=Activities of Daily Living; I=Instrumental; SPPB=Short Physical Performance Battery b. Onset of Self-reported Mobility Difficulty, (I)ADL, Difficulty- and Clinically Meaningful SPPB Decline in 18 Months by Baseline Pain Severity Quartiles. aChi-square test for p-value <.01 bChi-square test for p-value <.05 ADL=Activities of Daily Living; I=Instrumental; SPPB=Short Physical Performance Battery c. Onset of Self-reported Mobility Difficulty, (I)ADL Difficulty and Clinically Meaningful SPPB Decline in 18 Months by Baseline Pain Interference Quartiles. aChi-square test for p-value <.01 bChi-square test for p-value <.001 ADL=Activities of Daily Living; I=Instrumental; SPPB=Short Physical Performance Battery; inter.=interference
Figure 1
Figure 1
a. Onset of Self-reported Mobility Difficulty, (I)ADL Difficulty and Clinically Meaningful SPPB Decline in 18 Months by Baseline Pain Distribution Categories. aChi-square test for trend p-value <.001 bChi-square test for trend p-value <.05 ADL=Activities of Daily Living; I=Instrumental; SPPB=Short Physical Performance Battery b. Onset of Self-reported Mobility Difficulty, (I)ADL, Difficulty- and Clinically Meaningful SPPB Decline in 18 Months by Baseline Pain Severity Quartiles. aChi-square test for p-value <.01 bChi-square test for p-value <.05 ADL=Activities of Daily Living; I=Instrumental; SPPB=Short Physical Performance Battery c. Onset of Self-reported Mobility Difficulty, (I)ADL Difficulty and Clinically Meaningful SPPB Decline in 18 Months by Baseline Pain Interference Quartiles. aChi-square test for p-value <.01 bChi-square test for p-value <.001 ADL=Activities of Daily Living; I=Instrumental; SPPB=Short Physical Performance Battery; inter.=interference
Figure 1
Figure 1
a. Onset of Self-reported Mobility Difficulty, (I)ADL Difficulty and Clinically Meaningful SPPB Decline in 18 Months by Baseline Pain Distribution Categories. aChi-square test for trend p-value <.001 bChi-square test for trend p-value <.05 ADL=Activities of Daily Living; I=Instrumental; SPPB=Short Physical Performance Battery b. Onset of Self-reported Mobility Difficulty, (I)ADL, Difficulty- and Clinically Meaningful SPPB Decline in 18 Months by Baseline Pain Severity Quartiles. aChi-square test for p-value <.01 bChi-square test for p-value <.05 ADL=Activities of Daily Living; I=Instrumental; SPPB=Short Physical Performance Battery c. Onset of Self-reported Mobility Difficulty, (I)ADL Difficulty and Clinically Meaningful SPPB Decline in 18 Months by Baseline Pain Interference Quartiles. aChi-square test for p-value <.01 bChi-square test for p-value <.001 ADL=Activities of Daily Living; I=Instrumental; SPPB=Short Physical Performance Battery; inter.=interference
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